Developing competent coders and ensuring that radiologists follow best practices when it comes to documentation are just some of the steps radiology managers can take to ensure they'll be running a profitable radiology practice, according to Jeff Majchrzak, vice president of radiology services at Panacea Healthcare Solutions in Wesley Chapel, Fla.

In a recent article in Advance for Imaging & Radiation Oncology, Majchrzak and other radiology and healthcare executives described some of the strategies radiology managers should consider in areas affecting profitability, including reimbursement, equipment acquisition, and staffing.

Majchrzak said the first step a department should take as part of its reimbursement strategy is to hire a competent, compliant radiology revenue team, particularly coders who understand the current practices and procedures performed in the radiology department. It's critical that radiologists are educated regarding documentation, Majchrzak said, adding that this should include best practices such as "if it's not documented, it was not done," and that documentation can substantiate a claim during an audit.

With regard to equipment acquisition, considering the high cost of new devices such as multi-slice CT scanners, it's important to monitor expenses and maximize five- and 10-year strategic plans through constant examination so that changes and corrections can be made, if necessary, according to Kay McCormack, manager of the diagnostic imaging department at Hackettstown Regional Medical Center in New Jersey.

As for staffing, it's important to make sure that managers hire the right staff from the outset, said Pamela Atwood, president of Atwood Associates, a healthcare executive search company. A bad hire, she said, can leave radiology staffs undermanned and underperforming.

Meanwhile, temporary hires can help cut costs in situations when the workflow doesn't justify the hiring of a full-time employee, said Gerrit Salinas, director of Snelling Medical Staffing. In addition, he said, hiring a temporary person with the intention of turning that person into a full-time staffer after a given period of time can save money if, in the end, the employee doesn't work out.

In an article published last month in the Journal of the American College of Radiology, Dieter Enzmann, M.D., of the University of California, Los Angeles, and Donald Schorner, M.D., of Banner MD Anderson Cancer Center in Gilbert, Ariz., said that in order to best position themselves competitively, radiology practices need to define the dominant value propositions that support their business models.

According to Enzmann and Schorner, there are three main value propositions: the low-cost provider, the product leader, and the customer intimacy models.

"Each ... has been a valid market position," Enzmann and Schorner said, "but each demands specific capabilities and trade-offs."

To learn more:
- read the article in Advance for Imaging & Radiation Oncology

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The growth of image sharing services such Image Share can help informed patients avoid duplicative or repeat scans, as well as facilitate their ability to quickly get second opinions, according to a recent article in the Wall Street Journal.

Image Share is a network that allows radiologists to share medical imagines with patients using personal health accounts. The pilot project is funded by the National Institute for Biomedical Engineering and is administered by the Radiological Society of North America. According to the RSNA, Image Share currently provides services to patients at five major medical centers, including Mount Sinai Medical Center in New York, the University of California, San Francisco, and the Mayo Clinic in Rochester, Minn.

The WSJ article reported on the case of a little girl who last summer exhibited frightening stroke-like symptoms, underwent an MRI at a hospital in Oklahoma City, and had a diagnosis confirmed that same day by a neurologist in Boston. The neurologist was able to review the MRI images through an image sharing service called LifeImage, which provides a clearinghouse connecting Image Share patient accounts with radiology offices.

"This is all about giving patients control of their health information and engaging them in their own care," David Mendelson, director of radiology-information systems at Mount Sinai and principal investigator for Image Share, told WSJ. According to Mendelson, more than 3,000 patients are enrolled in the project and as many as 20 hospitals and radiology groups in multiple facilities may soon join the project.

Patients who enroll in the Image Share program receive personal health accounts to maintain and share test results via a password-protected site. The personal health accounts are provided by two vendors--Dell, Inc. and the aforementioned LifeImage.

To learn more:
- see the article in the Wall Street Journal
- read about Image Share

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Rachel Brem, M.D., director of breast imaging at George Washington University Medical Center, recently served as the principal investigator of a clinical study examining whether full-field digital mammography, in conjunction with an automated breast ultrasound system, could improve breast cancer detection when compared to mammography alone for women with dense breast tissue.

According to Brem, some studies have demonstrated that there is close to a 30 percent increase in cancer detection when 3-D automated breast ultrasound is used in conjunction with mammography. This is particularly important for women with dense breast tissue, Brem says, because in many cases, cancers detected in such women are larger and later staged, which means that finding them earlier when they are more curable could greatly impact survival rates.

