Sarah Jersild

Your patients want to view their medical images, and the federal government - through the meaningful use program - suggests they're going to get them.

So the big question becomes how should they get those images? Vendors are making a push for a next generation of patient portals, saying they can reduce costs, increase patient satisfaction and eliminate wasteful duplicate imaging.

"We started looking at patient portals about two years ago," said Cristine Kao, worldwide marketing manager for Carestream Health. "This is the right time."

That's in part due to how technology has advanced - and how comfortable the general public has gotten with that technology. With Carestream's portal, Kao said, "There's no dedicated training required. You know where to log on, you know where to navigate right away. It's like iTunes: You kind of open it up and you intuitively know how to organize and do what you need to do."

Sound like a bold claim? Carestream just completed a case study with Houston Medical Imaging. In all, 1,500 patients activated their image portal account and used it to view and share images. During the three-month case study, Kao said, they received only 47 calls for technical support.

Portals use zero-download clients so nothing has to be installed on a patient's computer. They just log in to a website, click on a folder and get the images they want. When they log out, the images are gone. Nothing is stored on their computer.

But that ease of use makes some physicians nervous. What if patients see the images before the doctor does? Don't panic: Vendors have taken that fear into account.

"One of the things we talked about with a lot of customers was setting up business rules so that either a certain amount of time would elapse or we would get some kind of notification from the referring physician to release the image," said Erica Agran, senior director of solutions management at Merge Healthcare, which has two portal solutions and another concept in the works. "We're not suggesting that we make the rules on delivering the image. We’re just suggesting that we can deliver the image and enable patients to share images."

That sharing is key. The easier it is to see an image, the less likely you are to have to repeat a study. "I have had the personal experience of getting a CD of an image and going for a follow-up right away," Agran said. "They told me they couldn't read the CD and they did the ultrasound again. ... You don't have that problem if you have an electronic copy."

Portals don't just make life easier for patients. They can also cut down on work in your practice. "If you think about how PACS have changed the film-based workflow for the clinician, this is sort of equivalent by taking film or manual media like CDs or DVDs away from the front desk staff and the administrators of the facility," Kao said.

You do have to adjust the workflow in your practice to allow time to educate patients about how to register and use the portals. But at Houston Medical Imaging, the time and costs saved from dealing with CDs outweighed the time spent on education. The case study estimated a cost savings of $7.69 per exam using the portal versus distributing CDs.

But Agran cautions that simply giving patients access to their images isn't enough. "It's not just as easy as giving someone a password," she said. "You still have to explain to patients what they're going to see, what information they're going to get. The technology is there, but there's still that translation that needs to occur."

And as compelling as a patient image portal is to radiology practices, they're just as appealing to other medical facilities, Agran said. "I think the real challenge here is there are too many things you're supposed to sign up for and sign into. For the majority of customers going into a radiology center, they're only going to go once in a while. If you're just going once a year or every other year, it's a challenge for the radiology's portal to mean anything to you."

That's why an ideal solution would aggregate all patent records, Agran said. Merge debuted the merge.com concept at RSNA: "You can do your scheduling, you can get your images, you can come back later and look for things - it doesn't matter if it was a test with your orthopedic surgeon or your mammogram," Agran said.

Both Merge and Carestream plan to roll out their image portals more widely in the coming months. Carestream's solution will be widely available in March, while Merge plans to beta-test the merge.com concept in a small market later this year.

Articles

Vendors are debuting a next generation of patient portals that may reduce costs, increase patient satisfaction and eliminate duplicate imaging.

Imaging Sharing Patient Portals Gaining Ground

The government wants to give you money - but you're probably leaving it on the table. And you're not alone.

Less than a quarter of radiologists qualified for the bonus money CMS hands out for meeting Medicare's Physician Quality Reporting System (PQRS) requirements. That's according to a study from the Harvey L. Neiman Health Policy Institute published in the 

Journal of the American College of Radiology

. Researchers found that only 23.7 percent of eligible radiologists qualified for PQRS incentives in 2010, the most recent year for which data is available.

Why? Three big reasons are cost, confusion or outright contempt. Some physicians crunched the numbers and figured out the 0.5 percent bonus on Medicare billings didn't cover the cost of complying with PQRS.

Others tried to comply, but got contradictory instructions. And some threw up their hands and decided the whole process was meaningless - which is a shame, because the intentions behind PQRS are pure.

