301
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Reiner B, Siegel E, Allman R. Strategies for the promotion of computer applications in radiology in healthcare delivery. J Digit Imaging 1998; 11:142-4. [PMID: 9735453 PMCID: PMC3453338 DOI: 10.1007/bf03168286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
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.
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302
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Durand-Zaleski I, Grenier P. [Radiology assessment: the European dimension]. JOURNAL DE RADIOLOGIE 1998; 79:643-4. [PMID: 9757290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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303
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[Radiologists suffer the greatest loss of income. Analysis of cost structure. Analysis of the ZI (Central Institute) cost structure shows a 82% sharing of costs]. Radiologe 1998; 38:M119-20. [PMID: 9738270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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304
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Hayes JC. Data show filmless imaging saves in high-volume setting. DIAGNOSTIC IMAGING 1998; 20:9, 13. [PMID: 10180996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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305
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Durand-Zaleski I, Dalla-Palma L, Dixon AK, Reiser M, Soimakallio S, Chaix C. [Economic assessment in radiology]. JOURNAL DE RADIOLOGIE 1998; 79:645-50. [PMID: 9757291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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306
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Krotz D. Surviving capitation via utilization management. DIAGNOSTIC IMAGING 1998; 20:51-4. [PMID: 10180984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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307
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Gabriele P, Ozzello F, Negri GL, Rotta P, Pasquino M, Sinistrero G. [THe cost of radiotherapy. Piedmontese experience]. LA RADIOLOGIA MEDICA 1998; 95:656-62. [PMID: 9717551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION An integrated task force of radiotherapists and administrators of the Piedmont region studied the estimated cost of radiotherapy (RT) to compare it with the figures in the 502/92 law modifying the financing of medical structures. This law changed the financing method from productive factors compensation to actually provided performances compensation. MATERIAL AND METHODS The RT departments of the Turin and Novara university hospitals, those of Ivrea and Asti and that of the Pinna Pintor Clinic (Turin) participated in the study, with 4889 examinations in the period of interest. The study consisted of 6 steps: 1) defining a nomenclator; 2) making a list of standard resources; 3) calculating the actual resource consumption; 4) relating 2) to 3); 5) calculating cost and times; 6) defining quality standards. A technical and/or a central group(s) carried out all the steps. The nomenclator indicates 13 main activities (e.g., irradiation, telecobalt therapy, brachytherapy, hyperthermia), each of them featuring some subactivities (e.g., telecobalt therapy: flash, a fixed beam, two opposing beams). The following productive factor were considered: a) personnel; b) material; c) investments; d) the service cost; e) general costs. The personnel cost (the main cost) was calculated as: A) routine activity; B) activity for other units; C) congress activity; D) research. The times for individual performances were estimated according to professional roles (e.g., medical doctor, physicist, technician, nurse, administrative) for each subactivity. RESULTS The estimated RT costs were as follows (please note that all figures are expressed in US $, at a rate of 1$ = ItL 1700). Irradiation: 15 (cost/session +/- 3%); telecobalt therapy: 30-55; Linac (energy < > 10 Mev): 38-60; special techniques: 931-2,314; HDR brachytherapy: 878-1,515; hyperthermia: 285; simulation: 50-92; dosimetry: 52-286; examination, treatment planning, follow-up, etc.: 24-59; immobilization devices, photographs, etc.: 3-66. The quality criteria are related to the personnel; high energy equipment; treatment planning; 3D dosimetry. CONCLUSIONS Our study led the Italian Ministry of Health to revise the estimated cost of RT examinations in July, 1996. We will further enquire into the new figures.
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308
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MacEwan DW. Introducing an integrated imaging delivery system in Manitoba. Can Assoc Radiol J 1998; 49:152-60. [PMID: 9640280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE As a result of the reform of a comprehensive government health plan, an integrated imaging system is being created in the province of Manitoba. The intent of the system is to reduce costs, avoid causing harm to patients, enhance physician referral services and add new programs. METHODS Evaluation of trends in examinations, equipment, personnel, expenditures and policy in the 1992-93 and 1995-96 fiscal years in Manitoba. RESULTS The population has remained steady, at 1.1 million. Hospitals have been amalgamated under new authorities, and Manitoba's annual health care spending of $1.8 billion has been reduced by $235 million. Between the 2 years, use of radiography declined from 835,748 to 726,394 examinations per year. Use of mammography, ultrasonography, computed tomography, magnetic resonance imaging and nuclear medicine increased moderately. The total number of radiologic examinations declined from 1,069,579 to 975,044. There was little change in equipment, but the plant aged as a result of freezes on construction and capital spending. Personnel declined by 20 full-time equivalent positions, from 794.3 in 1992-93 to 774.3 in 1995-96. Savings in operations were made as a result of hospital budget restrictions. Total expenditures declined from $100 million to $89 million. The income of imaging specialists did not change because they were paid higher fees for examinations involving newer technology. CONCLUSION Integration of rural/northern and urban hospital services has followed the plan set out in recent legislation. Savings of up to 20% are expected to be realized through reduction in personnel (saving $1 million), group tendering ($1 million), in-house repair ($1 million), reduction in deployment of equipment ($3 million), integration of services ($1 million), indirect cost reduction ($5 million), practice guidelines ($3.5 million), reduced breast screening costs ($1 million), physician payment reform ($1 million) and rigorous clinical/fiscal audit ($1 million).
