Whitney Palmer

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Threats to Radiology and the 20 Ways to Beat Them Back

Published on the Dec. 3, 2012, DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — It’s a common topic of conversation in radiology today: The profession is under attack from several fronts. This lament is most certainly true, but there are several ways to conquer these problems, industry experts said at this year’s RSNA annual meeting.

But before you know how to fix the situation, said Jonathan Berlin, MD, associate professor of radiology at Northwestern University Feinburg School of Medicine, you have to understand the forces working against you.

The Threats

1. Declining reimbursement: This issue is no surprise. Since 2006, Medicare reimbursement as slowly dwindled. Until recently, the drops only affected the technical component, but this year, CMS retained the multiple procedure payment reduction (MPPR) to the professional component. It will eliminate 25 percent of the payment you receive for CT, MRI, and ultrasound imaging conducted by one or more providers in the same practice, during the same session, on the same day. Add bundled payments, combined codes, and the new accountable care organization model, Berlin said, and CMS is whittling away your reimbursement.

2. Bad job market: Ask any radiology resident, and he or she will tell you there are simply no jobs available in the field. Confusion around reimbursement and the radiologist’s role in health care has prompted many practices and departments to freeze any hiring efforts. Less job opportunity is already equating to fewer medical students pursuing radiology as a specialty, and existing resident morale is at an all-time low, he said.

3. Commoditization: In recent years, rather than focus on all the work associated with diagnostic imaging — the pre-, intra-, and post-service — radiology has placed the greatest emphasis in image interpretation. And hospitals and referring physicians have followed suit, giving the profession the reputation for being a commodity rather than an integral specialty. Many facilities now outsource their image reading to the lowest bidder, and many insurance companies now steer patients to facilities that offer services at the lowest cost.

4. Teleradiology companies: Although shifting night reads initially seemed like a good idea, corporate teleradiology companies are now expanding beyond nighthawk work. Many are now stealing hospital contracts away from local radiology practices, promising to offer high-quality care at reduced cost.

5. Medically-inappropriate imaging: CMS and other health care agencies now estimate that 35 percent of all imaging studies conducted are unnecessary and don’t contribute to diagnosis. A major reason for this is self-referral, non-radiologists who purchase scanning equipment in order to perform studies without sending a patient to an outside radiology practice. In many cases, the physicians are practicing defensive medicine, but they lack the proper skills to correctly interpret studies.

While these challenges are significant, said Vijay Rao, MD, chair of radiology at Jefferson Medical College at Thomas Jefferson University, there are many strategies at your disposal to reverse these trends.

1. “Take back the night”: Don’t outsource to teleradiology companies, and don’t work for them. Instead, find a way to bring night reads back into your practice.

2. Consolidate: If your practice is too small to handle night reads alone, consider merging with a larger group or multiple groups. This move can also increase your ability to offer subspecialty services. Mega-groups, she said, will likely be very common in the future of radiology.

3. Affiliate: Free-standing practices are vulnerable under the new models of care. Contract with a hospital or a larger multi-specialty group. You could even consider becoming a hospital employee. Any of these decisions would help protect your revenue.

4. Build bridges: Work on your relationships with hospital administration and become more active in hospital management structure and culture. Currently, most of these relationships are strained, Rao said, but you can nurture them by serving on committees, getting involved with quality and safety measures, or participating in strategic planning or marketing efforts. Jumping into the hospital culture will show that radiologists add value.

5. Manage your department: Don’t be afraid to take on more responsibility for your department’s management; Hospital administration is generally amenable to letting you do this, and you could get paid for it. Create financial targets and propose getting a portion of the savings if you meet the goal. The more you show administrators you’re a team player and can help control costs, the less likely you are to lose out to a teleradiology company, she said.

6. Control image utilization, even if it hurts: Do everything you can to make hospital leadership understand the importance of order entry and decision support systems. It might take money out of your pocket, but it’s the right thing to do for patients, Rao said. As with department management, work on an arrangement where your department and the hospital split the cost savings from reduced imaging equally.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/conference-reports/rsna2012/content/article/113619/2117464

December 5, 2012 Posted by | Healthcare | , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

The Decision to Nighthawk Isn’t Always Crystal Clear

Published in the July 2011 American Hospital Association Hospitals & Health Networks

By Whitney L.J. Howell

Teleradiology is growing, but experts caution about potential pitfalls

Hospitals never close, but that doesn’t mean someone from every specialty is always on call. A growing number of facilities aren’t scheduling radiologists for overnight and weekend shifts, and others no longer have them on staff. Instead, they rely on teleradiology companies to fulfill their imaging needs.

Also known as nighthawking, teleradiology steadily has grown in popularity in recent years. A 2009 study by VHA Inc., a nationwide network of community-owned health systems, reported 56 percent of U.S. hospitals use it. Many hail the service for its convenience and instant subspecialty coverage.

