American College of Radiology blog

MedPAC to Augment Primary Care Physician Reimbursement: Will That Attract More Doctors or Just Hurt Others?

The Medicare Payment Advisory Commission (MedPAC) has proposed an increased reimbursement to primary care physicians treating Medicare patients. The recommended increase, which is scheduled to reach Capitol Hill in June, is due primarily to recent data that suggest some Medicare beneficiaries may have difficulty finding a primary care doctor, and that fewer medical students are entering primary care.
                              
However, Sen. Max Baucus (D-Mont.) plans to submit Medicare legislation to the Senate in May which could include the proposal to increase primary care physician reimbursement in addition to another delay to the 10 percent cuts scheduled to hit all physicians July 1. The increase to primary care may come at the expense of other specialties.

If Congress follows MedPAC’s recommendation, the budget neutrality rules in Medicare’s budget will offset an increase to primary care doctors with a cut to others. The ACR is educating Congress that radiology cannot absorb another round of cuts to pay for increases to other specialties and offering more effective, targeted measures such as accreditation and the use of Appropriateness Criteria that can actually help eliminate unnecessary costs and raise quality of care.

Also, while adjusting reimbursements is one way to attract more students, it won’t diminish all of the perceived drawbacks to a career in medicine. Take Monday’s article in Forbes Magazine for example: Reasons Not to Become a Doctor. Citing increased practice costs versus lower reimbursement rates, cost of malpractice insurance, preauthorization, and student debt, it’s no surprise students are fearful of physician careers. See my post from last December about attracting more medical students to radiology for more on this topic.

Some hospitals are compensating by adding a new position to their workforce: the hospitalist. I read last Tuesday’s Wall Street Journal article on hospitalists with great interest, as it described the up-and-coming physician generation as seeking a work-life balance — and they’re getting it.

There are many issues here. Some will affect us imminently and others will be more impactful in the future. But I wonder, is there an alternate way of addressing this physician shortage while not pitting one physician specialty against another? What do you think is causing fewer Americans to become physicians?

I look forward to your thoughts.

April Bulletin Calls for Patient Success Stories

I would like to call your attention to a particular article in the current issue of the ACR Bulletin titled “Patients Stranded in the Dark” — which explains all the ins and outs of the ACR’s “Face of Radiology” branding campaign to educate our patients regarding what a radiologist is and does (and why that is important to their health care).

With the research portion of this campaign complete and the testing portion just a week away, the College again needs your input. 

Sharing your best practices for patient interaction with us has been critical to the planning phase of this campaign — examples of how you, every day, educate and interact with your patients. We encourage you to continue offering these examples.

As an added bonus, you could win either a Garmin GPS or an iPod® touch! The ACR Branding Committee will select two best practices based on outstanding leadership in connecting with patients.

Please post your best practices for connecting with patients here on the blog or if you would prefer, e-mail them to ACR Public Relations Manager Shawn Farley (sfarley@acr.org).

We look forward to reading how you and your practice are connecting with your patients.

New Technology Puts Care in Patient Hands

Keeping up with advancing information technology and trends in radiology and medicine in general is a full-time job. It seems as though every day new equipment debuts, scientific studies are released and software is redesigned. People are constantly working to advance the field which makes our jobs as physicians ever-changing.

This week, I’ve been particularly aware of technology as it pertains to patients. As reported in last Friday’s Daily News Scan, the Florida Hospital system is introducing kiosks to their radiology department in an effort to speed up the check-in process and will eventually allow patients to make payments on the machines.

Here’s another example: Patients of the Duke University Health System can now book appointments online — which may save phone calls, waiting room time and possibly frustration for hospital staff and patients.

And take Ohio State University Medical Center. They’re publishing consumer-focused data directly on their Web site to allow patients access to more information and ultimately more control over their health, according to the site. Everything from medical results statistics to patients’ opinions of the quality of service they received is published for the public to see.

Now, these examples are taken from large hospital systems which may or may not apply to your practice; however, I do wonder how powerful allowing patients to access specific information online would impact any radiology experience. On Monday, USA Today reported that doctor-rating Web sites — which are becoming increasing popular (though highly criticized) — have put doctors on the defensive, which I can’t say I believe this is good for medicine.

Recently, Dr. Thrall blogged about the AIM site, which offers estimates of the radiation received from specific imaging procedures. Many of you wrote in expressing your concern and ideas to alter this tool to be of use to patients and referring physicians.

• How has patient access to technology impacted your career; or, how do you see it changing your role as a physician in the future?
• How can we harness in all of the available information and make it relevant and available to our patients?

I understand the convenience and in some cases cost-effectiveness of allowing patients to take charge of their health. But where do we draw the line?

I look forward to your thoughts.