"Ostensibly, this was established as a first step in moving our payment system from one that's a fee-for-volume system to one that's a fee-for-value system," said Richard Duszak, MD, chief executive officer and senior research fellow of the 

Unfortunately, PQRS became "a multi-paradoxical type of system that winds up emphasizing a lot of regulatory processes over what was the core intent, which is quality," Duszak said. But he doesn't advocate ignoring PQRS. Instead, he urges radiologists to participate: "I think we all have to look at this as a step in the right direction rather than be cynical about the process."

How? Here’s our guide to overcoming common PQRS objections.

Objection No. 1: The bonus isn't big enough to bother

A bonus payment of 0.5 percent doesn't sound like much - but it won't stay a bonus for long. In 2015, CMS will move to assessing penalties on physicians who don't participate in PQSR, and those penalties could rise to 2 percent or higher on all Medicare billings. What’s more, those penalties will be based on what happens this year, meaning what you don’t do now will come back to bite you in two years.

“It’s still early in 2013,” said Duszak. “There’s still 11 and a half months for folks who aren’t in the process to potentially achieve their metrics this year. Your performance in 2013 will dictate penalties for 2015.”

What's more, your compliance with the system will be a matter of record - a record your patients can see online on Medicare's Physician Compare website. "To some patients who aren't sophisticated enough to understand that this is a reporting metric and not a true quality metric, there may be some implications back to that practice," Duzsak said. "They may say 'Oh, Dr. Jones or Dr. Smith didn't meet his quality metric, he must not be a good doctor.'" You know that's not how the program works, but do you think you'll be able to explain that to potential patients?

Objection No. 2: It costs too much to comply.

Some billing companies are incorporating PQRS reporting into their services at no extra cost. But if you do your billing in-house, the costs may outweigh the bonus. If that's the case, Duzsak said, you might want to consider using a registry service instead.

"The registry gets composite data and reports them as a group," he said. "The key ones have been approved by CMS for reporting, so that information is accepted by CMS as a valid indicator that that physician had fulfilled his or her reporting responsibilities over the course of the year."

And besides, Medicare may not be the only entity paying for participation in the future, Larson said. "Other [payers] are going to start doing this, and you're going to set up a system that's going to get more money from more places in the future."

Objection No. 3: It takes too much effort.

Physicians actually have it easy, Larson said. "With a lot of people using voice recognition and templates for the reports these days, it's pretty easy to put in a line that says, for example, fluoroscopy time, which then reminds you to fill that in," Larson said. "More of this falls on whoever does your billing, whether you do that within your own practice or whether you use an outside billing firm. They're the ones that really are turning that information into a code that the CMS is looking at and using to track whether you're participating and whether you're submitting codes on enough of the patients."

Objection No. 4: The whole system is confusing and contradictory.

Well, yeah, this is government we're talking about. But things have improved since the start of the program, when practices and providers were getting contradictory advice on what we required.

That doesn't mean it's all smooth sailing, however. "You can get tripped up a little bit if Medicare decides some patients were eligible to be reported and you didn't report them. That's a way that people potentially fail," Larson said. "But as far as we can tell, there's no penalty if you submit the code on a patient and they say it's irrelevant. They don't say, 'And by the way, we're going to pay you less because you submitted a bad code.' You should probably err on the side of submitting anyone you think it might be relevant for."

Objection No. 5: The system doesn't measure actual quality, so why bother?

This is a tough one, because there's some truth to that. You get your bonus for reporting, not for reporting good things. "I think some people miss the point that reporting you didn't do the thing counts just as well as reporting that you did do the thing," Larson said. So, if you report that you didn't record your fluoroscopy time 75 percent of the time, that still counts, and you still get paid.

And that particular measurement can be maddening, Duzsak admits. The metric PQRS is looking for is did you report the fluoroscopy time, not whether that fluoroscopy time was appropriate. "To bring that to its illogical extreme, I could report I used six hours of fluoroscopy to perform a barium enema, a dose that no one would consider remotely appropriate, but still the coders would be able to apply it. And I would potentially get a bonus based on that," Duzsak said.

Metrics like that may be the crux of the PQRS image problem. "Folks feel like they're dotting these artificial i's and crossing these artificial t's, which really don't have substantial consequences for patient care," Duzsak said.

But Larson has an answer for these objections: "Get over it. Someone's offering you money for this. Just do it."