“Teleradiology is essential for small, rural practices that want to deliver high-end care, but don’t have enough volume to offer fellowships for subspecialty providers or that can’t afford to hire more staff to cover nights,” says William Bradley Jr., M.D., University of California–San Diego’s radiology chair. “Diagnosis quality also goes up because radiologists’ reading scans are already awake and alert. Someone who’s been awakened in the middle of the night is likely to miss finer details.”

Contracting with a teleradiology company also can help hospitals attract and retain talented radiologists, says Michael Modic, M.D., chairman of the Cleveland Clinic’s Neurological Institute. “Some radiologists are willing to forgo the additional reimbursement—sometimes as much as 10 to 15 percent of business—if they can avoid the night shift,” Modic says. “They want more work-life balance, and hospitals use teleradiology to retain them.”

But not everyone agrees teleradiology is financially sound or safe. Relinquishing additional reimbursement could have long-lasting effects, says David Levin, M.D., chairman emeritus of the department of radiology at Jefferson Medical College of Thomas Jefferson University. Having outside companies read scans could cause a permanent dip.

“It’s possible that reimbursement could start to drop because teleradiology companies bill less for reading scans,” he says. “If they’re billing $40 for reading an MRI, but hospitals bill $80, insurance companies will start wondering why they’re reimbursing at higher levels.”

Hospitals without in-house radiologists also lose an advantage when shopping for new imaging equipment, Levin says. Knowledgeable in-house radiologists can be intermediaries who negotiate with vendors for significant cost concessions on updated imaging equipment.

Levin disagrees that teleradiology improves diagnosis quality. Teleradiologists not only lack access to all patient records with potentially pertinent information that could alter a diagnosis, but neither can they consult with other providers if they have questions.

To read the article on the original Website: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2011/0711HHN_Inbox_telehealth&domain=HHNMAG

July 13, 2011 Posted by | Healthcare | , , , , , , , , , , , , , , , | Leave a comment

Five Ways to Improve Your Practice

Published on DiagnosticImaging.com on May 19, 2011

By Whitney L.J. Howell

Electronic health records. Digital technology. Teleradiology. Many advancements have changed the face of radiology over the past five years. Some in the industry believe, however, there are five tactics that will best improve your practice.

These steps, they said, can boost your patient satisfaction, as well as streamline your workflow.

Round Out Your Practice

You can speed up your workflow and increase patient satisfaction in one step, said Locke Barber, D.O., radiologist with Kennedy Health System in New Jersey.

“It’s important to have a well rounded skill set in your practice,” Locke said. “With good subspecialists, you have people who can read the more complex cases with substantial familiarity.”

Read All Your Scans In-House

In addition, if your practice is large enough, forgoing teleradiology coverage in favor of in-house care can save time and money, said Joseph Tashjian, M.D., radiologist with St. Paul Radiology in Minnesota. His practice has neuroradiologists available to read scans 24-hours-a-day. This rapid-response care once saved a 20-year-old man found seizing in his dormitory – on-site diagnostic tests revealed a brain abscess.

To read the remainder of the story: http://www.diagnosticimaging.com/practice-management/content/article/113619/1864230

May 19, 2011 Posted by | Healthcare | , , , , , , , , , , , , | Leave a comment

Thriving in the Era of Teleradiology

Published on DiagnosticImaging.com on Feb. 18, 2011

By Whitney L.J. Howell

When teleradiology on-call services burst onto the scene with the rise of the Internet in the late 1990s, they relieved many radiologists of night and weekend call duties. No doubt, many practices saw them as the answer to shorter-shift prayers.

But, if you mention the same companies today, you’re likely to prompt worry and fear about lost jobs and revenue in even the most established radiology offices.

In recent years — and especially in the past few months — some on-call teleradiology companies, such as the recently merged NightHawk and Virtual Radiologic, have taken what some in the industry consider to be aggressive steps to grow their clientele base, including going after hospitals and health systems that have existing relationships with smaller practices.

For many small groups, that possibility could become a reality. According to a study published in the February issue of the Journal of the American College of Radiology, more than half of all radiology practices in the United States use on-call services for night and weekend coverage.

“The situation has become predatory,” said Arl Van Moore, MD, chair of the American College of Radiology teleradiology task force and president of North Carolina’s Charlotte Radiology. “There are some companies that are pursuing hospitals that have contracts with other radiology groups to see if they can come in and replace the existing provider.”

Some practices are already feeling the impact. In October 2009, Consulting Radiologists in Toledo, Ohio, lost its long-standing contract with St. Vincent Mercy Medical Center to an out-of-town, on-call company. Others, such as Radiological Associates of Sacramento, are facing a similar fate.

To read the remainder of the article: http://www.diagnosticimaging.com/teleradiology/content/article/113619/1795711




February 18, 2011 Posted by | Healthcare | , , , , , , , , | Leave a comment


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