Minnies Awards: National Decision Support Company Named Best New Radiology Vendor

Best New Radiology Vendor

Winner: National Decision Support Company

While its ACR Select software came in second in the race for Best New Radiology Software, National Decision Support Company (NDSC) scored a nice consolation prize, being named the Best New Radiology Vendor by the Minnies expert panel.

NDSC was founded by an executive team that includes Michael Mardini, who has an impressive track record in founding imaging informatics companies. These include Talk Technology, which was bought by Agfa HealthCare in 2001, and Commissure, which was the recipient of the Minnies award for Best New Radiology Vendor in 2006 and was subsequently acquired byNuance in 2007.

Mardini and the rest of his team are hoping lightning strikes again with NDSC, which is theexclusive distributor of ACR Select, a decision-support software platform based on the American College of Radiology (ACR) Appropriateness Criteria. The software attacks the problem of overutilization of advanced imaging exams, which is costing the healthcare system millions in unnecessary costs and, in the case of some modalities such as CT, exposing patients to unnecessary radiation.

The idea is that ACR Select puts the information needed for more appropriate ordering at the fingertips of referring physicians — potentially replacing other utilization management tools such as radiology benefits managers.

ACR Select

Click image to enlarge.
The ACR Select decision-support platform is based on ACR Appropriateness Criteria. Image courtesy of NDSC.

ACR Select went into commercial release in mid-2013, and NDSC has been focusing its attention on performing integrations with major electronic health record (EHR) platforms used by clinicians to order studies. Integrations have already been completed with software offered byEpic SystemsCerner, and Allscripts, and they are underway with applications marketed byMeditech and Siemens Healthcare.

Referring physicians encounter ACR Select through their EHR software whenever they try to order an imaging exam. After entering data on the patient’s condition, clinicians are presented with a structured list of indications that highlight the appropriate imaging studies for that condition.

Should a referring physician wish for additional consultation, NDSC has a module that enables a healthcare organization to connect the clinician with a radiologist, according to Bob Cooke, vice president of marketing and strategy at the company. ACR Select can also be used in an offline mode, apart from the exam-ordering process, as a reference tool for physicians to determine the appropriateness of a scan they are considering. Doctors can even use ACR Select to consult with patients on exams patients might want but which aren’t clinically appropriate.

The latter features highlight how NDSC views ACR Select as more than simply a tool to nudge referring physicians to order less imaging.

“This is an incredibly powerful enabling tool to showcase how imaging can help improve patient care, as opposed to something focused on simply utilization management,” Cooke toldAuntMinnie.com. “We want to demonstrate that by using content we can drive imaging to a more appropriate level, and help radiologists define their role in the care cycle.”

Runner-up: Montage Healthcare Solutions

Lessons Learned From a Pioneer ACO – ImagingBiz

Lessons Learned From a Pioneer ACO

On July 16, 2013, CMS announced the results¹ of its accountable-care organization (ACO) program, the Pioneer ACO Model. The program was designed to test the impact of higher levels of shared savings and risk on ACO success, and it attracted 32 participants from around the country. After the first year of participation, seven Pioneer ACOs that did not produce shared savings announced their intention to transition to the lower-risk (and lower-reward) Medicare Shared Savings Program, while two dropped out of the ACO model entirely.

Among the participants staying in the Pioneer program is Bellin-ThedaCare Healthcare Partners (Appleton, Wisconsin). As David Krueger, MD, MBA, executive and medical director of the ACO, explains, “Bellin-ThedaCare was organized to create and deliver higher value before ACOs were really the rage. We have been continuously improving—driving toward better outcomes, lower readmission rates, and better value for consumers. In a fee-for-service world, we knew we were losing revenue because of that. There comes a point when you have to reengineer your financial structure to support your goals.”

The Pioneer ACO Model was a good fit for the health system, which was five years into its initiative to improve quality and lower costs when it enrolled. “We entered the program because it is a system of reimbursement that recognizes the creation of better value, and I think a lot of the success we’ve seen in the first year is owed to the work we had done before that. I look at these kinds of programs as accelerants: They create environments that encourage a drive to produce value over volume. Once the infrastructure is in place, then the clinical entrepreneurship can take off,” Krueger says.