Most radiologists aren’t meeting CMS’ Physician Quality Reporting System requirements. But bonuses will soon turn to penalties. Overcome your objections with this guide.

PQRS: Why Radiologists Should Care

Expect 2013 to be a big year for informatics... like every other year for the past decade or so.

But this time, analysts say, it's informatics with a difference. These IT tools could bridge the gap between radiologists and referring physicians, opening up the possibility of real consultation without disrupting workflow.

And the new developments are coming just in time, because the informatics tools that helped radiology thrive over the past several years may also be contributing to its precarious position now.

"The first phase of IT deployment in radiology has made radiologists more productive, more independent, more mobile, and it has allowed them to provide a service without the need for all the surrounded added value," said Nadim Michel Daher, principal analyst for medical imaging at Frost and Sullivan. "This next generation of its deployment has to keep in mind the role of the radiologist, because they feel the future is at stake."

One of the biggest breakthroughs in informatics this year isn't coming from the radiology side. It's coming from the client side.

"Mobile devices - with tablets, and their battery life, resolution, internet connectivity - mean the human-computer interface has gotten to the point where we can now bring back consultation and bring back our relationship with our referring physicians," said Paul Nagy, PhD, SIIM, director of quality at the Russell H. Morgan Department of Radiology at Johns Hopkins University.

About 70 percent of physicians use tablets in their practices, Nagy said, and that gives radiologists a tool to communicate with them in real time but in virtual space.

"Basically what we're talking about is like Skype for PACS,” Nagy said, referring to an Internet phone and chat service. “You're both logged in to the same session, you're both shared into the same video chat and you're actually sharing the images, looking at the same slice and the same nodules. You're both looking at the images together and having a conversation about them. You're guiding them in the image interpretation process and helping them interpret the results."

That's a huge improvement over the reports radiologists could send out via their PACS, Nagy said.

"Before PACS was really an asynchronous technology: The radiologist reads the image and the referring physician reads the report. There's not much collaboration going on as part of that, nor is there much feedback."

The rise of tablets, and the demand for greater collaboration, is both fueled by and is promoting the growth of zero-footprint clients. This technology uses standard, ubiquitous web technology to deliver images and communication.

"It's only HTML, CSS and JavaScript, so nothing else has to be loaded on your computer," said Jim Philbin, PhD, co-director of the Center for Biomedical and Imaging Informatics at Johns Hopkins University. "The application is downloaded automatically by the browser without storing anything on the [device]."

That's a huge plus to a referring physician - and for that physician's IT department. Before zero-footprint clients, Philbin said getting software updates pushed out to all the different departments at Johns Hopkins could take up to a year. Now? Any updates and necessary maintenance can take place instantly at the source. The referring physicians aren't disrupted at all.

This seamless delivery should only help the relationship between radiologists and their customers, Philbin said. "Zero clients are all pushing hard on the collaboration front so that you can do electronic consultation and the equivalent of an electronic curbside consult," he said.

All that collaboration means the push toward an easy way to share data is heating up. So this may be the year when the data breaks free of competing standards.

"Most of the industry is now using digital PACS - certainly more than 90 percent of radiologists' sites are now digital," Philbin said. "I expect this year will be a large leap in Vendor Neutral Archives (VNAs), and I expect that trend to continue in the future."

When that data can be easily shared between different platforms, the ideal of a truly comprehensive patient record could become a reality. "[There's a] whole movement toward having search within radiology," Nagy said. "The radiologist can do a Google-like search within the medical records... and be able to do search of different disease characteristics, to look at the relevant priors quickly, to be able to understand where this patient is and where this patient is going, to be able to put that in context to be able to make their diagnosis."

But the real potential benefit may be in giving patients the keys to all of their medical data.

"The biggest problem we have in the industry is the lack of an aggregated medical record, and the fact that it’s very difficult to share information across enterprises," Philbin said. "The best things we can do for patients is create an aggregated patient record ... so patients can start controlling who has access to their images, and also so they would get ready access to their medical imaging or other medical information through a website without having to do the aggregation themselves. It's all stored anyway, we're managing the cost of that. Just providing the patient access in a secure and controlled way is not a significant expense and would improve patient care significantly."

