Quality—A Radiology Imperative: Report of the 2006 Intersociety Conference

Recent publications by the Institute of Medicine have pointed out the many medical errors that occur and the adverse effect of those errors on patient outcomes. These errors are often the result of problems within our health care systems. In an effort to improve patient care outcomes, many health care providers have developed improved policies and practices. Third-party payers are encouraging participation in quality efforts through a variety of mechanisms, including pay for performance, pay for participation, and the creation of centers of excellence. If the quality of health care is to be improved and monitored, appropriate metrics must be developed. Such metrics must be within the control of providers, measurable, and likely to improve patient outcomes. The participants of the 2006 Intersociety Conference developed 49 metrics, which are offered for adoption by health care networks, payers, and regulation agencies.

The ACR Managed Care Committee: Focusing Private Payers on Radiology Issues

The ACR Managed Care/Private Payer Relations Committee is an important committee of the ACR Commission on Economics. This report reviews the committee's mission, structure, and processes and some of its current recommendations to ACR membership. The development of and participation in radiology advisory committees is a vital strategy in this process. Separating professional and technical charges, rather than submitting global charges, will help preserve radiology's professional integrity in the future. The Imaging Provider Report Card (IPRC) will allow radiology to define practice quality and performance in an era of pay-for-performance reimbursement. The IPRC also provides an external blueprint on what each practice needs to do to improve itself. American College of Radiology accreditation plays a key role in certifying radiology's quality to both payers and patients. Sound business management, group governance, and business size are also important elements of professional practice success. Working together through the ACR promotes the integrity of our profession and the quality of care patients want and deserve.

Advanced Marketing: How to Protect and Advance Your Practice

Radiology practices in the United States are facing mounting competitive challenges in many metropolitan areas. This competition is multifaceted and includes other traditional diagnostic imagers. However, the most severe pressures are from new entrants, such as primary and specialty physicians outside of radiology. The business science of marketing provides a set of solutions to help you fight back against this onslaught. In particular, advanced marketing techniques offer compelling strengths for raising awareness of the unique nature of our specialty among both the lay population and primary referrers. Applications of advanced marketing can be used to simultaneously hold and expand your turf. Relying on smarts rather than dollars, they also help overcome the fears that many radiology practices have about the high costs of traditional broadcasting.

Valuing the Professional Work of Diagnostic Radiologic Services

The challenges to the technical component (TC) of radiology services as a result of the Deficit Reduction Act of 2005 have been widely publicized, but a number of regulatory changes will affect the professional component (PC) of our physician work. The third 5-year review is complete, and although there were no major reductions in work relative value units (RVUs) for radiology, proposed budget-neutrality adjustments to physician work RVUs will potentially reduce payments for both the PC and global payments. Additionally, if there is no congressional intervention, reductions in the conversion factor will further decrease Medicare payments. In the article, the history of the radiology relative value scale and the methodology of American Medical Association/Specialty Society Relative Value Scale Update Committee's valuation of physician work are reviewed. The results of the third 5-year review are presented. Future challenges to radiology physician work valuation are discussed, including outsourcing, the Medicare Payment Advisory Commission's search for overvalued services, and the bundling of physician services. Whereas the TC is compensation for performing a diagnostic test, ultimately, it is our physician work that defines our specialty, and challenges to our physician work will be vigorously defended by the ACR without compromise.

A profile of Canada's radiologists: results from the 2004 National Physician Survey

OBJECTIVE

To evaluate the demographics and practices of radiologists nationwide as indicated by a selected subset of results from the 2004 National Physician Survey.

METHODS

The original email survey data were collected by the College of Family Physicians of Canada, the Canadian Medical Association, and the Royal College of Physicians and Surgeons of Canada. Data collected included information regarding physician demographics and research, teaching, and practice characteristics.

RESULTS

A total of 646 radiologists responded (of an estimated 1910), giving a response rate of 33.8%. The greatest number of respondents worked either in a community hospital (59.4%) or in a private practice (50%). Most preferred working within a group (78.8%). Most respondents spent up to 120 hours monthly on call (69.1%). On average, respondents spent nearly 41 weeks yearly on clinical care, administration, teaching, continuing medical education, and research. Most respondents (75.9%) obtained their income through fee-for-service payment plans.