Bellin-ThedaCare takes advantage of its electronic medical record extensively in tracking measurements related to quality and outcomes, establishing the benchmarks for improvement necessary to create savings. Claims data on its patients allow the system to take the next step, linking those data to outcomes.

“With the Pioneer program, we receive information on all patients attributed to us—where they’ve been and what they’ve had done, for all of their care,” Krueger explains. “We’re taking on accountability for their care being coordinated, no matter where they go. Now, our challenge is to figure out how to take these claims data and embed them in our clinical-improvement work: We want our physicians concentrating on the patients in front of them, not the screens next to them.”

Critical to this process will be finding a way to plug the existing gaps in patient data, Krueger says. “From a clinical-data perspective, we’re able to track and follow metrics, report scorecards, and drive improvements using data,” he says. “The drawback is that we can only see the care we deliver. Any care outside our network, we’re blind to, and that means we’re missing the total care experience of the patient. Patients with chronic conditions are vulnerable to needing additional, unnecessary services because of those gaps.”

Clinical Collaboration

As a component of care, imaging often falls in the unnecessary-services category because of inappropriate utilization or duplication of studies owing to incomplete records. “One of the gaps we know we have, in health care today, is the appropriateness of imaging,” Krueger says. “On the clinical side, the questions we are asking are when a test should be done—and in what way. If it’s the right test, it shouldn’t matter what it costs. What I don’t want are primary-care physicians who aren’t sure what to do (and don’t have the support they need) ordering the wrong test.”

Krueger stresses that he believes that the answer to this conundrum lies in deeper clinical collaboration, in which radiologists assume a leadership role in gauging appropriateness. “Who better to identify and create guidelines than the radiologists on the receiving end of the orders?” he asks. “That’s one of many areas where we’d like to see more collaboration and consultation between the various points in the care spectrum. We want to see efficiencies that don’t rely on rationing or cutting fee schedules, and I see more and more pulling of our radiologist colleagues to the table to help us work on patients’ total care.”

Krueger adds that providing incentives for collaboration will be critical to making it a permanent part of health-care culture. “Today, physicians are penalized for taking the time to collaborate,” he says. “They want to do things of value for patients, but they’re frustrated by a payment structure that tells them there should be more care, without regard for quality. It’s an incomplete incentive structure.”

Programs like the Pioneer ACO Model might not be the wave of the future, Krueger says, but he views them as an invaluable step forward. “Programs like this recognize that there is so much more to medicine than fee-for-service care,” he says. In terms of outcomes, he adds, “A large part of why we don’t stack up against other countries is that our incentives don’t support that direction. We have a lot of smart folks in health care, however, and if the incentives are right, look out: We’ll go a long way.”

Reference

1. CMS. Pioneer accountable care organizations succeed in improving care, lowering costs. http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-Releases/2013-Press-Releases-Items/2013-07-16.html. Published July 16, 2013. Accessed October 6, 2013.

One Radiological Halloween Night | Diagnostic Imaging

New Study in NEJM Exposes Overuse of Radiation Therapy Services When Urologists Profit Through Self-Referral | SYS-CON MEDIA

New Study in NEJM Exposes Overuse of Radiation Therapy Services When Urologists Profit Through Self-Referral

FAIRFAX, VA–(Marketwired – October 23, 2013) – A comprehensive review of Medicare claims for more than 45,000 patients from 2005 through 2010 found that nearly all of the 146 percent increase in intensity-modulated radiation therapy (IMRT) for prostate cancer among urologists with an ownership interest in the treatment was due to self-referral, according to new research, “Urologists’ Use of Intensity-Modulated Radiation Therapy for Prostate Cancer,” released today in The New England Journal of Medicine (NEJM) for its October 24, 2013 issue. This study corroborates the increased IMRT treatment rates among self-referrers reported in theGovernment Accountability Office’s (GAO) August 2013 report, “Medicare: Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny.”