All that data can also help improve the way radiologists run their businesses. "Radiology has been at the forefront of technology adoption in healthcare, and because of that, we're now sitting on mountains of data: about our referring physician utilization, about how we utilize our scanners and about how we provide services to our customers," Nagy said. "People are beginning to really mine their databases from the RIS and from the PACS, and are building graphical dashboards as a support tool to help them improve service. That's going to be a big deal for building a competitive practice that can reduce costs and improve service at the same time."

But it takes more than one system's data to get the biggest bang for your informational buck, and that amplifies the need for VNAs and other common standards. "The challenge is you need to know more information than just what's in your PACS," Nagy said. "You need to know more about the RIS and maybe the order entry system to have a holistic view of your department. The trick is to be able to aggregate that data in a way that's constant so you can build models around how your patents are experiencing service within your organization. That requires a data warehousing strategy where you're able to extract the data into a common area, translate the format and the able to put a graphical dashboard tool on top of it."

Radiologists and referring physicians are leading the charge for this - but vendors are taking notice. "A real differentiator between the different vendors is how interoperable they are," Nagy said. "Are they trying to hoard the information, or are they trying to provide an open architecture where [physicians] can reuse that data for other purposes?"
 

2013 will be a big year for informatics, helping radiologists collaborate and consult with referring physicians and increase productivity.

The New Informatics: Productivity Meets Collaboration

CHICAGO - Referring physicians have simple needs. All they really want is for you to read their minds, deliver exactly what they desire, and pinpoint what's wrong with the patient every time. Oh, and if you can stop the MRI from making so much noise and freaking out the patients, that would be awesome.

Don't panic. Your referring docs know that's impossible. But there are things you can do to keep them happy - and other things you can avoid to keep them from going nuts. The referring docs shared their dos and don'ts at RSNA 2012 this week.

Do give them all the relevant information.

You're the imaging expert, and the physicians wants your input. "A description of the findings with a differential diagnosis does help me," said Sally Reynolds, MD, medical director of the emergency department at the Ann and Robert Lurie Children’s Hospital of Chicago.

Incidental findings are also important, said Stephan Wyers, MD, assistant professor of surgery at the University of Chicago. "If there are incidental findings, which are increasingly picked up as imaging gets better and better, and those incidental findings require action, that needs to be in the summary at the very bottom of the report."

"The busy internist has 12 minutes to see a patient," said Mary Mahoney, MD, director of breast imaging at the University of Cincinnati Medical Center. "They can't spend 20 minutes to read the radiology reports. And don't be pixel catalogers. We don't need to prove that we've looked at every single corner and speck on the image and cataloged every pixel that's there."

Reynolds agreed. She likes differential diagnoses, but "a differential that's 72 things long isn't going to help me."

"It would be helpful to get some sense in a layman's term: How much radiation is that really?" Reynolds said. "A radiologist a long time ago told me a chest X-ray is the same amount of radiation that you get flying from Chicago to Denver round trip." More of that, please.

"This issue of 'do we need contrast or not' is a one for primary care doctors," said Jeffrey Kopin, MD, medical director of the Northwestern Memorial Physicians Group. "Anything you can do to help your docs know whether to do that or not would be very, very helpful."

Don’t share your expertise on things you don't actually know about.

"I don't have a problem with people telling patients what they see on an X-ray," Reynolds said. "The trick to this is don't tell them what's going to happen next. Sometimes you don't know what's going to happen next. We've had radiologists say 'The orthopedic surgeon will come see you.'
We have a list of things that I do and a list of things that the orthopedic surgeon does. The list of things I do is pretty long, and they don't come see everybody with a fracture."

Do use structured reports and standardized language.

"I like reports to be structured. It gives me the sense that the radiologist has a checklist and they've looked at everything," Wyers said. "That makes it easy to go back and find specifics."

"What does peribronchial cuffing mean?" Reynolds asked. "I don't know. I always look at that and say 'Jeez, I shouldn't have ordered that chest X-ray; I'll never be able to explain this to the patients.'"

"I think it's the best thing that's ever happened to medicine," Kopin said. "We need to leverage the technology that we have. It's happened so fact that we haven't had a change to properly digest it, and we haven't had a way to properly acculturate all this technology into our patient care that truly benefits our patients while making our lives as the physicians that much easier and that much more fulfilling."

Don’t let things fall through the cracks.

"There's nothing like a physical inbox to remind you to check that final report, so significant pathology that really wasn't integral to the acute problem is addressed later," Wyers said. "We need to find a way to push important information in a timely fashion. ... There is an inbox on our EMR but I don't think the radiologists use it, and not even all the clinicians have adopted it."

