Facility Management

Prostate imaging can be a lonely, thankless line of work for radiologists. Specialists are scarce, and urologists have the upper hand. Cancer screening is controversial, and imaging research has yielded a mixed bag of results. Nevertheless, prostate guru Dr. Ethan Halpern is bullish about the future.

Buoyed by highly promising preliminary results, radiologists and cardiologists are lining up to learn coronary artery CT. Interest is growing in new CCT fellowships and medical conferences offering CCT training. Record sales of cardiovascular 64-slice CT scanners, many installed in the first half of 2006, are fueling the demand.

I believe myself fortunate to have a soapbox-this column in DI-from which to opine my views on the legal and regulatory issues encountered in my practice representing radiologists. Few issues have been as nettlesome, or as hot politically, as the one involving shared arrangements for radiologists and cardiologists to interpret cardiac CT angiography studies. It is my strongly held view that there are significant regulatory issues with many of these shared reading or overread arrangements between cardiologists and radiologists. If such arrangements are not structured correctly, I am concerned radiologists could face legal exposure.

Congressional bill would delay DRAAgfa formalizes splitGE opens clinical center in India

Nearly four dozen members of the House of Representatives have signed on to a bill that calls for delaying cuts in Medicare reimbursement for two years. Lawmakers, who were kept in the dark about last-minute provisions affecting imaging, insist on knowing the impact reductions of up to 50% will have on access for Medicare recipients.

Diffusion kurtosis imaging (DKI), a new MRI-based technique, may help find hard-to-detect lesions in patients with mild traumatic brain injury, according to a study presented at the 2006 International Society for Magnetic Resonance in Medicine meeting. DKI could help understanding of persistent post-traumatic disorders affecting these patients.

Several stocks jumped yesterday on the release of what wire service reports called good news for freestanding radiation oncology centers: a change in Medicare reimbursement that was not as draconian as expected.

The third phase of clinical PET adoption appears imminent and Integrated Cardiac Solutions intends to be ahead of the curve.

GE’s Infinia Hawkeye defines the value end of SPECT/CT devices. Until this spring, the Infinia was a single-slice. Now it’s a quad-slice hybrid that delivers thick-slice CT data competitors refer to as “nondiagnostic.” The middle ground is held by Siemens and Philips scanners sporting 16 or fewer slices. The high end of the spectrum is populated by a rarified breed of scanners more theoretical than real. Among these is Philips’ Precedence 64, cleared by the FDA but not likely to enter production until next year at the earliest.

After a late night congressional session in December, Congress passed the 2005 Deficit Reduction Act, sending a shock wave that’s still reverberating through the radiology community. Referred to by many in this community as “reduction without proper representation,” this draconian act targets the so-called “freestanding advantage.”

Once again, it’s time for leadership change in the American College of Radiology.

The future of PET instrument design is likely to follow the pattern of past developments, with incremental improvements to sharpen resolution and increase sensitivity to physiological aspects of disease.

Siemens Medical Solutions USA announced today that Heinrich Kolem, Ph.D., has replaced Thomas McCausland as president of its Customer Solutions Group. In an exclusive interview with DI SCAN, Kolem discussed how his experience in the MR business will shape his now broader agenda, his early plans for the company’s U.S. operations, and how Siemens’ pending acquisition of Diagnostic Products might change the character and approach of Siemens Medical Solutions USA.

Most of the poor revenue performance confronting radiologists and radiology business professionals originates from weaknesses in the overall base design of the billing system. So, although much has been written on the micro aspects of radiology billing and reimbursement, this article takes a macro view. We’ll look at the revenue-generating infrastructure of radiology practices to explain the basic design requirements that should be incorporated into every radiology billing system.

The 2006 meeting of the Academy of Molecular Imaging occupied the middle ground between meetings of its two sister societies, the eminently scientific Society for Molecular Imaging and the clinically oriented Society of Nuclear Medicine.

Florida is home to a large aging population at risk for dementia. Palm Harbor, not far from St. Petersburg and Tampa, is also close to a retirement town. There are many nursing homes and extended care facilities throughout the region, and the reimbursement climate includes sizable expenditures for Alzheimer's disease care.