Authored by Jean M. Mitchell, PhD, economist and professor at the McCourt School of Public Policyat Georgetown University, the NEJM manuscript provides an intricate analysis of treatment patterns by urologists before and after they acquired ownership of IMRT services, compared to the treatment patterns of non-self-referring urologists and urologists who practice at National Comprehensive Cancer Network® (NCCN®)-designated cancer centers (also non-self-referrers).

ASTRO Chairman Colleen A.F. Lawton, MD, FASTRO, voiced the Society’s grave concerns regarding this study’s results, “Dr. Mitchell’s study provides clear, indisputable evidence that many men are receiving unnecessary radiation therapy for their prostate cancer due to self-referral. While I am a prostate cancer specialist impassioned to eradicating the disease, I am equally dedicated to utilizing these powerful technologies prudently and in the best interest of each individual patient. We must end physician self-referral for radiation therapy and protect patients from this type of abuse.”

The two cohorts for the NEJM study data, obtained through Medicare claims from January 1, 2005 through December 31, 2010, include Medicare patients in 26 geographically dispersed states who were 1) treated at 35 self-referring urology groups in private practice matched to a control group of 35 non-self-referring urology groups in private practice, for a total of 38,765 patients; and 2) treated by 11 self-referring urology groups in private practice within close proximity to and matched directly to non-self-referring urologists at 11 NCCN® centers, for a total of 6,713 patients. Patient records were followed for a period of six months from the initial prostate cancer diagnosis to track treatment choices. Sixty percent of the self-referring urologists established their IMRT services during the period from January 1, 2008 through January 15, 2010.

A difference-in-differences analysis was used to isolate the impact of self-referral on changes of IMRT utilization over time, according to self-referral status. This approach controls for initial differences in practice patterns during the pre-ownership period as well as secular trends that affect the use of IMRT and are unrelated to ownership status. The analysis found that:

  • IMRT utilization among self-referring groups increased from 13.1 percent to 32.3 percent once they became self-referrers, an increase of 19.2 percentage points (146 percent). In contrast, IMRT utilization by non-self-referring urologists who were peers practicing in the same community-based setting was virtually unchanged-with a modest increase of 1.3 percentage points. Therefore, the difference-in-differences analysis reveals that self-referral accounts for 93 percent of the growth in IMRT.
  • IMRT utilization among the subset of 11 self-referring urology practices near NCCN® centers increased from 9 percent to 42 percent, an increase of 33 percentage points (367 percent), from the pre-ownership to the ownership period, compared to an insignificant increase of 0.4 percentage points at the NCCN® centers.
  • In addition to increased IMRT utilization, the data demonstrate decreases in utilization of other effective, less expensive treatment options by self-referring urologists. For example, brachytherapy decreased by 14.9 percentage points to just 2.7 percent of patients receiving this treatment in self-referring urology practices. These results are in stark contrast to non-self-referring urologists, for whom the study reports “virtually no change in practice patterns.”

The NEJM report concludes that “men treated by self-referring urologists, as compared with men treated by non-self-referring urologists, are much more likely to undergo IMRT, a treatment with a high reimbursement rate, rather than less expensive options, despite evidence that all treatments yield similar outcomes.”

At a press conference unveiling the study tomorrow, one of the nation’s leading urologists, James L. Mohler, MD, of Roswell Park Cancer Institute in Buffalo, will release a joint statement on the overtreatment of prostate cancer and physician self-referral from the expert members of the NCCN® Prostate Cancer Guidelines Panel, which he chairs.

“We are concerned unanimously by the prostate cancer treatment patterns identified in today’s article,” says Dr. Mohler. “We are disappointed to learn that urologists who self-refer for IMRT services use this expensive technology more than urologists who don’t self-refer and more than NCCN® Member Institutions.” He added, “Prostate cancer treatment recommendations should be based on the best available clinical evidence and not influenced by business or personal interests of the care provider.”