Do remember that everyone loves a phone call.

"If you page a primary care doctor and you say 'I need to talk to you about Mrs. Jones' CT scan', I'll have to pull myself off the floor because I'll be so surprised and delights that somebody wants to actually talk to me directly from radiology," Kopin said. "That's a game changer to do that."

Don’t make it difficult to get in touch with you.

"If you're part of a big radiology group and people rotate through various parts of the group, publish telephone numbers for referring physicians," Kopin said. 'And if you can publish your schedule ... if you share it with your referring physicians, you're going to be amazed at how efficient it's going to make you and how happy you're going to make your referring doctors. If you make it easy, you're going to be the radiology group that everyone is going to want to send their patients to."

"If I could do one thing, I would make all the imaging be the same so I can actually open all those crazy discs," Reynolds said. "If I have an intubated trauma kid, and I have a disc with a head CT on it, I really need to look at that right now."

Don’t ever use this one phrase in your reports.

"Please banish this sentence from every report: Clinical correlation recommended," Wyers said. "It would be as if I came to you and said 'Please look at the images before you prepare your report.'"

CHICAGO - Referring physicians share their list of dos and don’ts for their colleagues in radiology.

The Dos and Don'ts of Dealing with Referring Physicians

CHICAGO - According to legend, the Mayan calendar predicts the world will end on December 21, 2012 - a prediction that has conspiracy theorists and dwellers of the fringe speculating on what's going to cause your ultimate demise. A meteor? A heretofore invisible planet?

Radiologists have been facing down another apocalypse: Consumerism. But according to a panel at RSNA 2012 this week, that's about as likely to end radiological life as we know as an ancient stone timekeeping device.

"The word ‘consumer’ bothers a lot of physicians," said Richard Duszak, MD, FACR, CEO and senior research fellow of the Harvey L. Neiman Health Policy Institute of the American College of Radiology. "They're really just smart patients."

Yes, smart patients are concerned about costs. But that doesn't mean they're bent on cutting out imaging. In fact, the latest study of health consumers by Harris Interactive found that "unrestricted access to medical technologies like CT and MRI" was high on consumer's list of priorities in choosing a health plan.

"What we find is that price continues to be the No. 1 criteria," said Debra Richman, senior vice president of healthcare business development and strategy at Harris Interactive. "What we also find is there is an interest in not having a restriction on primary care services and preventive services. Our thought is interest in unrestricted access to advanced imaging was so high because consumers’ perception was that it was such an important service as a diagnostic tool, it was seen within the context of preventive care."

But cost containment is definitely part of the picture for health consumers. They're facing larger deductibles, higher co-pays, and other costs that they have to swallow themselves. So services that help compare costs of imaging services may gain traction. "You can pay $200 for a CT scan, or $2000,” said David J. Soffa, MD, FACR, senior vice president of medical affairs for AIM Specialty Health. “Often that is on the same scanner, sometimes with the same radiologist reading it."

Competing on cost alone is unlikely to be a sound business plan. So how can you attract savvy health consumers and live to image another day? It's all about how you position yourself, said Christine M. Hughes, advocacy research leader for the healthcare economics team at GE Healthcare.

"Market yourself to the consumer as a credence good, similar to accountants and lawyers," she said. Those professionals attract clients with their reputation for expertise, service and results, not low costs. After all, would you really trust the cheapest accountant to keep you from getting in trouble with the IRS?

And Duszak said there's another tactic you can adopt from accountants and lawyers: "We're sort of culturally indoctrinated into believing we as physicians, we know what's best for our patients," he said. "That's a very different paradigm from how a lot of other professionals are brought up to deal with their clients. They're clients. They make decisions together about processes. That's something that historically we haven't done a very good job of doing."
 

CHICAGO - The rise of the health care consumer may frighten you, but here’s how to compete and thrive in an era of the highly engaged patient.

Who's Afraid of the Health Care Consumer?

CHICAGO - Radiology practice marketing: Do it right, and you'll attract new patients, get some love from referring physicians, and grow your practice. Do it wrong, and you could end up facing a hefty fine or even jail time.

Peggy Martin, marketing communications manager for Adventist Health, and W. Kenneth Davis, JD, an attorney at KattenMuchinRosenman LLP, helped the RSNA 2012 attendees figure out how to promote their practices without ending up in the pokey.

