The problem: medical imaging would get squeezed.

BCBSA’s recommendations follow a by-now familiar pattern: 1) Replace fee-for-service reimbursement with outcome-based reimbursement, 2) Invest in primary care, and 3) Invest in preventative care.

The details, however, bring out the trouble for medical imaging. The recommendations use a partnership between Wellmark Blue Cross Blue Shield and a radiology benefit management company as a model. The partnership relied on prior authorization from the benefit management to reduce the use of medical imaging.

The Medical Imaging Technology Alliance (MITA) and Access to Medical Imaging Coalition (AMIC) have been critical, pointing out the following:

• There is no peer-reviewed study that shows that prior authorization requirements save money for Medicare.
• According to the AMA, 63 percent of 2400 physicians surveyed said that prior authorization delays necessary medical treatment.
• HHS has noted that prior authorization is at odds with “the public nature of the Medicare program” because of its lack of transparency and would be burdensome because of the Medicare appeals process.
• The State of Delaware shut down Blue Cross Blue Shield’s Delaware prior authorization program after scrutinizing the quality of care received by cardiac nuclear imaging patients.

In the end, BCBSA’s recommendations are just that – recommendations. It is unlikely that Medicare will implement them any time soon. Still, there is little doubt that medical imaging will continue to be a target for cost-cutters in the government and in the healthcare industry in general. What will this mean for medical imaging professionals? Stay tuned. Better yet, subscribe to this blog and keep up to date with  the latest in medical imaging.

Information from a Cardiovascular Business article was used in this post.

That’s the conclusion of Eugene Lin, M.D., of the Virginia Mason Medical Center in Seattle in a recent article in the American Journal of Roentgenology. The medical imaging field of today, with its variety of options for the new radiologist, will slowly disappear, predicts Lin.

Citing the probable rise of ACO’s and the ongoing effort to trim healthcare costs, Lin thinks that the following features will dominate the medical imaging market in 2020:

• Fewer independent practices. Shrinking profit margins will force many small and independent practices to consolidate or get bought out by a larger practice. The trend will be amplified by the growth of teleradiology, which limits the need for medical imaging professionals in a particular location.
• More large and hospital-based practices. See above. Well-established hospital and large medical imaging practices will have the means to take advantage of the changing marketplace. They’ll also be under pressure to generate profits even as reimbursements shrink, so they’ll be eager to expand their volume and types of medical imaging services.
• More volume – but not much more. Lin thinks that medical imaging services will be a frequent target of healthcare budget cutters..
• More teleradiology. It enables medical imaging practices to drastically reduce travel and courier costs, expand their customer base, and free radiologists to work more from home.
• More national competition. More teleradiology + a greater need to expand services = more practices reaching beyond – perhaps well beyond – their state borders.
• Ongoing efforts to control costs. These may include strict prior authorization rules and lower reimbursement for medical imaging services.

Lin doesn’t say whether these changes are good or bad. Nor does he say they are certain. In fact, he reminds readers that predictions should be taken with a grain of salt by quoting Yogi Berra: “It is tough to make predictions, especially about the future.”

For ongoing coverage of medical imaging, subscribe to this blog.

• Declining Revenues. This was the #1 business priority for physician group practices, imaging centers, and community hospitals. Cuts in Medicare and insurance company reimbursements are driving down revenues. The good news: many medical imaging practices are becoming more efficient, improving their marketing efforts, and adding new services to compensate.
• Improving Customer Satisfaction. This was the #1 business priority for academic medical centers and multi-hospital organizations.
• IT Investment. While many practices added or upgraded medical imaging systems, most chose to spend money on basic IT infrastructure: workstations, laptops, mobile devices, wireless capacity, and technologies associated with meaningful use goals. Imaging technology is holding steady, in other words, while information management is taking a larger slice of the IT pie. Speaking of which…
• PACS and RIS top the investment list. Again, managing images is taking priority over producing better ones.
• Ultrasound tops imaging system purchases. Second place: CT. Last year, MRI topped the list, CT was in second place, while ultrasound was in fourth place.

For those following the world of medical imaging, these highlights can’t be much of a surprise. Dollars are more scarce than ever, which means that large capital investments – like medical imaging systems – will tend to take a back seat to less expensive IT infrastructure investments which can have quick productivity payoffs.

The survey results were based on answers given by over 400 decision makers from a wide variety of medical imaging facilities from July 26 – Aug. 31 of this year.

Not surprisingly, many of the scores for 2011 have been on the lower end of the spectrum and don’t show signs of going up:

It is clear that confidence in reimbursement is quite low and, given the uncertainties surrounding health care reform and Medicare policy, does not appear to be trending upward. Such low confidence – along with the ongoing difficuty of obtaining loans – hampers investments in capital equipment, better software, staff training, and all sorts of other potential improvements.

