Recent trends in utilization of cardiovascular imaging: how important are they for radiology?

PURPOSE

To determine (a) the role cardiovascular imaging (CVI) plays within the spectrum of noninvasive diagnostic imaging (NDI), (b) the role radiologists play in CVI, and (c) recent trends in CVI workload among radiologists and cardiologists.

METHODS AND MATERIALS

The national Medicare Part B databases for the years 1993 and 2002 were used to identify all CPT-4 codes pertaining to NDI. Those codes relating specifically to noninvasive CVI were grouped together in seven categories. The 2002 Medicare total professional component relative value units (RVUs) were then used to determine RVU rates per 1,000 Medicare beneficiaries as a measure of physician work for each code. The percentage of all NDI RVUs accruing to CVI in 2002 were calculated. Also calculated were the 9-year changes in RVU rates for each of the seven CVI categories, and the changes in those rates among radiologists and cardiologists.

RESULTS

CVI represented 29% of all Medicare NDI work in 2002. Between 1993 and 2002, the RVU rate for all CVI rose by 75%, compared with 34% for all non-cardiovascular imaging. Over the same years, the CVI RVU rates among cardiologists grew by 110%, compared with 50% among radiologists. In 2002, cardiologists performed 448 RVUs per 1,000 in CVI, (mostly in echocardiography and cardiac nuclear imaging) whereas radiologists performed 162. The most rapid growth among the major CVI categories was in cardiovascular nuclear imaging performed by cardiologists; this grew 452% between 1993 and 2002. Radiologists predominate in vascular US and cardiovascular CT and MRI.

CONCLUSION

CVI represents a large and important component of total diagnostic imaging services and is growing more rapidly than other types of imaging. Cardiologists dominate in CVI RVU rates and their utilization is growing more rapidly than that of radiologists'. However, radiologists predominate in vascular US and cardiovascular CT and MRI. SUMMARY SENTENCE: Cardiovascular imaging represents almost one-third of total noninvasive diagnostic imaging services and is growing more rapidly than other types of imaging; the authors explore the relative roles of radiologists and cardiologists in this field.

Pay for performance: pay more or pay less?

Several recent publications in the radiology literature have reported on the growing phenomenon of pay for performance. This potent new business model seeks to reward health care providers with financial incentives for improvements in the performance and delivery of medical services. This paper briefly reviews some of the obstacles to the implementation of this strategy in the practice of radiology. Radiologists are encouraged to participate actively with payers in discussions about improving quality care but should carefully consider the potential contractual implications associated with these initiatives.

Communication errors in radiology: a liability cost analysis

PURPOSE

We evaluated the economic effect on radiologists involved in litigation of failures in communication of results.

METHOD

We examined claims data from the Physicians Insurers Association of America 2002 report on breast cancer and identified malpractice cases in which miscommunication, rather than misdiagnosis, was the primary cause for litigation.

RESULTS

The average indemnity payment for primary errors in communication by radiologists was between $228,000 and $236,000, or twice as high as when appropriate communication occurred. As a percentage of total indemnity payments to plaintiffs, such awards were 15 times higher than when communication was effective.

CONCLUSIONS

Notwithstanding diagnostic accuracy, errors attributable to ineffective communication of results account for high indemnity awards. These errors can be easily resolved in clinical practice.

Retirement savings plans for radiologists, part 2: a comparison of academic and private practice retirement benefits

A survey on retirement benefits was conducted involving 42 academic radiology departments and 42 private practice radiology groups. In this article, we present and discuss the survey results and provide recommendations for improving the retirement benefits for radiologists in both private practice and academic settings. A previous article, in last month's issue, provides details of how the various retirement plans mentioned in this article operate.

Retirement savings plans for radiologists: part 1--the options

Employer-sponsored retirement plans are the primary savings vehicles used by radiologists to fund their retirements. A variety of retirement plans are available with guidelines, benefits, and restrictions specified by the Internal Revenue Code. In this article, we review and summarize the salient features of these plans. A second article, in an upcoming issue of JACR, explores the current status of radiologists' retirement plans.