While there are plenty of legal restrictions on how you market your practice, two areas are especially relevant. The first is anti-kickback laws. That's a federal law that prevents you from offering money or gifts to lure patients into your clinic. This is a felony. Violate it, and you could go to jail.

The second is Stark laws. This prevents you from offering incentives, money or gifts to referring physicians so they funnel patients to you. The good news? It's a civil code, so you won't go to jail if you run afoul of the code; you'll just face a fine. The bad news? You don't need to show intent to be in the wrong. Even if you had no idea you were violating the law, you'll still pay a penalty.

Here are a few scenarios that demonstrate some dos and don’ts for marketing your practice.

A radiology practice partners with local restaurants to promote awareness for mammograms. They place breast-health-awareness banners in local restaurants. Users can post a picture of themselves posing with the banners on the practice's Facebook page for a chance to win small prizes.

This is about building brand awareness, not specifically bribing patients to come in to the clinic. Plus, it's about breast health. Since the federal government is making mammograms and breast health a priority, you're probably in the clear.

A clinic offers a deal through the service Groupon for sclerotherapy. Patients get the procedure as a steep discount, and Groupon gets a cut of every deal sold.

If Medicare or Medicare pays for a procedure, and you offer a discount to Medicare patients, that counts as a kickback. Plus, Groupon getting a cut is a lot like offering a commission for patients. That's a no-no for anything Medicare pays for. If it's not offered to Medicare patients, or it's not something Medicare pays for, you should be OK.

To promote a new PET scanner, a clinic offers branded Beanie Babies to the first 50 referring physicians each month.

If you're offering an incentive to referring physicians only, that violates Stark laws. You won't go to jail, but you could pay a huge fine.

A clinic invites referring physicians to a barbecue to show their appreciation for their business

The verdict: Keep track of how much you spend.

Stark laws allow clinics to spend a certain amount a year on non-monetary compensation - you know, things like pens, mugs, tchotchkes, and yes, food. For 2013, the limit will be $380 per referring physician. To stay in the clear, you'll have to do some math. Figure out how much you spent on food and divide it by the number of doctors present, and put that on the spreadsheet you're using to keep track of how much you've spent this year. (You are using a spreadsheet or some other tracking mechanism, right? If not, start immediately.)

 A clinic offers free educational lunches to physicians in the area. They provide subs and chips, and spend the full hour educating clinicians on new technology.

Educational offerings don't run afoul of Stark laws. If you want to be extremely cautious, you can do the same thing you did for the barbecue: Figure out how much you spent per doc and put that on your spreadsheet.

: A clinic offers free educational dinners to referring physicians at a high-end steakhouse. They spend 15 minutes talking about technology, and two hours binging and boozing.

The Verdict: Nice try, but that's not education.

Stark laws are designed to prevent large gifts that would sway physicians to send patients to you. High-end parties count as large gifts. What's more, in that situation you may have to apply the entire cost of food to each physician present, instead of dividing it up per person. So be careful when schmoozing, sponsoring holiday parties, or providing other ritzy entertainment. It adds up.

 The office manager at a referring physician suggests that a clinic bring a bunch of pizza for lunch just to you can get to know each other.

If anyone at the referring physicians asks for a gift, a party, a meal, a beanie baby, it doesn't fall into the allowable non-monetary compensation realm. It's forbidden.

A clinic wants to provide CME for physicians in your area.

If this is CME that the referring physician would have to pay for if you weren't offering it, you need to charge them. If you don't, it goes on that non-monetary compensation spreadsheet. The good news? You're not comparing your course to the fancy ones in Aspen that charge thousands of dollars and involve skiing breaks. You can check out what the cost-conscious CME providers in your area charge, and use that as a basis for comparison.

You're one of several departments in your hospital that is marketing to referring physicians. You want to send them a nice fruit basket on the holidays.

The total amount of non-monetary compensate you can give to referring physicians is calculated by entity, not by department. So if the radiologists, the cardiologists, the hospital CEO, and all the other departments are each sending a fruit basket, you may be violating Stark laws. Check to see who's giving what, and how much it coasts.

: You've got a great ad full of smiling faces proclaiming your clinic the "best in town."