“This study confirms that permitting physicians to self-refer, particularly urologists to self-refer for IMRT, leads to unnecessary treatment and added health care costs to Medicare and beneficiaries,” continued Dr. Lawton. “Prostate cancer is a complicated disease that needs input from multiple specialists, not just one, to determine the best treatment for the individual patient. There are many different treatments available, and in many cases, no treatment at all is the right thing to do, particularly among the elderly. For many men with early stage prostate cancer, active surveillance, or watchful waiting, is the best option. Unfortunately, the continuous stream of data indicates that patient choice is being restricted — patients are being steered to the treatment that provides the most profit for the urologist. As a result, patients are subjected to unnecessary treatment and side effects, and millions of dollars are wasted.”

The federal “Ethics in Patient Referrals Act,” also known as the self-referral law, prohibits physicians from referring a patient to a medical facility in which he or she has a financial interest in order to ensure that medical decisions are made in the best interest of the patient without consideration of any financial gain that could be realized by the treating physician. However, the law includes an exception that allows physicians to self-refer for so-called “ancillary services,” including radiation therapy. Over the years, abuse of the in-office ancillary services (IOAS) exception has weakened the self-referral law and diminished its policy objectives, making it simple for physicians to avoid the law’s prohibitions by structuring arrangements that meet the technical requirements of the law, thereby circumventing the intent of the law. Numerous studies have shown that physician self-referral leads to increased utilization of services that may not be medically necessary, poses a potential risk of harm to patients and costs the health care system millions of dollars each year.

To-date, the GAO has issued three reports in a four-part series on physician self-referral, the most recent one, from August 2013, also details abuse in radiation therapy treatment for prostate cancer. The report found a 356 percent increase in IMRT utilization by self-referrers, compared to a 5 percent decrease by non-self-referrers, and that the number of treatments rose by 509 percent compared to a 3.8 percent decrease at non-self-referring multi-specialty groups. In July 2013, the GAO report, “Action Needed to Address Higher Use of Anatomic Pathology Services by Providers Who Self-Refer,” found that self-referring providers likely referred nearly one million more unnecessary anatomic pathology services than non-self-referring providers, costing Medicare approximately $69 million. “Higher Use of Advanced Imaging Services by Providers Who Self-Refer Costing Medicare Millions,” the first GAO report in November 2012 on self-referral in advanced diagnostic imaging, found that “providers who self-referred likely made 400,000 more referrals for advanced imaging services than they would have if they were not self-referring” — at a cost of more than $100 million in 2010. The final report, expected by the end of this year, will detail self-referral for physical therapy services.

“Unfortunately, when you look at the numbers in this report, you start to wonder where health care stops and where profiteering begins,” said Senate Finance Committee Chairman Max Baucus (D-Mont.), in a statement about the GAO’s August 2013 report on radiation therapy self-referral. “Enough is enough. Congress needs to close this loophole and fix the problem.”

“ASTRO urges Congress to promptly pass the ‘Promoting Integrity in Medicare Act of 2013’ (PIMA), introduced August 1, 2013, by Rep. Jackie Speier (D-Calif.) and Rep. Jim McDermott (D-Wash.). PIMA will close the self-referral loophole for radiation therapy, advanced imaging, anatomic pathology and physical therapy services, resulting in better care for patients and billions of Medicare dollars saved that could offset the costs of repealing the Medicare physician payment formula (sustainable growth rate-SGR).

“PIMA closes the self-referral loophole in a conscientious and strategic manner that abolishes abuse while allowing truly integrated multi-specialty groups and high-performing health systems to continue to provide high-quality and efficient care,” concluded Dr. Lawton. “This blatant abuse of our patient’s trust and our country’s limited financial resources endangers our ability to work with health policy leaders in developing a new quality- and value-based payment system for Medicare. Closing the self-referral loophole will protect patients, restore trust, reduce costs and strengthen Medicare.”

Reps. Speier’s and McDermott’s PIMA legislation would enact the recommendations of influential bipartisan groups who have examined self-referral abuse. In September 2012, a New England Journal of Medicine article, authored by leading health policy experts including former CMS administratorDonald Berwick, MD, MPP, called for closing the self-referral loophole for radiation therapy and other so-called “ancillary services.” The Center for American Progress agreed with narrowing the IOAS exception, as well as several notable bipartisan groups, including the Bipartisan Policy Center, under the leadership of former Senate Majority Leaders Tom Daschle (D-S.D.) and Bill Frist (R-Tenn.), and the Moment of Truth Project, headed by Erskine Bowles and former Senator Alan Simpson (R-Wyo.). President Obama’s proposed FY 2014 Budget also recommended closing the self-referral loophole and estimated savings of more than $6 billion during the standard 10-year budget window for Medicare.

