Controlling film costs in a DRA environment

Pressure to go filmless has been mounting for years. Rising chemical costs and reimbursement cuts under the Deficit Reduction Act have compounded the pressure on outpatient centers such as ours to rein in escalating expenses. To make a serious dent in costs, imaging centers need to achieve at least a 70% filmless environment.

The question is how. The answer goes well beyond the simple installation of PACS.

Asking a referring physician to stop requesting film is like asking a smoker to quit cold turkey. It's hard to let go. Many referring physicians have grown accustomed to film and would get upset without it, raising the risk of losing their business.

Hospitals have an easier time achieving a filmless environment, as they are less beholden to outside referrals. Many have done so, aided by the advent of the electronic medical record (EMR) and the proven efficiencies of filmless imaging. The push to go filmless has little impact on volumes, as many procedures performed at hospitals include studies from the emergency room, as well as those performed both pre- and postsurgically. These cases are better managed by PACS and reading stations. Though these transitions are not easy, they are more easily done, largely because the physicians and records are all in one location.

With outpatient imaging centers, however, promoting CDs as a vehicle to control costs is challenging. Any such effort must be accompanied by funding to place the computers in physicians' offices to read them.

The government continues to prevent imaging centers from supplying computers, adequate reading monitors, network gear, and maintenance to referring sources. Unless the imaging center owns the equipment, tags and maintains it, and can prove that the equipment exists solely for accessing images, the center could be in violation of anti-kickback laws. Complicating this is the physician's natural tendency to use the equipment for more than just viewing images, such as accessing an EMR, running surgical planning software, or checking e-mail.

Further complicating matters, the cost and time savings of web access to reports and images are counterbalanced by the learning curve required to gain this access. Then, too, there is the hassle of maintaining proper security.

These factors alone would be enough to give pause, but consider the plethora of PACS and teleradiology solutions imaging centers may need to connect to, depending on the hospitals and referring physicians they serve. These systems often come with hefty maintenance and service fees. Without proper planning, the cost savings that might be gained in moving from film to digital can quickly disappear as a result of IT costs and unsatisfied physicians. For these reasons, the transition to digital imaging is often a difficult one.

Vendors can help.

When referring physicians have an EMR that imports and displays images, the outpatient imaging center can increase efficiencies by integrating with this system. Doing so, however, means getting vendors to integrate their PACS into referring physicians' EMR systems. This allows referring physicians to use one system for viewing patient images, which also can provide access to patient history, current medications, allergies, and surgical planning, as well as radiology exams. To the benefit of the imaging center, the referring doctor's EMR vendor maintains the software. The imaging center can then focus on secure transmission of the images.

Outpatient centers will be hindered in their ability to cut film costs unless physicians migrate their practices toward EMR and PACS vendors develop products to integrate easily with these systems.

Steven R. Renard is president and chief operating officer of Liberty Pacific Medical Imaging, based in Encino, CA, which owns and operates diagnostic imaging centers located primarily in California. The company also provides third-party management, consulting, and medical development services.