Facility Management

Imaging centers across the U.S. have cut back drastically on their purchase of big ticket products. Demand for 64-slice CTs and PET/CTs has plummeted in the wake of belt-tightening prompted by the Deficit Reduction Act. MR sales are sliding, as are those for ultrasound. RIS/PACS, however, is gaining ground, and much of its gain is coming in the outpatient arena.

The need for nighttime coverage relief was the initial driver of commercially viable teleradiology. For several years, however, the local in-house radiology group gained no economic value for outsourcing its nighttime work, because its members had to reread the cases the next day to formally convert the reports to primary reads. The group also had to pay a premium for nighttime services.

Vendors have employed a multitude of approaches to cut patient radiation dose by making data acquisition and analysis more efficient. Software has been developed to adjust dose to fit different body types and segments. Methods to factor in body weight, particularly when scanning children, have been considered. Step-and-shoot protocols have been devised to eliminate the overlap that comes from spiral scanning.

FDG-PET performed after two cycles of standard chemotherapy can accurately predict which patients with Hodgkin’s lymphoma will respond or relapse, according to a multicenter international study published in the Aug. 20 issue of the Journal of Clinical Oncology.

Over the past year, many payers and utilization management companies have been looking at accreditation and certification. Large payers, such as United Healthcare, Aetna, and Blue Shield (and soon Blue Cross), require the outpatient facility and its equipment to meet the American College of Radiology requirements at the risk of losing their contracts. These requirements can be demanding, as seen in the Blue Shield list for MRI or CT, according to Guidelines for Providers Performing Imaging Procedures: Blue Shield of California.

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The American College of Radiology has redesigned its MR imaging accreditation program to address six clinical subspecialties served by the modality.

Deficit Reduction Act spurs PACSMerge delays 2Q resultsIMV report examines prostate cancer treatmentStereotaxis revenues rise, loss widens Acusphere loss narrows

Radiologists may not be in such hot demand as years past, but those who are working command larger salaries than ever. Physician recruiter Merritt, Hawkins & Associates found that demand for the new placement of radiologists has slipped more than 20% compared with 2006. On the brighter side, average and starting salaries rose, staffing incentives show an all-time high, and some radiology subspecialties are in high demand.

After absorbing the details contained in 924 pages, analysts are finding reasons for both optimism and caution regarding the proposed 2008 Physician Fee Schedule from the Centers for Medicare and Medicaid Services. Radiologists may immediately focus on its 9.9% rate reduction, but the mammoth document also lays out sweeping reforms covering the hot points of alleged kickback and self-referral abuses.

North American Scientific plans divestitureAlliance Imaging slips under federal axVolcano revenues rise, shares drop

The Children’s Health and Medicare Protection Act of 2007 may look like straightforward legislation to reauthorize a popular healthcare insurance program for poor children, but major reforms directed at medical imaging and the healthcare system as a whole are embedded in the bill passed by the House of Representatives Aug. 1.

Big-ticket items are suffering this year as reimbursement cuts resulting from the Deficit Reduction Act have had a wider and longer lasting effect than initially expected. Particularly hard hit has been PET/CT. The hybrid juggernaut had defied the odds for several years, marching forward with ever higher sales despite utilization rates at individual sites that allowed plenty of unused capacity.

Vendors of CT and MR equipment are taking it on the chin. A sales slump in the U.S., which began in the second half of 2006, has continued through the first half of 2007 on the heels of diminishing demand from imaging centers. The problem stems from reimbursement cuts brought about by the enactment this year of the federal government's Deficit Reduction Act and the chilling effect these cuts have had on purchases by outpatient facilities.

The Deficit Reduction Act of 2005 and the resulting decrease in Medicare's reimbursement schedule could result in as much as a 25% to 45% reduction in revenue for outpatient imaging practices, according to industry sources.1 Faced with such a potentially drastic scenario, many practice owners are reevaluating the very viability of their imaging operations.

Interventional radiology is growing rapidly as a subspeciality. The presence of a state-of-the-art interventional service within a radiology department will have a significant impact on that department's staffing, training, logistics, finances, and resources. Ongoing turf battles will also require substantial involvement from department heads.

Next month, a dazzling array of multidisciplinary academics will highlight promising prostate imaging techniques at a meeting in Washington, DC.

Pending tomosynthesis platform may stem price erosion seen with Selenia

Legislation proposing accreditation for most medical imaging modalities has been caught up in a fight between Capitol Hill and the White House over the renewal of federal healthcare insurance subsidies for poor children.

Radiologists could be shortchanged if Medicare goes through with plans announced Monday to end its long-standing policy of paying separately for imaging contrast media, radiopharmaceuticals, interventional radiology supervision, and interpretation.

Radiology and nuclear medicine are the focal points of proposed Medicare reforms that would bundle reimbursement in 2008 for seven categories of ancillary services covered by the Hospital Outpatient Prospective Payment System.

As imaging centers across the country fall behind on equipment payments, they are getting calls from workout groups. We’re not talking gym memberships here. These groups try to recoup lost revenues from notes in default and are being used more than ever in the radiology finance world. During the past few months, I have spent a good portion of my time speaking to finance vendors involved in attempting to salvage centers. It is frightening to see the washout of once-profitable centers, as they fall victim to the draconian cuts in Medicare reimbursement resulting from the Deficit Reduction Act.

Despite heated interest in cardiac CT, echocardiography continues to anchor the diagnosis and evaluation of coronary artery disease for most clinical practices. Echo possesses prognostic as well as diagnostic power, as demonstrated in a large Weill Cornell Medical College study. It found strong correlations between wall motion abnormalities detected during echocardiography and risk for cardiovascular death. On the cardiac CT front, more research investigating its clinical utility and radiation exposure was reported.

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To get reasonable reimbursement for cardiac CT, imagers need to collaborate, put sound data together, train staff to bill properly, and prepare to fight proposed Medicare reimbursement cuts for 2008.

Blue Cross Blue Shield of Michigan and Blue Care Network are partnering with Michigan hospitals to examine whether coronary CT angiography, under certain circumstances, can be used as a complement or replacement for cardiac catheterization.

Award-winning studies presented at the Society of Cardiovascular Computed Tomography meeting suggest that cardiac CT angiography may be more cost-effective than myocardial perfusion SPECT and a good financial choice when performed after a positive nondiagnostic stress test to weed out unnecessary cardiac catheterization.

The Centers for Medicare and Medicaid Services has initiated a national coverage analysis to evaluate the available evidence for coronary CT angiography. As part of the effort, the agency on June 13 asked practitioners to submit comments. If the remarks so far are any indication -- and if CMS listens -- coronary CTA will have no problem securing Medicare reimbursement.

Acting in their capacity as medicine's designated custodians for issues involving ionizing radiation, radiologists defined strategies this year to address the dangers accompanying the explosive growth in the number of medical procedures that require ionizing radiation.

After scoring high marks in a new cost-effectiveness study, virtual colonoscopy is poised to crawl out of clinical obscurity and boost colorectal screening rates.