Turf wars in radiology: introduction

Turf wars over medical imaging have become ubiquitous. At many centers, radiologists already have lost access to important technologies and their applications. A combination of decreasing revenues in other specialties and a growing attachment to imaging further threatens radiologists' practices in the future. This is the first of an extended series of articles that will address the phenomenon of self-referral--its motivations, extent, and the threats it poses to radiologists. Each article will focus on a specific aspect and provide advice on how radiologists can deal with self-referral in their locales.

The economic benefit of organizational restructuring of the cardiothoracic intensive care unit

OBJECTIVES

Compare cost/benefits of organizational restructuring of the cardiac intensive care unit (CICU).

DESIGN

Prospective, with a retrospective control period.

SETTING

Academic medical center.

PARTICIPANTS

Sixty-six CICU patients (prospective) and 57 patients who received care before restructuring (retrospective) were compared. Entrance criteria were constant for both study periods.

INTERVENTIONS

The CICU was restructured from a level III ICU to a level I ICU with the initiation of a consultant CICU service. The CICU service provided an attending physician dedicated to ICU care daily. All cardiac patients admitted into the CICU received consultation by the CICU service.

MEASUREMENTS AND MAIN RESULTS

The average postoperative intubation time decreased during the intervention period (61% extubated within 6 hours v 12%, p = 0.004). Pharmacy, radiology, laboratory, and ICU costs decreased 279 US dollars (p = 0.004), 196 US dollars (p = 0.003), 190 US dollars (p = 0.15), and 470 US dollars (p = 0.12), respectively. The ICU length of stay (0.28 days shorter) as well as the overall postsurgery stay (0.54 days shorter) were reduced in the intervention period (p = 0.11 and 0.10, respectively).

CONCLUSIONS

The CICU service significantly reduced both total ICU-related costs ($1,173/patient) and overall costs (2,285 US dollars/patient) during the intervention period. Professional fees only reduced overall savings by 8%. These results indicate that organizational restructuring of the CICU to newer models can reduce costs associated with cardiac surgery.

Spinal injection procedures: volume, provider distribution, and reimbursement in the U.S. medicare population from 1993 to 1999

PURPOSE

To evaluate spinal injection procedures for trends in volume, reimbursement, and physician specialty participation.

MATERIALS AND METHODS

By using the 1993, 1996, 1998, and 1999 Medicare Part B claims database, we studied Current Procedural Terminology revision 4 codes used for percutaneous spinal injection procedures, including cervical and lumbar discography, disk aspiration and/or injection, facet and/or perifacet joint injection, and epidural steroid injection. For each of these procedures, volume, reimbursement, and physician specialty participation (categorized as radiology, anesthesiology, surgery, physiatry, and other specialties) for each year were recorded.

RESULTS

Despite an overall increase in spinal injection procedure volume and reimbursement from 1993 to 1999, nonradiologists performed most of these procedures. Epidural steroid and facet joint injections had the highest volume and reimbursement during this time period and were performed almost exclusively by nonradiologists (predominantly anesthesiologists). Radiologists performed more discography procedures than did other specialists in 1993, but participation decreased each year, while anesthesiologist participation increased; as of 1999, anesthesiologists performed more discography procedures than did radiologists. Although radiologists performed more disk aspiration procedures than did other specialists, procedure volume remained low during the period studied.

CONCLUSION

Spinal injection volume and reimbursement have increased substantially in the Medicare population from 1993 to 1999. During this interval, radiologist participation has decreased. Nonradiologists perform most spinal injection procedures.

The development of a pediatric radiology sedation program

BACKGROUND

An increase in the number of patients undergoing sedation for imaging procedures has led to many changes in practice over the past 10 years.

OBJECTIVE

The purpose of this study was to compare and evaluate sedation practice changes in a pediatric radiology department during the last 5 years.

MATERIALS AND METHODS

The radiology computer database and corresponding minutes of the Radiology Sedation Committee were reviewed to identify changes in sedation policy. Data from three blocks of time were analyzed to determine time to sedation, time to discharge, drug frequency, rates of adverse events, sedation failure, and paradoxical reaction.

RESULTS

Specific practice changes undertaken over the 5-year period include: (1) increased speed of administration of IV pentobarbital, (2) alternating pentobarbital and fentanyl, (3) presedation with midazolam, and (4) administering oral pentobarbital to children under and (5) over 12 months of age. Based on data analysis, changes 1 and 4 were incorporated into the sedation policy, while changes 2, 3, and 5 were abandoned. Comparison of data from the three time segments revealed improvement in the time to sedation, sedation failure, adverse event, and paradoxical reaction rates.

CONCLUSION

There is improvement in all aspects of patient outcomes with sedation, as a result of several changes in sedation practice.

[Stroke unit: requirements for diagnostic imaging and interventions]

Stroke Units are specialised centers of expertise with the aim to optimize acute therapy of stroke. More specifically, the aims are (a) to reduce the area of brain infarction, (b) to prevent or appropriately react to complications, (c) to ensure an optimal strategy of secondary stroke prevention after having clarified etiopathogenesis, and (d) to establish a basis for subsequent rehabilitation. Stroke Units should collaborate for the evaluation and development of new diagnostic and therapeutic means. Patients' medical history, their clinical presentation and brain imaging create the basis for therapeutical decisions. The value of interventional therapy is presently evaluated for acute stroke therapy (e.g. intra-arterial thrombolysis) and secondary stroke prevention (Stent-protected angioplasty of carotid stenosis).