Preauthorization of Imaging — Cautious or Controlling?

The recent Associated Press article "Health Insurers Limit Advanced Scans" was in the forefront of medical news recently, published in hundreds of newspapers nationwide and on countless Web sites.

The article highlighted the preauthorization process for many diagnostic imaging procedures instituted by some private insurance companies, citing soaring costs and radiation concerns as sources of their scrutiny.

Preauthorization may help these payers save money and may help some patients avoid unnecessary exams. However, it does not address self-referral, a primary driver of increased utilization and the quality and safety concerns associated with imaging performed by poorly-trained providers.

Also, the lag time for even certified radiologists with expert knowledge to receive approval for a necessary examination has the potential to deter physicians from ordering what they believe to be the most appropriate exams, for fear of the claim being rejected or the decision reversed after the scan has already been completed.

With the cost of the medical imaging skyrocketing, it’s no surprise that payers are taking a hard look at our field. Instead of criticizing the health insurance companies for doing what they may believe is a service to patients (in addition to saving them money), the College is working to better educate them regarding which tests are appropriate and when.

A fact based foundation for preauthorization is the ACR Appropriateness Criteria®, which Dr. Bettman pointed out in response to Dr. Thrall’s recent blog post. ACR accreditation can be an alternative quality assurance measure.

How have you managed preauthorization in your practice and how do you think the ACR can lead efforts to help ensure safe, effective, necessary imaging for patients in the future? Please remember that any comments will be in the public domain and your name will be posted along with your comment.

I look forward to your thoughts.

Imaging Safety Concerns Over Online Interactive Tool

Next week’s edition of AMNews features an article criticizing a health-plan owned company for a new interactive tool on their Web site. I visited the American Imaging Management Web site to try this tool out for myself. There is a 3-D image of a woman beside a list of imaging modalities and procedures. If you click on one of the procedures, the woman’s body lights up in the area to be scanned. A summary of common uses for the selected procedure is provided, along with alternatives to the imaging study. The user is also provided a numeric total at the bottom of the screen: exposure in mSv, number of equivalent chest x-rays, and natural equivalent in years. Of course natural background radiation is to the whole body and adding site specific information as is done on this Web site is incorrect and misleading.

While the company contends that the purpose of the tool is to educate patients about the radiation exposure associated with their imaging exam, I have to agree with the AMA, and wonder if there is more to the story. If you didn’t have time to read the article, it clearly states that health plans have acknowledged the increased utilization of imaging over the past several years, and have had to reevaluate their patient access to medical imaging for financial reasons.

Nowhere on the site can you find information about the benefits and cost-effectiveness of early detection through medical imaging, radiation dose variance between patients and machines or the financial interest a health plan-owned company may have in keeping imaging costs down. In Dr. Moore’s column in this month’s ACR Bulletin, he addresses the ACR’s ongoing patient safety efforts — which aim to educate, not confuse patients.

• Would any of you refer your patients to this tool?
• What value could it have for health care?
• What can we, as physicians do to prevent our patients from once again receiving incomplete information that may lead them to question getting necessary examinations?
  

Should the ACS Have Added CT Colonography to List of Recommended Screening Exams for Colorectal Cancer?

The American Cancer Society (ACS) recently added Computed Tomographic Colonography (CTC) — also known as virtual colonoscopy — to their list of recommended screening techniques for colorectal cancer.

In the first-ever joint consensus guidelines for colorectal cancer screening, released jointly by the ACS, ACR, and the U.S. Multi-Society Task Force on Colorectal Cancer (a group that comprises representatives from the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy), CTC now is included as one of several options for colorectal cancer screening and prevention in average-risk adults age 50 years and older and recommended to be received once every five years.

The ACR supports the inclusion of CTC as a front line screening tool.

• What are your thoughts on the future of this exam?
• Do you think that Medicare and private insurance companies should now reimburse for the exam?
• Will more patients be screened once physicians are fully reimbursed for providing the exam making it more widely accessible?

Making Connections With Referring Physicians

Members of the ACR staff recently discussed topics related to the Face of Radiology branding campaign with residents and fellows at the Armed Forces Institute of Pathology (AFIP). One item that was a focus of this discussion was the need to not only educate patients about our expertise in medical imaging, but also the need to educate referring physicians. Making connections with other doctors and making time to engage in a genuine relationship with them may seem like an impossible task, but is it?

Ronald E. Cordell, M.D. FACR, recently wrote in to our blog asking us to discuss the increased utilization of imaging stemming from the emergency department (ED). It was suggested that radiologists educate medical students as to appropriate times to order particular studies from the ED and when.

