Perioperative X-rays in arthroplasty surgery: outcome and cost

Numerous legislative proposals to cut reimbursement to surgeons and hospitals are presently included in U.S. congressional and senate agendas. Perioperative x-ray films in arthroplasty surgery are standard operating procedure. Our objective was to assess the effects of the radiologist reading on the clinical and economic outcome of arthroplasty procedures. One hundred consecutive cases were prospectively studied. The radiologist reading, clinical management, and outcome of each case were carefully reviewed. The amount billed for the radiologist interpretation was noted for each examination. A total of 398 studies in 100 patients were done. Ninety-six preoperative, 110 intraoperative, and 192 postoperative radiographic studies were reviewed. These reports took an average of 1.71 days to be recorded on the chart (SD +/- 2.45). The total radiologic professional fees billed to Medicare in these cases was $11,054. (The radiologist's interpretation was not useful in the clinical management and did not affect the outcome in any case.) Assuming that each surgeon takes 1 x-ray film on every arthroplasty case, the total actual savings to Medicare of not having a radiologist reading these studies could reach $536,000 per year; if 2 intrahospital x-ray studies are performed per procedure (preoperative, intraoperative, or postoperative), the savings are $1.1 million per year. These cost reductions are achieved at no sacrifice to quality of care or outcome. Numerous areas of excessive spending with no improvement in outcome exist in the treatment of Medicare patients. There areas should be identified and eliminated before surgical fees are lowered even further.

Turf battles in radiology: how to avoid/how to fight/how to win

Turf battles have always existed in radiology although recently, we have observed an increase in their numbers and sometimes in their virulence. The main reasons for this increase include the relative plethora of physicians especially in industrialized areas, and the rapid progress and development of medical technology and minimally invasive techniques. These turf battles risk interfering with the over-all medical costs of local health care systems as they will inevitably lead to an increase in the concentration of complex medical devices controlled by different specialties which, in turn, will lead to an increase in number of invasive and noninvasive, diagnostic and therapeutic examinations. The only way that radiologists can hope to maintain control of today's techniques will be if they are willing to offer qualitative expertise in their procedures with full clinical, academic and technological backing similar, or superior to that presented by our respective clinical and surgical colleagues. Furthermore, they should be fully involved in the decisional process and actual purchase of the technological equipment of their entire institution.

Public financing systems for radiology: experience in 12 European countries

This paper illustrates the evolution in public health care financing systems in 12 European countries, in terms of the financing of radiology services. The financing systems for radiology used by public health care financing agencies are described in detail. The implications of these new financing conditions for health care delivery are briefly sketched. The paper concludes with some strategies to help radiologists cope with the tightening financing conditions for medical imaging.

The radical revolution of radiology

The radiologic segment of the health care industry has grown dramatically in size and functions. The focus on cancer and heart disease has made it a key core functional area for health systems and physician groups. Aggressive growth plans are based on key strategies, high demand services, and other critical success factors.

[The virtual university in medicine. Context, concepts, specifications, users' manual]

The widespread use of Web servers, with the emergence of interactive functions and the possibility of credit card payment via Internet, together with the requirement for continuing education and the subsequent need for a computer to link into the health care network have incited the development of a virtual university scheme on Internet. The Virtual University of Radiology is not only a computer-assisted teaching tool with a set of attractive features, but also a powerful engine allowing the organization, distribution and control of medical knowledge available in the www.server. The scheme provides patient access to general information, a secretary's office for enrollment and the Virtual University itself, with its library, image database, a forum for subspecialties and clinical case reports, an evaluation module and various guides and help tools for diagnosis, prescription and indexing. Currently the Virtual University of Radiology offers diagnostic imaging, but can also be used by other specialties and for general practice.

Strategies for the promotion of computer applications in radiology in healthcare delivery

The objective of this paper is to identify current trends in the development and implementation of computer applications in today's ever-changing healthcare environment. Marketing strategies are discussed with the goal of promoting computer applications in radiology as a means to advance future healthcare acceptance of technologic developments from the medical imaging field. With the rapid evolution of imaging and and information technologies along with the transition to filmless imaging, radiologists must assume a proactive role in the development and application of these advancements. This expansion can be accomplished in a number of ways including internet based educational programs, research partnerships, and professional membership in societies such as the Society of Computer Applications in Radiology (SCAR). Professional societies such as SCAR, in turn, should reach out to include other professionals from the healthcare community. These would include financial, administrative, and information systems disciplines to promote these technologies in a cost conscious and value added manner.