The inappropriate use of imaging studies: a report of the 2004 Intersociety Conference

The participants of the 2004 Intersociety Conference met to discuss the growing problem of self-referral. The United States spends more of its gross national product on health care than other countries, especially Japan and those in Western Europe. Imaging accounts for a large and growing portion of those costs. Despite spending so much on health care, the United States ranks relatively low in measures of national health, including such parameters as infant mortality and even life expectancy. Because the federal government must keep health care expenditures to a "sustainable growth rate," increases in use are likely to be accompanied by decreases in reimbursement per case. Thus, conference participants agreed that the real problem is inappropriate use, which may arise from (1) ignorance of what specific imaging studies are needed when, (2) high public expectations for imaging tests, (3) the fear of liability for a missed diagnosis (defensive medicine), and (4) self-referral. The Stark laws have been largely ineffective in preventing self-referral because there are many loopholes, and the laws are inconsistently enforced. Among the many potential solutions are the education of our clinical colleagues on appropriateness criteria; the education of the public on the costs of inappropriate use; tort reform; and working with third-party payers, especially the private insurance industry, to develop vigorous privileging programs, to require precertification for self-referred studies, or to establish differential payments for self-referred and non-self-referred imaging.

Comparison of productivity and cost of full-time and part-time faculty members in an academic department of radiology

PURPOSE

To compare financial productivity and employment costs of full-time and part-time faculty members and to assess qualitative factors related to part-time employment.

MATERIALS AND METHODS

Financial productivity and employment costs were compared for full-time and part-time staff members on the basis of a review of financial records from fiscal year 2005. Part-time and full-time faculty members were interviewed to determine reasons for working part-time and to assess the attitudes of both full-time and part-time faculty members toward part-time status.

RESULTS

Part-time radiologists working an average 65% schedule constituted 13% of the total full-time equivalent faculty complement and performed 14% of the clinical work at an average of 0.88 physicians' component total relative value units while more than covering their costs. Part-time radiologists were more productive while interpreting examinations of lesser relative value unit value than full-time radiologists.

CONCLUSION

Part-time radiologists are an important resource for the specialty and should be nurtured to stay in practice.

Buy-sell options for radiology: what works and why

Buy-sell agreements for shareholders entering and leaving a radiology practice are different from those commonly used in other business endeavors. This paper explores the reasons for these differences, focusing on the culture of radiology and its unique influence on the buy-sell process. Buy-sell methodologies commonly used in most business transactions are described, and basic principles that influence these methodologies are discussed. The reasons these traditional methods are not applicable to most radiology groups are explored in depth. The paper concludes with a presentation of several workable buy-sell options for radiology practices. The strengths and weaknesses of these options are enumerated, so that each group can customize the option that best suits its needs.

A resident's primer of Medicare reimbursement in radiology

After having completed medical school, residency, and in many cases specialized fellowships, radiologists are well equipped to practice clinical radiology. However, they receive little if any exposure to the business of radiology, such as coding, billing, and other administrative duties that maintain the financial well-being of any medical practice. Medicare insolvency, managed care, self-referral, and increasing imaging by nonradiology specialists are all issues creating a competitive and ever changing medical environment, and understanding the economic and business aspects of health care is becoming increasingly important for both academic and private practice radiologists. The intent of this paper is to provide new radiologists as well as radiologists in training an introduction to the reimbursement system, as well as to provide a generalized review of the process for practicing radiologists. In particular, this article addresses the fundamentals of the Medicare fee-for-service reimbursement process as well as the factors considered in arriving at the valuation of radiologic services by Medicare.