A November 2012 Bloomberg News investigative report scrutinized questionable IMRT treatment for prostate cancer by a self-referring urology clinic in California and concluded that physician self-referral resulted in mistreated patients and higher health care costs. The Wall Street JournalThe Washington Post and The Baltimore Sun have published similarly critical reports since 2009 to call attention to the mounting evidence that limited specialty [urology] groups who own radiation therapy equipment have utilization rates that rise rapidly and are well above the national norms for radiation treatment of prostate cancer.

The NEJM study was approved by the institutional review board of Georgetown University and funded by an unrestricted educational research contract between ASTRO and Georgetown University. No potential conflict of interest relevant to the study is reported.

ABOUT ASTRO

ASTRO is the premier radiation oncology society in the world, with more than 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals that specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes two medical journals, International Journal of Radiation Oncology • Biology • Physics (www.redjournal.org) and Practical Radiation Oncology (www.practicalradonc.org); developed and maintains an extensive patient website,www.rtanswers.org; and created the Radiation Oncology Institute (www.roinstitute.org), a non-profit foundation to support research and education efforts around the world that enhance and confirm the critical role of radiation therapy in improving cancer treatment. To learn more about ASTRO, visitwww.astro.org.

The following files are available for download:

Contact information
Michelle Kirkwood
703-286-1600
press@astro.org

 

© 2008 SYS-CON Media Inc.

Emergency docs want decision support to tackle CT overuse

Emergency docs want decision support to tackle CT overuse

By Erik L. Ridley, AuntMinnie staff writer

October 21, 2013In a survey of emergency physicians (EPs) in the St. Louis area, respondents reported that overutilization of CT is a problem in the ED, and they showed interest in imaging decision support to help address the issue, according to lead author Dr. Richard Griffey, associate chief of emergency medicine at Washington University School of Medicine/Barnes-Jewish Hospital.

The researchers shared their results in a poster presentation last week at the American College of Emergency Physicians (ACEP) Research Forum in Seattle.

The poster is part of a series of three projects being funded by the Washington University Institute of Clinical and Translational Sciences, the Emergency Medicine Foundation, and the Emergency Medicine Patient Safety Foundation, Griffey said. The first project was a survey of EPs to evaluate their attitudes, preferences, and knowledge regarding CT utilization, radiation, and imaging decision support, while the second was an exploratory retrospective project to identify “highly imaged conditions,” he said.

The third project, which has just concluded data collection, evaluated the impact of providing CT study counts and other information to emergency physicians, he said. The initial survey was the subject of the poster.

Imaging decision support

A number of studies have evaluated the efficacy of different computer-based interventions to help optimize imaging, producing mixed results. However, the success of these systems often hinges upon the attitudes and preferences of the end users and how the systems meet their workflow needs, Griffey told AuntMinnie.com.

As a result, the researchers sought to assess the knowledge, attitudes, and preferences of emergency physicians related to CT utilization, radiation risks, and decision support. In particular, they wanted to determine whether emergency physicians view overutilization as a problem, whether they want imaging decision support, and, if they do want decision support, what kinds they prefer, according to the researchers.

A secondary goal of the survey was to determine what factors or demographic characteristics, if any, were associated with interest in decision support.

The team asked 235 EPs in the St. Louis area to fill out a 42-item Web-based survey. Of these, 155 (66%) responded.

Opinions were gathered on topics including the following:

  • Whether overutilization is a problem with significant opportunity for improvement in the ED
  • Whether cumulative study counts affect decisions to order CT or the type of study ordered
  • Whether multiple prior evaluations with CT influence the decision of whether or not to order a CT exam
  • The impact of malpractice and patient satisfaction on CT ordering
  • The information EPs want for decision support before ordering a CT

A problem

On a scale of 1 (strongly agree) to 5 (strongly disagree), respondents had a mean score of 1.79 for the three questions related to whether there is significant opportunity for improvement regarding overutilization in the ED.