As the diagnostic CT side of hybrid imaging adds new clinical potential for nuclear practices, some sites are facing questions about how to bill properly for the procedures. While practitioners in Germany and the Netherlands have encountered no problems with reimbursement, the situation outside of Europe is different.

Radiology groups are producing more work per full-time equivalent than ever before. Yet in many cases, their incomes are flat or decreasing. One of the major factors contributing to this phenomenon is consolidation within the healthcare insurance industry. This consolidation has fueled new rounds of cost-cutting by the major carriers. To remain competitive, other insurers are following suit.

Next week at the SNM meeting, Hitachi Medical Systems America (HMSA) will unveil a new version of its Sceptre PET system, one dedicated to cardiac applications. The system, called SceptreC, is configured to use rubidium-82 to gauge myocardial perfusion and fluorine-18 FDG to assess myocardial viability.

For all their promise, information systems don’t appeal much to my sons’ pediatrician. The system installed in his clinic does not live up to its promise. It doesn’t even come close. Aside from a learning curve that continues to rise, even though it’s been in place for six months, the system that is designed to make his life easier does not. Most maddening is how it restricts him from keying in the dosage he wants to prescribe. This might be understandable, if that dosage veered from the norm. But it doesn’t. So important is the dosage on this particular drug that the manufacturer has actually packaged the drug in specific quantities in plastic, foil, and cardboard. This does not matter, however, to the information system, which robs our doctor not only of his time but ours.

Rather than fight to repeal the Deficit Reduction Act of 2005, the American College of Radiology has chosen instead to support a two-year delay in its implementation.

Executives at Kitchener, ON-based Medicalis want to help referring physicians and radiologists make the right decisions. The company has come up with Web-based software that helps physicians at the point of care choose the right imaging exam based on its clinical appropriateness and the likelihood of receiving reimbursement for it.

For all their promise, information systems don’t appeal much to my sons’ pediatrician. The system installed in his clinic does not live up to its promise. It doesn’t even come close. Aside from a learning curve that continues to rise, even though it’s been in place for six months, the system that is designed to make his life easier does not. Most maddening is how it restricts him from keying in the dosage he wants to prescribe. This might be understandable, if that dosage veered from the norm. But it doesn’t. So important is the dosage on this particular drug that the manufacturer has actually packaged the drug in specific quantities in plastic, foil, and cardboard. This does not matter, however, to the information system, which robs our doctor not only of his time but ours.

Understanding the rules and regulations as they apply to purchased diagnostic testing and professional courtesies is necessary if vendors are to appreciate the pressures that providers -- especially those in outpatient settings -- must face. In my experience as a consultant, I see vendors book orders that get canceled months later because their customer lacks the proper legal structure to qualify for Medicare’s safe harbor rules.

Hundreds of facilities that preregistered for the National Oncologic PET Registry might be caught off guard by recently enacted changes, according to Dr. Barry Siegel, cochair of the NOPR working group.

After more than a year of delays, the National Oncologic PET Registry will officially launch on Monday, May 8. It is intended to gather data proving the efficacy of FDG-PET imaging to diagnose, stage, and manage rare cancers currently not covered by Medicare.

Minimally invasive CT colonography has been embraced by radiologists and patients alike. As the technique evolves, its use is shifting from specialized academic centers to community hospitals and private practices. That transition is focusing increased attention on reimbursement, clinical efficacy, and interpretation issues. Computer-aided detection for CTC could affect all three.

"Bones! You've got to do something."

A powerful clinical case can be made for using cardiac CT angiography as a screening tool to help avoid cardiac catheterization. But does the technique make financial sense in nonemergent cases? A new cost-effectiveness study says yes -- if the price is right.

Tumors require new blood vessels in order to grow beyond a few millimeters in size. Once this "angiogenic switch" is thrown, a series of events occur that lead to the progression and spread of cancer. The vessels formed by tumors are not only larger and more numerous but also more permeable than normal vessels1 (Figure 1). Thus, when a patient with a tumor is injected with a gadolinium-chelate MR contrast agent, the tumor enhances more than the surrounding normal tissue.