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309
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Du Bois M, Donceel P, Debbaut B. Social insurance cost of standard discectomy and percutaneous nucleotomy. A retrospective study of 87 social insurance claim files of male blue collar workers. Acta Orthop Belg 1998; 64:144-9. [PMID: 9689753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A retrospective review of social insurance claim files of male blue collar workers was conducted to compare the social insurance costs of percutaneous lumbar nucleotomy with standard lumbar discectomy ; 29 percutaneous nucleotomy procedures were matched with 58 standard discectomies all carried out between January 1992 and December 1994. It was concluded that a standard discectomy procedure results in significantly higher costs during hospitalisation with respect to surgery, anaesthesia and hospital stay. A percutaneous nucleotomy leads to a significantly higher outpatient expenditure especially in radiology and medical devices. The relative proportion of outpatient practitioner's visits and hospital stay costs was significantly higher for the standard discectomy whereas medical devices had a relatively higher share in outpatient expenditure for the percutaneous nucleotomy. In this population of 87 compensation claimants, the average social insurance costs did not significantly differ between the percutaneous nucleotomy and the standard discectomy.
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310
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Kuhn FP. [Radiology scenario 2000. Need-dependent physician supply, economic aspects and graduate education in diagnostic radiology: the quadrature of the circle? 2]. Radiologe 1998; 38:M89-91. [PMID: 9646359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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311
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312
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McGlone R, Durham S. Developments in radiology. J Accid Emerg Med 1998; 15:209. [PMID: 9639200 PMCID: PMC1343082 DOI: 10.1136/emj.15.3.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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313
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Blackmore CC, Smith WJ. Economic analyses of radiological procedures: a methodological evaluation of the medical literature. Eur J Radiol 1998; 27:123-30. [PMID: 9639137 DOI: 10.1016/s0720-048x(97)00161-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Increasing pressure to curb health care costs has led to considerable interest in economic analyses, including both cost-effectiveness and cost-benefit analyses. Numerous economic analyses of radiological procedures have appeared in both the radiology and non-radiology literature. The objective of this study was to evaluate the methodological quality of economic analyses of radiological procedures published in the non-radiology medical literature during the years 1990 1995. METHODS Original investigations from the medical (non-radiological) literature that include economic analyses of radiological interventions were identified from a computerized literature search. Each economic analysis article was evaluated by two independent reviewers for adherence to ten methodological criteria. The criteria were derived from review of the medical and radiological economic analysis methodology literature and consisted of the following: (1) Comparative options stated; (2) perspective of analysis defined; (3) outcome measure identified; (4) cost data included; (5) source of cost data stated; (6) long term costs included; (7) discounting employed; (8) summary measure provided; (9) incremental computation method used; and (10) sensitivity analysis performed. The results were compared to a previous study that evaluated the radiological literature. RESULTS Of the 56 articles in the medical literature that included economic analyses of radiological procedures, only eight (14%) conformed to all ten methodological criteria. The cost data (98%) and comparative options (89%) criteria exhibited high compliance, while the perspective of analysis (25%) and discounting (32%) criteria had relatively low compliance. Agreement between the reviewers was excellent (kappa = 0.88). CONCLUSIONS Published economic analyses of radiology procedures usually do not meet accepted methodological standards.
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314
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Kuhn FP. [Radiology scenario 2000. Need-based management, economics and graduate education in diagnostic radiology: the quadrature of the circle? 1]. Radiologe 1998; 38:M65-9. [PMID: 9622830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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315
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316
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Bhatia RS, Collingwood P, Bartlett P. Radiologic versus surgical placement of vena cava filters: a comparative study of cost, time and complications. Can Assoc Radiol J 1998; 49:79-83. [PMID: 9561009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To compare the cost- and time-effectiveness of 2 methods of placement of vena cava filters for the prevention of pulmonary embolism: the radiologic percutaneous placement of the Vena Tech LGM filter and the surgical cutdown placement of the 24 Fr Greenfield filter. METHODS Retrospective review of radiologic and clinical records for 15 consecutive patients who had the Vena Tech LGM filter placed radiologically and 15 consecutive patients who had the Greenfield filter placed surgically. Factors studied were cost, procedure time, waiting time and rates of immediate and delayed complications. The follow-up period ranged from 1 to 26 months (mean 7 months). RESULTS The procedure cost for the radiologic method was $702 less than for the surgical method. The procedure time for the radiologic method was 30 minutes shorter, and the waiting time for placement was also shorter. There was no difference in the complication rates following each procedure. The higher cost of the Greenfield filter accounted for 80% of the total cost difference. CONCLUSION The radiologic percutaneous method of filter placement is preferred over the surgical cutdown method because of its benefits in terms of cost and time with no increase in risk. However, when the difference in cost between filters is taken into account, there is little difference in overall costs for the 2 methods. Therefore, radiology and surgery departments can place a filter percutaneously at a similar cost. Other factors such as waiting times, complication rates, venography capabilities and physician interest in performing the procedure will dictate which department places the filter.