Brem recently took some time to talk with FierceMedicalImaging about how such technology can impact clinician workflow compared to use of traditional ultrasound, and why she thinks adoption by imaging professionals could be slow.

FMI: What are the workflow advantages of automated breast ultrasound?

Brem: ABUS harnesses the significant ability of ultrasound to detect cancer by using it in an automated way so that the acquisition and interpretation of images is uncoupled. The image can by acquired by trained personnel and the radiologist gets the entire data set so that she can use her expertise to find the smallest clinically, significant cancers. And it only takes about three minutes of physician time to interpret an ABUS examination--so it really makes it possible to harness the screening power of ultrasound in a way that creates a very efficient workflow to it can be integrated into a screening environment.

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Academic radiology departments increasingly are relying on dashboard technology to track all the data they have to deal with on a daily basis.

According to a survey published last week in the Journal of the American College of Radiology--the results of which were first discussed at the 2012 annual meeting of the Radiological Society of North America--two-thirds of responding academic radiology departments use digital dashboards to keep track of data such as that associated with revenue, expenses, examination volume and turnaround time. Fifty percent of respondents said that they have utilized dashboard technology for two years or less.

The idea behind computer dashboards is to pull together data from disparate systems--such as a radiology information system, a picture archiving and communication system, or a billing system--to show certain financial or performance metrics. In the presentation at RSNA, lead author, Bahar Mansoori, M.D., of Case Western Reserve University in Cleveland, said that by consolidating such data, radiology decision makers can take action in real time to improve organization efforts.

For the study, the researchers asked respondents what they considered to be the most important performance indicators in three areas: financial, productivity and access. They found that the most important financial indicators were revenue (76 percent), actual expense (73 percent) and days in account receivable (73 percent). The most important performance indicators were total examination volume (81 percent), examination volume by modality (78 percent) and relative value units (73 percent). The most common access indicators were turnaround time (88 percent), backlog (80 percent) and signature time (60 percent).

"Right now in our department, we are using this data to develop the dashboard for ourselves, and monitoring all this data," Mansoori said at RSNA, according to the RSNA Daily Bulletin. "Before the survey, we were not sure what the most important things were. It's not easy to measure everything. There are thousands of things you could monitor in a radiology department."

She went on to say that based on the survey findings, her department was factoring in turnaround time and backlog in its dashboard.

To learn more:
- see the study in the Journal of the American College of Radiology
- read the article in the RSNA Daily Bulletin

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Despite the fact that the Centers for Medicare & Medicaid Services halted reimbursement for computed tomography colonography (CTC) in 2009, partly due to concerns about how the procedure was used in the elderly population, a study of asymptomatic Medicare beneficiaries has determined that CTC--known as virtual colonoscopy--is being used appropriately.

In the study, published online recently in the Journal of General Internal Medicine, researchers from the Perelman School of Medicine at the University of Pennsylvania examined records for 10,538 asymptomatic older patients who underwent CTC from 2007 to 2008. They compared those records to more than 160,000 similar patients who underwent optical colonoscopy. The researchers found that the vast majority of those patients who underwent virtual colonoscopy had incomplete optical colonoscopies, and therefore were appropriate candidates for CTC.

Not only were the individuals appropriate candidates for CTC, almost half of them underwent CTC on the same day as the optical colonoscopy.

"Given that bowel preparation is a strong barrier to screening, offering same day CTC could improve completion of screening by eliminating the need for an additional bowel preparation," lead researcher Hanna Zafar, M.D., an assistant professor of radiology, said according to an announcement. "As such, it is reassuring that CTC following incomplete optical colonoscopy is covered by most insurance companies and CMS."

Of the remaining patients who underwent CTC and had no history of incomplete optical colonoscopy, more than half demonstrated other medically appropriate indications for screening CTC, such as the risk of bleeding or complications from sedation (which is unnecessary with virtual colonoscopy). According to the authors, the data suggests that virtual colonoscopy has been used to expand colorectal cancer screening, instead of just replacing optical colonoscopy.

"Additional research is needed in this important area since approximately 40 to 50 percent of Medicare patients do not undergo any recommended method of colon cancer screening," Zafar said.

To learn more:
- see the study in the Journal of General Internal Medicine
- read the announcement

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