“CT overutilization is perceived as a problem,” the authors wrote.

Four questions related to cumulative study counts and their effect on ordering decisions had a mean response score of 3.37 on a scale of 1 (never) to 5 (always). Three questions related to whether multiple prior CT evaluations affect CT ordering had a mean response score of 1.79 on a scale of 1 (strongly agree) to 5 (strongly disagree).

“CT count impacts ordering only some of the time, but knowledge of repeat/multiple imaging impacts ordering behavior,” the authors wrote.

The survey also asked about other factors that influence the decision to order a CT.

“EPs felt unavailability of other imaging modalities, especially at night or on weekends, impacted this decision,” Griffey said. “They also felt pressure from patients and other physicians, such as consultants and referring MDs; concern about patient satisfaction scores; and concern about malpractice.”

Decision-support capabilities

The researchers also surveyed the EPs for their interest in the following imaging decision-support capabilities:

  • Effective dose of the imaging study being ordered
  • A patient’s cumulative CT study count
  • A patient’s cumulative radiation exposure in mSv
  • A patient’s lifetime attributable risk (LAR) of cancer based on this exposure
  • The appropriateness ranking of a particular study for a given indication
  • Other imaging options
  • Reminders or alerts about patients at increased risk due to multiple imaging, etc.

On a scale of 1 (strongly agree) to 5 (strongly disagree), respondents had a mean score of 2.00 for the first four capabilities and 2.05 for the remaining three.

“EPs are interested in all types of imaging decision support proposed to help optimize imaging ordering in the ED and to reduce radiation to their patients,” the authors wrote.

Poor knowledge

Emergency physicians performed poorly on three questions assessing knowledge of radiation dose information and effects.

“EPs want effective dose information but are not familiar enough with this information to make use of it,” the authors wrote. “Knowledge of common dosages is poor, consistent with other studies across specialties.”

If provided with information about the risks of imaging, 87% of respondents said they would use the information to discuss risks with patients.


Copyright © 2013 AuntMinnie.com

Imaging and the ACO: Collaborating on Patient-centered Care – ImagingBiz

IMAGINGBIZ NEWSLETTER

Imaging and the ACO: Collaborating on Patient-centered Care

Michael Budimir, regional director of imaging services for Franciscan Alliance, an Indiana accountable-care organization (ACO), defines the principal goal of the ACO simply. “Everything has to be patient centered,” he says. “Today, in health care, we have to reevaluate everything from the patient’s perspective. In the ACO model, what helps the patient also helps the institution.”

Budimir, who oversees imaging at the health system’s four northern Indiana hospitals, says that Franciscan Alliance’s path to achieving this goal is based on partnering with physicians—both those it employs and those with whom it is affiliated, such as its radiologists. “We were searching for the best way to partner with our physicians to collaborate in providing high-quality care to our patients in a cost-effective manner,” he says. “In looking at the way health care is headed, we thought this was a component of the ACO model that would benefit us.”

Role of the Radiologist

While some ACOs have turned to large-scale employment as a means of encouraging collaboration among their physicians, Franciscan Alliance has maintained the contracts that it had with its radiology groups prior to making the transition to the new payment model. “We look at the radiologists as having a key role to play in the care of our patients,” Budimir says. “They have as much of a stake in the success of our institutions as the referring physicians have (or any other service line has). They have become even more participative and collaborative: That’s what is required, in this environment, for everyone’s benefit.”

Franciscan Alliance’s radiologists are embracing these roles, discussing the appropriateness of ordered studies with referring physicians and helping to direct patients’ care. “We are seeing a lower volume of imaging studies being ordered now, and what is being ordered is more appropriate,” Budimir says. “Physicians are making better-informed decisions about what needs to be ordered, and they’re looking to the radiologists either to substantiate those choices or to advise them as to whether they’re using the right modality for the right exam for the right proper diagnosis.”

Should an inappropriate study be ordered, radiologists bring the issue to the attention of the ordering physician, and inform him or her as to the proper method of testing required. “We want to provide what’s best for the patient,” Budimir says. “We’re all engaged in being the best possible advocates for our patients, and coordinating their care is paramount.”

