Facility Management

Burned out and discouraged, many physicians consider chucking their careers because of the state of healthcare today, according to a survey of physician morale conducted by the American College of Physician Executives.

Half of the people in the U.S. older than 50 could suffer fractures caused by osteoporosis over the next 13 years, according to a 2005 Surgeon General's report. Such ominous predictions move musculoskeletal conditions to the top of a long list of chronic diseases confronting baby boomers.

As if haunted by some kind of Ghost of Healthcare Future, the latest crop of breast imaging papers reported at the RSNA meeting conveyed an ominous undercurrent of uncertainty.

'Tis the season for congressional wrangling over Medicare reimbursement to physicians. Before the 109th Congress adjourned, it did not eliminate reimbursement reductions to the technical side of imaging, which come from two reimbursement reductions included in the Deficient Reduction Act of 2005. Private payers also will be very quick to take advantage of these cuts, if they haven't already.

At the RSNA meeting this year, I found that customers are focusing on upgradeability and low-cost entry rather than the latest and greatest 3T MRI. I surmise that many vendors at the RSNA are sensing this change of heart and mindset.

Clinical extensions will be the main thrust of MR vendors in the year ahead. Breast, orthopedic, and cardiac MR will take on added weight. Speed will continue to be an issue as companies attack motion artifacts accompanying scans as one means to extend clinical capability. Efforts will focus on making results more reproducible and less dependent on the skill of operators.

The good news is that Congress passed a bill that eliminated a reduction in Medicare physician payment for 2007. The bad news is that it had no money left over to reverse or delay the huge imaging reimbursement cuts called for in the Deficit Reduction Act.

Lame duck lawmakers, as well those staying on for the 110th Congress, are feeling the heat from the imaging community to delay the implementation of draconian reimbursement cuts slated to take effect in less than a month.

Contrary to popular practice, both pre- and postcontrast imaging is necessary for proper MR evaluation of articular cartilage repair, according to new research conducted in Japan. The small study could carry implications for treatment evaluation.

Radiologists face a choice between relinquishing control of ultrasound for good or reclaiming a modality that could thrive in their hands through the next decade. An indication of which way the specialty is leaning can be gleaned from an October seminar in which luminaries dissected practice trends and applications in use of ultrasound.

GE Healthcare's latest invention, SnapShot Cine, is a multislice CT software enhancement that borrows its method from the days of axial scanning. The big difference is that it cuts the x-ray dose for cardiac scans by 70% or more compared with conventional CT.

Over the last five years, outsourcing has become a global trend in business because, when performed properly, it can produce efficiencies not attainable when these functions are performed internally by an organization. Although outsourcing has existed in radiology practice for some time, its use has recently risen, driven by a more competitive marketplace and the need to increase efficiencies. Businesses must find the most efficient way to produce their goods if they are to remain competitive and profitable.

I recently completed a task that we expect will lead to a more refined search engine for the Diagnostic Imaging Web site and those of our sister publications at CMPMedica. The project required perusing some 400-plus articles in the radiology literature from the past 30 years, covering every conceivable subcategory, and tagging those that best define each clinical application and modality. It involved some tedious parsing of wheat from chaff but provided ample opportunity for reflection on how far radiology has come.

Cardiologists impressed by the diagnostic power of PET/CT are beginning to recognize its clinical importance. In sites where the transition from PET to PET/CT has been made, rising cardiac PET imaging volumes have followed.

Carbon-11 tracer's 20-minute half life makes it too expensive for most community hospitals, but it can minimize radiation exposure and enable repeat measurements without interference from previous studies.

Two major providers of teleradiology services, NightHawk and Virtual Radiologic, offered to sell the secrets of their success at the RSNA meeting this week. The companies unveiled on the exhibit floor productivity tools and resources developed for in-house use and made them available for sale to other providers.

Radiologists frequently ask how they can maximize practice revenue. One way is to include proper billing documentation in dictated reports. This strategy will ensure the practice receives proper payment for services and that the proper documentation exists in case Medicare ever conducts an audit.

A special feature on utilization management programs in the October issue of Diagnostic Imaging included discussion of one of the principal tools employed to tamp down overuse of diagnostic imaging services: preauthorization programs. I commented in that story about how I regularly hear from my clients that referring physicians demand "assistance" from the imaging provider in obtaining preauthorization from health plans.

Use of breast ultrasound and breast MRI in Medicare beneficiaries has been on the rise, but mammography utilization has not kept apace. Following a big boost in the number of mammograms in the late 1990s, growth has slowed in recent years. The reason could be waning awareness of screening programs or possibly a decline in access due to center closures.

New analyses of data from the Digital Mammographic Imaging Screening Trial show that digital mammography is superior only for pre- and perimenopausal women with dense breasts. Screen-film mammography may actually have an edge in older women with fatty breasts, according to a study presented at the RSNA meeting on Sunday.

Powerful corporations and Congress make big headlines -- for all the wrong reasons. Scandals plaguing the private and public sectors, however, can provide a wakeup call for radiologists to renew their commitment to ethical behavior, according to RSNA president Dr. Robert R. Hattery.

New analyses of data from the Digital Mammographic Imaging Screening Trial show that digital mammography is superior only for pre- and perimenopausal women with dense breasts. Screen-film mammography may actually have an edge in older women with fatty breasts, according to a study presented at the RSNA meeting on Sunday.

I was caught off guard last week by the barrage of news reports that stemmed from a study regarding lung screening for early cancer detection. Every news channel in my area was reporting it with the same vigor they use to convey news of North Korea and the Iraq war. PBS even had a special on it. What many of us in the imaging community already knew, and those in Congress seem to forget, is that medical imaging saves lives and money.

U.S. hospitals are in trouble, with an estimated shortage of up to 200,000 beds nationwide predicted by 2012. Profitability issues are to blame, according to a report by the Center for Health Design in Concord, CA.

The Access to Medical Imaging Coalition (AMIC) will push hard for the postelection Congress to pass legislation to delay scheduled Medicare cuts aimed at medical imaging reimbursement, but prospects do not look good.

After a 60-day comment period on proposed changes to the Medicare physician fee schedule, the Centers for Medicare and Medicaid Services released its final rule this month, a document that deviates little from the changes announced earlier in the year. Comments sent in by interested stakeholders, however, reveal concerted efforts to amend provisions that reduce payment.

Burned out and discouraged, physicians in significant numbers have considered chucking their medical careers, according to the American College of Physician Executives’ first Physician Morale Survey.