Article – Report Offers System to Separate Useful and Wasteful Imaging

In this article, the authors describe a simple classification system for defining different types of additional imaging exams. Too often, additional imaging is deemed wasteful, so having a model to separate the necessary from unnecessary is a good idea.

The model excerpted from the article…

  • A supplemental image — many of which are medically necessary — would occur during the same clinical encounter but utilize a different modality, such as a non-contrast CT scan and a renal ultrasound to identify kidney stones.
  • Duplicative images involve the same modality during the same or subsequent clinical session. These images are taken for a variety of reasons, including the unavailability of previous scans or a change in the patient’s condition.
  • Follow-up imaging can involve the same or different modalities during later clinical meetings, such as repeated imaging in cancer patients to verify there’s been no relapse of disease.
  • Unrelated imaging — scanning of the same body area with any modality — is often an unforeseen event. For example, in its paper, HPI discussed unrelated imaging in a woman who had CT screenings for breast cancer staging two weeks prior to a car accident that prompted identical scans.

Article – Survey finds growth in use of department dashboards

This article has some stats from a survey on the use of dashboards in Radiology.

Some key stats…

  • 62% of the respondents used dashboards for managing accessibility, financial, and productivity indicators; of these…
    • 50% started using dashboards < 2 years ago
    • 10% had used dashboards for > 10 years
  • 73% of departments used their RIS (only) as the source of data, 6% from their PACS (only), and the remainder from both the RIS and PACS
  • 35% viewed productivity metrics more than once a month, only 8% viewed the information daily
  • Most commonly viewed access metrics: department turnaround time and patient backlog were the most frequently used
    • 50% regularly reviewed transcription times
    • 60% were interested in the time from preliminary findings to report finalization and sign-off
  • Most commonly viewed financial metrics: reporting revenue, actual expenses compared to budgeted expenses, and the number of days that billable exams were in accounts receivable
  • Most commonly viewed productivity metrics: total examination volume, volume per modality, and productivity performance by radiologists and technologists

Article – Patient Steerage Could Harm Radiologists, Confuse Patients

This article explores the trend of “patient steerage”—a practice of payers directing patients to lower-cost imaging providers.

Some thoughts…

  • The article also touches on the idea of patients with high-deductible insurance plans, and awareness of costs, steering themselves to lower cost options. How long until consumer-driven review web sites rating costs and quality (like a travel review and booking site) become ubiquitous? The site could even broker the scheduling across involved facilities, like a travel site does this for airlines.
  • The frequent mention of quality of service as a method for imaging providers to differentiate themselves ties into the blog post I did on the SIIM web site here. The ability to offer services at a lower cost ties into my commentary on Productivity.
  • This trend could have another implication on the management of results. Often, referring physicians will refer to an imaging provider that not only provides quality of service (summarized in the article as “scan quality, turnaround time, communication with referrers and patients”), but convenient results access. So, I might send my patients to Imaging Provider A because they provide me with a secure portal to access the report and images, and send me notifications when the results are available. If my patients are steered to an imaging provider with lesser capability (just faxes reports out), I would not be as productive (or happy). If patients are steered to several imaging providers in the area, how results are accessed may vary significantly from one exam to the next. Referring physicians in regions that have an operational HIE, capable of managing both reports and images, and providing a so called “EMR Light” portal function will likely experience less of a negative impact from patient steerage when accessing results.

Article – Death of the general radiologist: Have reports been exaggerated?

A friend shared this with me. Interesting stuff (requires registration, I think). Check out the comments, as well.

The author uses a phrase that I believe determines the outcome of many paths: “good enough”.

MP3 audio is lower audio quality than CDs, but people appreciated the flexibility that MP3 provided over fixed media—and the quality was “good enough”. The same battle of quality vs. cost/convenience is waging with monitors used for diagnosis, lossless vs. lossy image compression, mobile device access, dedicated equipment vs. app on multi-purpose device, etc.

Article – Creating a Clearer Picture of Patient Flow

This is cool.

It would be interesting to see the convergence of the output of SIIM‘s SWIM initiative and this application to understand real-time metrics of a Radiology department. The dashboard could show the actual location of patients, their spot in the prescribed workflow, and the comparison to statistical norms and/or KPIs.

Layered on top of a BI (business intelligence) platform for historic data analysis, and you would have something special.

Article – Imaging centers hit with surprise 30% cut for MRI codes

Full article is here, but requires (free) registration. A short summary (no registration required) is also available here.

The full article is worth a read as it goes into several reimbursement changes happening and pending.

An excerpt…

Because of adjustments made by the Centers for Medicare and Medicaid Services (CMS) in its assumptions about room use time for 2013, reimbursements for CPT code 73721 (lower extremity joint MRI) and 73221 (upper extremity joint MRI) have been cut dramatically, according to Mike Mabry, executive director of the Radiology Business Management Association (RBMA).

“To calculate [relative value units (RVUs)], Medicare estimates labor, medical supply, and equipment costs associated with every procedure,” Mabry told “For these two codes, CMS decreased its estimate of the amount of time the room would be used, from 63 minutes to 33 minutes. They cut the room time in half for those two codes, which results in lower equipment and direct costs and a lower technical component. That’s why freestanding centers are seeing cuts in the range of 30% for these two MRI codes.”

Rick Davis, vice president of Palm Coast Imaging, a freestanding center in Palm Coast, FL, was shocked when he saw his center’s Medicare explanation-of-benefits report.

“In 2012, reimbursement for CPT code 73721 was $427.21,” Davis told “This year, the Centers for Medicare and Medicaid Services reduced the reimbursement to $297.58. If managed care companies follow suit, freestanding centers will find it difficult to remain open.”

Blog – March Madness in Radiology: the Push for ACOs

March Madness in Radiology: the Push for ACOs

This excerpt…

Prompt, consistent report delivery must be available and employ current technologic standards that streamline this, including tablet and smartphone delivery to providers. Rigorous quality reviews, peer evaluation and communication between radiologist and technical centers must be used to improve quality. Electronic methods of tracing and evaluating incidents should be employed.

…is on the money, but this technology platform should be part of the EMR (probably sourced as an add-on) and managed by the same group that manages the EMR, not Radiology. Radiology should indeed provide the guidance to configure the platform to meet Radiology’s needs, but they aren’t the only specialty that needs these tools, so a shared service is the best approach.