However, low growth or no growth is not the same as declining revenues and a shrinking market.

What type of confidence will the fourth quarter of 2011 inspire? Stay tuned – we’ll report the numbers in early January 2012.

Subscribe to this blog for more information on medical imaging, PACS and CVIS issues.

• Liver cancer treatment. Interventional radiologists may have discovered a way to better identify and modify blood vessels so that radiation-emitting – and cancer killing – beads can be delivered to inoperable liver tumors. Continue reading.
• Stress and sleep studies. Neuroimaging has been used to study all kinds of things, but not the effect of stress and sleep deprivation. Scientists in Virginia hope to better understand how the brainstem and thalamus by recording the effects of stress and sleeplessness. Continue reading.
• Fiber optic illumination. New technology enables huge amounts of photons to illuminate targets inside the body, helping surgeons and other professionals to use smaller cameras (and other medical imaging equipment) while still seeing a sharp picture. Continue reading.
• Optical frequency data imaging. Advances in this technology are getting medical imaging professionals closer to comprehensive, volumetric images of esophageal tissue in less than 60 seconds. Continue reading.
• Alzheimer’s education. It’s not a technological advance, but an educational one. Several radiologists worked together to produce a digital e-booklet on Alzheimer’s which included several MRI, CT, and ultrasound images. Continue reading.
• Breast cancer treatment. Researchers in Florida have developed an infrared excitable dye, detectable by MRI and other medical imaging technology that will indicate where otherwise hard-to-detect breast micrometastases are. Continue reading.
•  Bladder cancer treatment. A small number of medical facilities across the country are beginning to use a new optical imaging agent that should increase detection of bladder cancer. Continue reading.

Subscribe to this blog for more updates on medical imaging technology and medical imaging news.

The other reason medical professionals look forward to RSNA is to learn about the economics that drive the industry. ACO’s, meaningful use, teleradiology, commoditization – these are all changing the medical imaging market, and professionals in the field should know how they may define the role of the medical imaging professional in the future.

If you’re interested in the economics of medical imaging, we suggest you think about attending the following sessions:

• Special Lecture: Year Two of Health System Reform—Where Are We Now? Arie Crown Theater, Monday, Nov. 28, 1:30 – 2:45 PM. Get an update on the impact of healthcare reform on the economics of the healthcare industry from Peter Carmel, MD, President of the AMA.
• How Payment Policy Will Impact Technology Development in the 21st Century: An ACR Interactive Session. S404AB, Tuesday, November 29, 4:30-6:00 PM. Learn “about the current process of how reimbursement for new technology and procedures is obtained and consider strategic partnerships between industry, researchers, governmental agencies and third party payors in order to optimize the process in the future.”
• Monetary Decisions in Radiology Practice: Valuing Your Practice, Assessing Future Financial Trends, and Optimizing Personal Finance. S403A, Thursday, Dec. 1, 8:30 – 10:00 AM. Learn about key market trends, valuing services, growing a business, wealth management, and other topics from a panel of experts in healthcare economics.
• Health Policy and Economics. LL-PPE1021, Lakeside Learning Center, every day.  Actually, it’s an exhibit, not a presentation. But it’s hosted by noted healthcare economist James Vincent Rawson, who also happens to be a radiologist.

Pre-book an RSNA demo with McKesson online or visit booth #211 Lakeside Center.

Can’t go to RSNA? Register to attend the RSNA Virtual Conference and explore a virtual world complete with educational offerings. Attend sessions and be sure to visit the McKesson Showcase on your own time, from anywhere in the world.

This blog post includes information from a recent article in HealthImaging.com

According to the the authors of the article in the Journal, healthcare reform, with its overriding focus on controlling costs, has led to an “industrialized” or “standardized” approach to medicine. The result: hospitals, clinics, and other medical facilities are viewed as “providers” of services which are used by “consumers.” Likewise, the language used to describe medical professional-patient interaction is that of a commercial transaction.

The danger in such a switch is that medical care really will become transactional instead of personal. The authors write that the “words ‘consumer’ and ‘provider’ are reductionist; they ignore the essential psychological, spiritual and humanistic dimensions of the relationship—the aspects that traditionally made medicine a ‘calling,’ in which altruism overshadowed personal gain.”

Under a transactional model, a successful doctor is one who generates a profit, not necessarily one who has a history of professionalism among his or her peers and patients.