The Blue Cross Blue Shield Association Technology Evaluation Center: how we evaluate radiology technologies

Evidence-based technology assessment can help answer critical questions concerning the safety, effectiveness, and appropriate uses of medical technologies. This practice can be used to avoid the promotion of ineffective technologies and the premature diffusion of technologies that have not been demonstrated to improve patient-oriented health outcomes, both of which draw resources from effective and appropriate medical care. This article describes the process of such evaluation as undertaken by the Blue Cross Blue Shield Association Technology Evaluation Center. The key components of the assessment process are described, including the problem formulation and evaluation of study quality, as well as the process by which the available evidence is judged against the five Technology Evaluation Center criteria.

Report of the ACR task force on medical liability reform in radiology

The ACR Board of Chancellors commissioned a task force to investigate the issue of needed reforms in medical liability as it relates to the specialty of radiology. This article relates the task force deliberations and recommendations.

Paying for performance in diagnostic imaging: current challenges and future prospects

As concerns regarding medical errors and patient safety continue to escalate, policy makers and purchasers of care are developing novel methods to improve health care quality. One strategy for encouraging quality improvement uses financial incentives to reward physicians and hospitals for meeting or exceeding benchmarks of quality. This model, known as "paying for performance," is currently being implemented in a number of health care markets. Although most of these programs focus on primary care physicians and hospital care, it is only a matter of time until pay-for-performance incentives will be designed for diagnostic imaging groups. This article describes the pay-for-performance model and discusses its implications for the field of radiology.

Pay for performance: survey of diagnostic radiology faculty and trainees

PURPOSE

Pay-for-performance (P4P) programs have been implemented in many health care markets in the United States. The purpose of this study was to survey faculty members and trainees regarding familiarity with the P4P model and their interest in further education.

METHODS

An eight-question survey designed to explore faculty member and trainee awareness of and attitudes toward P4P was distributed. Data were analyzed using Microsoft Excel.

RESULTS

One hundred four of 144 questionnaires distributed to faculty members (50 of 70) and trainees (54 of 74) were returned. Sixty-one percent of trainees stated that they had never heard of the P4P model. Seventeen percent of trainees and 26% of attending radiologists were aware that P4P programs have already been instituted. Although 74% of trainees agreed that P4P will influence their reimbursement in the future, only 42% of attending radiologists agreed. A minority of trainees and attending radiologists (35%) felt that P4P improves the quality of care, whereas 42% were neutral. A majority were interested in further education.

CONCLUSION

Faculty members and trainees in diagnostic radiology in a university-based program were unfamiliar with the P4P model of reimbursement and were interested in learning more. Additional investigation is needed to ascertain whether this knowledge gap is widespread. This could influence future education about P4P on a national level.

Molecular imaging: the vision and opportunity for radiology in the future

Molecular imaging is being hailed as the next great advance for imaging. This introductory article in the molecular imaging series to be published over the next several months in Radiology sets the stage for the subsequent set of articles by providing relevant definitions and background information and traces the evolution of molecular imaging to its current state of research and clinical practice. It discusses in detail the evolution of molecular imaging and the role that the National Cancer Institute and the National Institutes of Health have had in the funding and development of many of the important molecular imaging research programs that are in existence today. The article also provides basic information about the complex biology of the cell and details of the pathogenesis of cancer and how molecular imaging will be critical for earlier detection and management of cancer in the future. The article lays the foundation for the subsequent articles in the series and describes how and why molecular imaging will be critical and integral for clinical care of patients in the future. The introductory article also discusses the relevance of molecular imaging to clinical radiology practice and why it is critical for the practicing radiologist to understand these evolving techniques, as they will be the future of imaging.

Strong branding creates a competitive edge

This article encompasses the basics of branding and how it relates to radiology organizations. It also provides tools to help develop your brand. To effectively use branding as a component of your marketing strategy, it is important to follow 3 basic principles: focus on where you excel, understand the existing markets, and be consistent. You do not need to be a large hospital, imaging center, or department to create a brand identity.