Facility Management

It's not a question of if, but of when. Both academic and private-practice radiologists who perform cardiac CT angiography predict that reimbursement for the procedure will become widespread within a year.

Faced with possible Medicare payment cuts, the American College of Radiology will lobby Congress for legislation that would require Medicare to define physician qualifications for performing diagnostic imaging.

Radiology groups in growing numbers are entering into imaging joint ventures with hospitals. These are beneficial to both parties for many reasons, but all such joint ventures must address important strategic decisions. One is the choice of what Medicare enrollment status the joint venture will operate under. This choice is generally enrollment as an independent diagnostic testing facility (IDTF) versus radiology group practice. The latter is the better choice, in my view, but the requirements for onsite service by the radiologists can make qualifying for non-IDTF status difficult.

About 90 digital mammography systems were shipped to U.S. customers in the first half of 2004, compared with 130 film-based units, according to industry executive estimates. Full-field digital mammography systems thus accounted for almost 40% of the units delivered in the first half of last year. The percentage of revenue tips the scales in FFDM's favor, as each digital system sells for more than a half-million dollars, about six times more than the cost of a film system.

Digital mammography has so much to offer that it might, almost, overcome the fact that it has yet to prove clinical superiority over screen-film mammography. Many users have, in fact, already decided that digital is worth its higher cost-about 40% of all mammography systems sold in the first half of 2004 were digital.

The continuing challenge for every specialty in oncology is to improve the therapeutic ratio, which is the balance of the biological effectiveness of the treatment and the severity of treatment-related side effects.

Several oncologic imaging modalities have evolved significantly since CT was developed in 1973. Although CT provides a noninvasive method for evaluating cancer patients, first-generation scanners were limited in their speed of data acquisition and spatial resolution. Current multislice CT scanners can evaluate a patient completely, with exquisite anatomic detail, in as little as 15 to 30 seconds.

Integrating a profusion of digital healthcare information systems is central to providing efficient, high-quality healthcare, and this need spans national boundaries.

The Centers for Medicare and Medicaid Services has announced a new initiative to provide reimbursement for PET when patients and physicians participate in high-quality clinical studies or submit information to a PET data registry. The announcement heralds a move away from PET coverage decisions on an indication by indication basis.

Paperwork for hospitals and facilities using teleradiology services has gotten easier since the government enacted interim guidelines relaxing billing requirements for out-of-state interpretations. Final regulations should be in place by April.

VitalWorks changes name, completes medical division saleIT developer VitalWorks has completed the sale of its medical division to Cerner for $100 million in cash. The company announced Nov. 15 a definitive agreement to sell the division, following its decision to focus on radiology IT systems. With the deal now finished, the company has changed its name to Amicas and moved its headquarters to the Boston digs of this PACS vendor, which VitalWorks acquired in late 2003.

Faced with possible Medicare payment cuts, the American College of Radiology plans to lobby Congress for legislation that would require Medicare to define physician qualifications for performing diagnostic imaging.

Virtual colonoscopy took a roller coaster ride last year. Some peer-reviewed studies touted the technique, while others favored conventional colonoscopy. Experts on each side complained of flaws in the other side's methodology. With that background, an international working group has developed a standardized reporting system for CT colonography.

The Sequoia Imaging Center of Visalia, CA, was to be a full-service operation, featuring everything digital from MR to DR. But it almost didn't happen, at least not by the scheduled grand opening. As the deadline approached, digital radiography was threatening to make a mess of it. Director of imaging services, Gordon Ah Tye, was fed up.

Volume at the imaging center has improved over the past year, although revenue has remained flat. The billing manager explains that the center faces personnel problems: Employees have refused to take the necessary steps to ensure that complete and accurate information is captured for each patient. As a result, an increasing number of claims are being denied, and the billing staff is doing extra work to correct and refile these procedures. It seemed that terminating an employee for her bad attitude might help, but the current staff is falling into the same patterns. The billing manager suggests hiring an additional employee for insurance claims follow-up.

Physician credentialing and benchmarking are two of seven draft recommendations the influential Medicare Payment Advisory Commission is considering as part of an effort to define strategies to reduce escalating Medicare imaging costs.

For the better part of a decade, system manufacturers have eyed the DR market with growing anticipation, focusing blockbuster hopes on it, but realizing only modest returns. Their faith in the future of this segment fueled the development of early-stage systems.

How well a patient can count, remember word lists, or perform other basic tests may not indicate how far Alzheimer's dementia has progressed biologically, researchers said at the RSNA meeting.

The use of expert witnesses in radiology malpractice cases had a few defenders, but it continued to draw fire in a pro-and-con debate Monday.

How well a patient can count, remember word lists, or perform other basic tests may not indicate how far Alzheimer’s dementia has progressed biologically, researchers said Wednesday afternoon.

Even highly experienced radiologists can overlook cancers, a fact that bedevils breast imagers. Double reading has been shown to help inexperienced readers and increase cancer detection rates. It turns out that even old hands at mammography can also benefit from the practice.

Digital mammography is inevitable. People may argue over the details, but everyone accepts the fact that screen-film mammography-radiology's last major analog holdout-cannot stand forever.

The American Medical Association has approved a Current Procedural Terminology (CPT) code for use of dual energy x-ray absorptiometry (DXA) to perform spinal imaging as a means for assessing the presence of vertebral fractures in osteoporosis patients. Guidelines for implementing the CPT code are still being worked out. Reimbursement is still further away. But the development of the code, the end result of some five years of lobbying by proponents of bone mineral densitometry, is a critical first step.

Sales of gamma cameras have been flat for so long they have become one of the few certainties in the otherwise unpredictable marketplace of medical imaging. True to form, the two factors in a major predictor of future change, equipment orders versus sales, were virtually equal for gamma cameras in the first half of 2004 at about $185 million for North American customers. But there is reason to believe that will change and that the progenitor of this change will be SPECT/CT.

Toshiba's strength in CT is an outgrowth of its development of sensor technologies in key modalities. Efforts in CT have produced a 64-slice detector, which will be showcased at the RSNA meeting as part of a continuum of engineering that already extends to a 256-slice detector prototype. The company will display the prototype as evidence of its technological prowess.