The authors recommend that medical professionals “eschew the use of such [economic] terms that incorrectly characterize patients and professionals alike and dangerously neglect the essence of medicine.” Not “consumer” and “provider,” in other words, but “patient,” “doctor,” “nurse,” and other such terms that capture the personal, caring heart of healthcare.

Follow this blog for regular updates on the world of medical imaging.

In the meantime, though, it’s best to proceed as if PPACA will be implemented as planned. For hospitals and healthcare organizations with radiology systems, that means that this article from Diagnostic Imaging is probably worth reading.

The article reports on the words of Robert Still, a doctor and practice manager at Lancaster Radiology Associates in Auburn, Pennsylvania. Still recently spoke at the AHRA’s annual meeting in Dallas.

According to Still, the healthcare system will change dramatically in the next few years because of PPACA. The biggest change will be in reimbursement methods. Instead of the old (and familiar) fee-for service system, a “bundled” payment structure will predominate. For radiologists and other medical imaging professionals, this probably means a cutback in radiologist reimbursement. And that, in turn, probably means an end to solo and small radiology practices.

A cutback in demand for images is another likely consequence of the shift in reimbursement systems, according to Still. Because of their costs, images will have to be pre-authorized by non-radiologists, and that almost surely means fewer images ordered.

Still also notes present and future trouble with meaningful use compliance. In order to qualify for reimbursement (or, after 2015, avoid a penalty), physicians have to spend a certain amount of time at one facility. Radiologists, who often divide their time between hospitals and clinics, are often left out of reimbursement schemes. Still hopes that officials at CMS will expand their reimbursement qualifications so that more radiologists see the money they deserve.

One thing is for sure, says Still: the practice of radiology will change to accommodate the need for more efficiency and lower costs.

For more information about radiology systems, contact us.

But the growing volume of data leads to the growing number of data management problems. Information has to be organized to be meaningful, and today’s volume of information is too large for any one person to manage, especially in the high-volume fields of medical imaging.

A recent study published in Radiology, authored by a team headed by Katherine Andriole of Brigham and Women’s Hospital in Boston, offered 5 suggestions for dealing with the huge volume of data in radiology work:

1. Improving the Signal-to-Noise Ratio to more quickly direct a radiologist’s gaze to difficult-to-recognize abnormalities.
2. Using Motion and Color to Convey Change Over Time. According to Andriole, advances in 3D volumetric rendering and the addition of time and other functional measures can, if used properly, make change over time easier for radiologists to see and analyze.
3. Time-Saving Interface Devices like joysticks, touch-sensitive screens, voice-activated commands, and other developments (many from the world of gaming).
4. Easy Access to Multiple Relevant Studies would enable radiologists to consult a wide range of situation-specific literature without leaving their chairs or their medical imaging programs.
5. Easy Methods for Annotating Images so that radiologists can quickly convey their analyses to other medical professionals. Likewise, incorporating handheld devices, wireless networks, and cloud computing into medical imaging communications will make it easier to convey images and their interpretations to primary caregivers.

In order to keep up with the need to manage ever-larger sets of data, radiologists and other medical imaging professionals have to be somewhat revolutionary. The ongoing revolution in the volume and management of information technology is leading to a revolution in the role of the medical imaging specialist in direct patient care, says Andriole.

Learn how intelligent workflow tools and a system optimized for high volume data sets improves the radiologist experience by viewing McKesson’s Horizon Medical Imaging™ demo .

Imaging the World (ITW), a non-profit that develops medical and technologies to bring medical imaging to remote areas around the world, recently received a $100,000 grant from Grand Challenges Explorations, which funds scientists and researchers worldwide to explore ideas that can break the mold in how we solve persistent global health and development challenges. Grand Challenges Explorations is one of many global health initiatives funded by the Bill and Melinda Gates Foundation.

ITW aims to use the money to support its efforts to bring low-cost ultrasound technology to areas of high maternal and neonatal mortality. According to ITW, advance warnings of critical maternal conditions made possible by ultrasound technology can dramatically improve maternal and fetal morbidity and mortality in the most vulnerable populations.

McKesson Medical Imaging vice presidents Joe Biegel and Rex Jakobovits serve on the Board of ITW. “Joe and I were personally inspired by the ITW team,” says Jakobovits. “Serving on the ITW Board is a golden opportunity: A chance to leverage our unique expertise in a ‘ground floor’ effort that has a good chance of making a real difference in the lives of millions of people by helping to usher in the ‘age of imaging’ in the developing world.”

Biegel and Jakobovits don’t just help govern ITW. They recently coordinated a McKesson donation of a PACS and time from experts to the organization, and they devote many hours of their own time to help spread medical imaging around the world.