Evolving Technology Needs

As its radiologists’ roles evolve to become more patient focused, so do the organization’s imaging-technology needs, Budimir says. “We’re looking at the technology more in terms of where the market is going than ever before: Can the equipment be multipurposed to optimize its use and maintain efficiency? We have to consider whether the patient is going to be comfortable and whether this will help ease his or her anxiety. Additionally, we have to consider how the equipment is serviced and its dependability. That’s also in the best interest of the patient,” he notes.

As an example, Budimir points to the organization’s implementation of two Oasis boreless 1.2T MRI systems from Hitachi Medical Systems America in 2012. “This piece of equipment has really helped us create a closer working relationship with our patients,” he says. “The Oasis systems have addressed, on numerous occasions, the issues of patients feeling confined or claustrophobic in traditional, closed-bore MRI systems. MRI is one of the most dreaded imaging exams. With the Oasis and its open bore, the patient doesn’t feel enclosed: It reduces patient anxiety as it relates to claustrophobia.”

He adds that imaging technology, in general, is evolving to meet patients’ needs better. “Tables for radiography, CT, and MRI are getting bigger, to be able to handle much larger patient sizes: We have a growing society, and we need to address that issue,” Budimir observes. “Our society also experiences a lot of claustrophobia with CT and MRI. We have to consider how our patients are treated, and that is something that is increasingly important.”

Going forward, Budimir expects to see Franciscan Alliance’s radiologists continue to deepen their collaboration with other physicians and service lines, and he believes that imaging technology will play a critical role in supporting that evolution. “Medical teams will come together to coordinate patient care, bringing us a wide range of expertise, and radiologists will be important consultants in that process,” he says. “Radiologists have to be very collaborative and patient focused, and the technology they use has to benefit our patients and remain patient-focused. The Oasis and other technologies that are on the market now help address some of patients’ biggest anxieties.”

Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.

What rads can do to protect against commoditization – FierceMedicalImaging

What rads can do to protect against commoditization

A pair of recent studies–both published in the Journal of the American College of Radiology–seem to offer some ammunition to radiologists worried about their specialty’s wider reputation and who have questions about what it is becoming.

Is it in danger of becoming a commodity? Is it a product like bathroom cleaner, or something more that provides value?

The typical view among many healthcare providers has been that radiologists spend their time locked away in reading rooms, interpreting studies and avoiding contact with consulting physicians and patients.

The supposition behind one study, carried out at the University of California, Irvine, is that thecommoditization of radiology is being driven by a focus on relative value units and a lack of radiologist communication with referring physicians and patients, resulting in poor service to those physicians and patients. Furthermore, unless they’re trained to be “helpful consultants,” learning those skills on the job may come to late

Consequently, the researchers formulated a study in which they had radiology residents accompany internal medicine teams on rounds for two weeks. A survey administered after the two weeks found that clinicians that formed a strong clinician-radiologist relationship improved patient care and that the experience improved radiologists’ consulting skills, as well as their understanding of clinicians’ perspective.

The other study, carried out at three hospitals in the greater Vancouver area, followed a number of radiologists while they performed their daily duties and documented what most radiologists know: thatradiologists offer much in the way of on-site added value on a daily basis other than interpreting images.

Actually, the researchers determined, radiologists spend just slightly more one-third of their time interpreting images. The rest of their time is spent on noninterpretive tasks such as those dealing with quality assurance, or communicating with patients and referring physicians. In fact, they spend an extraordinary amount of time dealing with other health personnel–up to six interactions per hour that impact patient care.

These studies demonstrate ways in which the specialty can move forward. Radiologists who focus on providing service to referring physicians, other clinicians and their patients should be taking every opportunity to demonstrate how they’re adding value to the healthcare environment–apart from their traditional role as imaging interpreters.

In this way, they will be less susceptible to the charge that they’ve been commoditized. – Mike  @FierceHealthIT

Curing the prior authorization headache | Medical Economics

Curing the prior authorization headache

Outside, Looking In | Diagnostic Imaging