CONCLUSIONS

The fundamental characteristics of Canadian radiologists currently in practice are described, and their implications for the future of radiology in Canada are discussed.

What characterizes academic radiology departments that secure large amounts of external funding for research?

RATIONALE AND OBJECTIVES

We sought to identify factors associated with high levels of external research funding in order to provide departments with information that may help them increase their external research funding.

MATERIALS AND METHODS

National Institutes of Health (NIH) data on grants were analyzed to identify the 72 radiology departments receiving funds for diagnostic radiology research. A survey was sent to these departments. We placed them into one of three categories according to total NIH funds to the department. The survey asked about department characteristics such as size; breakdown of full-time faculty among MDs, MD/PhDs, and PhDs; research space; equipment type; and number and types of trainees.

RESULTS

Thirty-nine surveys were returned, including 20 from the 21 departments with the most NIH funding. PhDs played a larger role in the most research funding-intensive departments than in others. These departments also were more likely than others to give protected time to all MDs and to devote over 5% of clinical revenues to research, and they had a lower clinical workload per MD. NIH was the source of 70% of their research funding, The role of MD/PhDs and research space per 1000 research dollars did not vary by research intensity.

CONCLUSIONS

These findings only demonstrate associations; they do not show the direction of causality. Nonetheless, they suggest what departments need to do if they wish to increase their external research funding.

Gender differences in diagnostic radiologists' annual incomes

RATIONALE AND OBJECTIVES

Specialty, work effort, and gender have been shown to be associated with physicians' annual incomes; however, careful examination of the association between provider gender and physician incomes after correcting for other factors likely to influence income has not been conducted at the subspecialty level. We sought to determine the association between provider gender and diagnostic radiologists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics.

MATERIALS AND METHODS

Using survey responses that were collected throughout the 1990s from 491 actively practicing white diagnostic radiologists, we generated a linear regression model to determine the association between provider gender and radiologists' annual incomes after controlling for work effort, provider characteristics, and practice characteristics.

RESULTS

White female radiologists reported working 2% fewer annual hours than their white male counterparts. Female radiologists had practiced medicine for fewer years than males, were more likely to be employees, as opposed to having an ownership interest in the practice, and were equally likely to be board certified. After adjustment for work effort, provider characteristics, and practice characteristics, female radiologists' mean annual income was $273,907, or $80,090 (23%) lower than that for white males (95% CI: $113,930 lower to $46,250 lower, P < .001).

CONCLUSIONS

During the 1990s, female gender was associated with lower annual incomes among diagnostic radiologists. Researchers should further explore the relationship between physician gender and incomes to determine what factors might cause the differences that we found.

Pay for Performance in Radiology: ACR White Paper

During the next few years, some portion of physician reimbursement will be increasingly based on the quality and efficiency of service, a practice commonly referred to as pay for performance (P4P). Performance benchmarks are the discrete parameters of structure, process, or outcome metrics whose attainment defines good quality care. Private payers are already rewarding primary care physicians for practices that adhere to quality standards, are efficient, involve information technology, and result in high patient satisfaction. The Centers for Medicare and Medicaid Services will have completed the development of performance measures to be used in Medicare payment strategies for all specialties by the end of 2006 and anticipates phasing in the program fully by 2008. This article describes P4P, its importance to the ACR, the organizations involved in developing it, the ACR's activities to date, and the steps the ACR must take to ensure that radiologists are remunerated fairly as physician payment becomes based, in part, on performance.

Turf Wars in Radiology: Privileging and Site Accreditation Programs—What They Have Accomplished for Commercial Health Plans

In recent years, some commercial health plans have instituted privileging and site accreditation programs for providers of diagnostic imaging. This article describes how these programs work and points out that they can help restrict self-referral and the overutilization that accompanies it. Another advantage is that they can help eliminate low-quality providers. Radiologists should encourage health plans in their area to develop and implement these measures.