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317
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Schumacher G. [Equal distribution or appropriateness of coverage. What is left when one or the other is lost in physician self-regulation?]. Radiologe 1998; 38:M75-8. [PMID: 9622833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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318
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[Radiologists support KBV by the "IGEL" concept]. Radiologe 1998; 38:M70. [PMID: 9622831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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319
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Taylor CR. The measure of professional quality in radiology. AJR Am J Roentgenol 1998; 170:847-50. [PMID: 9530021 DOI: 10.2214/ajr.170.4.9530021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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320
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Katayama AC. Finally, HCFA proposes regulations interpreting stark II. WMJ : OFFICIAL PUBLICATION OF THE STATE MEDICAL SOCIETY OF WISCONSIN 1998; 97:67-73. [PMID: 9540454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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321
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Levin DC, Spettell CM, Rao VM, Sunshine J, Bansal S, Busheé GR. Impact of MR imaging on nationwide health care costs and comparison with other imaging procedures. AJR Am J Roentgenol 1998; 170:557-60. [PMID: 9490930 DOI: 10.2214/ajr.170.3.9490930] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We wished to determine the extent to which MR imaging contributes to the overall costs of imaging in the United States and to compare MR imaging costs with other imaging techniques. MATERIALS AND METHODS All 23 current procedural terminology, version 4 (CPT-4) codes for MR imaging were extracted from the national 1993 Part B Medicare annual data reimbursement file. For each code, we calculated total Medicare physician reimbursements. Aggregate reimbursement for all MR imaging was compared with aggregate reimbursement for all 659 imaging-related current procedural terminology, version 4 codes and also with comparable figures for echocardiography and other categories of cardiovascular imaging. RESULTS Within the 23 MR imaging codes, 1,449,911 examinations were performed on Medicare patients in 1993, for which physicians were reimbursed $370 million. Medicare reimbursement of physicians for all 659 imaging-related procedures was $5.3 billion. Thus, MR imaging accounted for only 7% of all imaging costs. By comparison, a group of just 10 imaging codes, which are primarily cardiovascular in nature, accounted for $1.67 billion, or 32% of the entire Part B costs for imaging. Reimbursements for echocardiography alone are more than twice those for MR imaging. CONCLUSION From the national perspective, MR imaging does not appear to warrant its reputation as a costly procedure. The costs of echocardiography and other imaging related to the cardiovascular system are considerably higher.
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Lufkin KC, Smith SW, Matticks CA, Brunette DD. Radiologists' review of radiographs interpreted confidently by emergency physicians infrequently leads to changes in patient management. Ann Emerg Med 1998; 31:202-7. [PMID: 9472181 DOI: 10.1016/s0196-0644(98)70307-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE To determine whether radiologists' review of radiographs is unwarranted when emergency physicians are confident in their interpretations. METHODS This was a prospective, descriptive study. Treating emergency physicians at a high-volume, urban teaching hospital and a moderate-volume nonteaching hospital indicated their confidence or lack of confidence in their plain-film radiographic study interpretations. All radiographs were then reviewed by radiologists according to the preexisting practice of each hospital. A total of 16,410 emergency department radiographic studies were included, comprising consecutive patients at each hospital. Charts of all discordant readings in the confident group were reviewed and judged clinically significant if treatment was altered. Charges for radiologic review of the confident ED interpretations were calculated. RESULTS The ED physicians were confident in 9,599 sets of radiographs out of a total of 16,410 (58%). Discordant interpretation rates for the "confident" and "not confident" groups were 1.2% and 3.1%, respectively (difference, 1.9%; 95% confidence interval [CI] of the difference, 1.44% to 2.36%). Review of the 118 discordant interpretations in the confident group demonstrated that 11 were significant. Few management changes were made as a result of radiologists' review of these radiographs. Total radiology review charges for the confident group were $215,338. Therefore the average radiology charge for each significant discordant interpretation was $19,576. CONCLUSIONS Of 9,599 sets of radiographs interpreted confidently by the emergency physicians in this study, there were 11 clinically significant discordant interpretations (0.1%). The standard practice of radiologists' review of all ED radiographs may not be justifiable.
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323
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[Changing trends in radiology]. ROFO-FORTSCHR RONTG 1998; 168:1-12. [PMID: 9531997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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324
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Rode D. RBRVS rule update expands procedural and documentation requirements. HEALTHCARE FINANCIAL MANAGEMENT : JOURNAL OF THE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION 1998; 52:80-1, 83. [PMID: 10175114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
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325
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Dreisbach JN. Radiology managing radiology. AJNR Am J Neuroradiol 1998; 19:1813-4. [PMID: 9874527 PMCID: PMC8337724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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