So here we have two examples of the same problem: How do we emphasize to students and our peers the importance of proper utilization of imaging? We're hopeful that our branding campaign will deliver some solutions to both scenarios. How many of you have great relationships with your referring physicians, and how did you get there? Would discussions in medical schools from seasoned radiologists deliver any results? Or how about a networking event with local doctors at a sporting event? I'm anxious to hear how you go about educating and building relationships with your nonradiologist colleagues without overstepping boundaries.

I'd like to thank Dr. Cordell and the participating residents for shedding light on this import topic and welcome any feedback you may have.

Arl Van Moore, M.D., FACR

Chair

Board of Chancellors

American College of Radiology

What Your Patients Are Saying About You

The ACR and one of the most respected research firms in the country have conducted focus groups, surveys, and in-depth interviews with the general public and Capitol Hill staff as the first phase of the “Face of Radiology” branding campaign.

The purpose of this research was to determine the public’s knowledge level of radiologists’ expertise, training, and role in patient care. Research results will be used to craft an effective campaign to inform the public of the importance of these three factors — a radiologist’s education, training, and expertise — to their health care.

What we have learned, although surprising — is not totally unexpected:

• Many people thought that radiologists were not doctors
• Many considered radiologists to be “passionless”
• Many did not think radiologists had to be college-educated

The research suggests that the public has an inaccurate perception of radiologists and their involvement in diagnosing and treating medical conditions. The good news is that the research also shows that these perceptions can change.

A video containing many of the focus group subjects’ views about radiologists and their role in the health care process was recently presented at a meeting of the ACR Board of Chancellors. We thought that it would be helpful for you to see the video and hear what many of your patients may be saying about you.

After watching the video (at the link below), I invite you to post comments regarding steps your facility may be taking to educate patients as to the radiolgist's training and expertise at the local level. Your discussion and feedback are critical to the success of this effort. 

Watch the video now.

ACR, Alliance for Radiation Safety in Pediatric Imaging Launch “Image Gently™” Campaign to Publicize Proper Radiation Dose for Children

The College has joined the Alliance for Radiation Safety in Pediatric Imaging, a coalition of medical organizations and government bodies, to launch the “Image Gently” campaign, which focuses on informing medical imaging professionals about opportunities to lower radiation dose used in pediatric imaging.

Children obviously have smaller bodies than adults and the Alliance want to ensure that imaging providers are accounting for the potential adverse affects imaging could have on younger patients as the grow. As part of this effort, the College and all Alliance member organizations urge that, when performing imaging exams on children, providers:

 Significantly reduce, or “child-size,” the amount of radiation used

 Not over-scan:
- Scan only when necessary
- Scan only the indicated region
- Scan once; multi phase scanning (pre-and post contrast, delayed exams) is rarely helpful

 Be a team player:
- Involve medical physicists to monitor pediatric CT techniques 
- Involve technologists to optimize scanning

The Image Gently Web site (www.imagegently.org) was developed as a resource for all radiology professionals. It includes educational material as well as imaging protocols. We ask that you share this important with your imaging staff and referring physicians. Remember, what we do now will affect children for their lifetime. I hope you take the time to review the educational material on the Image Gently Web site (www.imagegently.org) and familiarize yourself with the information the ACR will be providing you in the coming weeks.

Here are some statistics:

 4 million pediatric CT scans were performed in 2006
 The number of pediatric CT scans performed in the United States has tripled in the last five years

Questions for you:

• Have you noticed an increase in pediatric imaging over the course of your careers?
• Do you have any suggestions for lowering CT dose in pediatric patients that perhaps were not included in the Image Gently Web site?

I look forward to hearing your thoughts.

Disruptive Technologies Present Challenges, Opportunities for Radiology

The ACR recently posted to the Web site an original article titled, The Double-Edged Sword of Technology: “Disruptive Technologies” Concerns Radiologic Profession Built on Innovation. The article focused on what it termed “cheap, good-enough scanning technologies that may enable competitors to infiltrate the world of radiology, compete on unequal terms, and redefine the standards of practice.”

There is little doubt that as scanners become smaller and more available to lesser trained personnel, the trend will present challenges to radiologist physicians intending to protect patients from substandard care.

What do you think that the radiology community needs to do to make sure that patients receive the best care possible in the face of advancing technology that could place price, portability, and perceived convenience over quality?

Presidential Candidate Health Plans: Exactly Where Do They Stand?

You have, no doubt, heard the 2008 Presidential candidates speak about their health care plans and how they think that their plans will fix what is wrong with America’s health care system.

It occurred to me in watching the endless hours of coverage on television that you might want to see in black and white exactly what the candidates’ plans are.

Click here to read a table that ACR staff has put together regarding the health plans of the major candidates in quick, bullet point form.

What do you think are the strong points and shortcoming of some of these plans?