The best? Really? How are you quantifying that? If you can't prove it, you may be violating your state’s truth-in-advertising laws. And those smiling faces, are they models, or patients? Passing off stock-art models as patients is also a truth-in-advertising violation. If they're patients, did you get signed releases allowing you to use their images? If not, that may be a HIPAA violation.
 

CHICAGO - Radiology practice marketing can be tricky. Here are 10 scenarios outlining some dos and don’ts for attracting patients and referrers.

10 Dos and Don’ts for Radiology Practice Marketing

CHICAGO - Should radiologists provide reports directly to patients?

Many physicians say no. They fear that patients will be confused or stressed out by the reports. That’s not just cruel to the patient, they say, it’s also more work - we’ll spend all our time fielding calls from terrified laymen who don’t understand what they’re seeing. Really, it’s kinder to insulate them.

Patients tend to disagree.
 




Why the disconnect? It’s possible radiologists don’t realize just how hard waiting for results can be. Annette Johnson, MD, associate professor of radiology at Wake Forest University, surveyed patients who had recently undergone scans at the facility. A whopping 92 percent of them reported they suffered from anxiety until they got their results.

So Johnson, who spoke of her survey at an RSNA 2012 session this week, gave these patients a hypothetical scenario. What if they had quick access to their results via an online portal before they talked to their doctor? She put together three scenarios. One involved a positive result - basically, nothing was wrong. One gave an indeterminate result. And one delivered very bad news in stark, medical terms.

About 80 percent of the patients Johnson talked to said they preferred to find out their results early via the portal - even the patients who got the negative diagnosis.

But that’s hypothetical, and from a small study at that. In real life, it would be different, right?





Not according to Curtis Langlotz, MD, PhD, professor of radiology and vice chair for informatics at the University of Pennsylvania. They ran a three-month pilot program allowing patients to see reports from abdominal imaging, breast imaging and interventional radiology studies via a portal.

The radiologists were nervous. Surely they’d be deluged with calls from anxious patients who didn’t understand what they were looking at.

That didn’t happen.

“We received a grand total of four patient calls, none of which were related to any of the report types that were released as a part of this project,” Langlotz said.

The results were promising enough that they expanded the program to all University of Pennsylvania hospitals in June. So far, Langlotz said, they haven’t had any problems. That’s not to say they haven’t gotten some complaints. Those complaints just tend to come from physicians.





There are things to be aware of before you jump into sharing records. For example: Not every patient will be onboard.

“They’re all different,” Johnson said. “They don’t all want the same access. Some patients would never want to log on somewhere and see a bad result. Some of them would want to immediately regardless. They need to be able to individually choose how much access they want.”

And those who do choose to receive the reports will go over them with a fine-tooth comb, so you’d better brush up on your copyediting skills.

“We did a lot of radiologist education about this,” Langlotz said. “If a patient sees a report where it says that the gall bladder is normal, but they know that they’ve had their gall bladder out, they might assume that someone has read the wrong images, as opposed to the fact that we might have used a macro that didn’t get edited.” 

If you really want to make patients happy with these sorts of reports, consider providing a layperson-friendly summary. But if that’s too much to contemplate, just providing hyperlinks to reputable information about the medical terms is almost as good.

In Johnson’s study, more than three-quarters of the patients surveyed said they’d definitely use those hyperlinks to do their own research. “They want our input on what is reliable medical information,” Johnson said.

Most of all, patients don’t want to wait. If they can get results immediately, many of them would jump at the chance - even if the news is bad.

Instant gratification isn’t always possible. But a three-day turnaround for reports would keep patients happy, give referring physicians time to review, and would fall within the federal meaningful use guidelines for electronic health records, which could put you in line for incentive payments.
 

CHICAGO - Patients want access to their imaging reports, but radiologists hesitate. Here’s what to consider when opening your files.

Should Radiologists Provide Reports to Patients?

CHICAGO - Paul Chang, MD, has a lot of titles. He’s a professor of radiology at the University of Chicago. He’s the vice chair of Rad Informatics. He’s one of the presenters of the Eugene P. Pendergrass New Horizons Lecture at RSNA 2012.

But his father, a retired radiologist, has a different title for Chang: The Man who Ruined Radiology.

That’s because Chang is an informatics guy, a PACs person. Chang said his dad told him, “Before PACS, we were the doctor’s doctor. Medicine and surgery rounds started in radiology. ... Every morning the clinicians and the radiologists collaborated.”

Now? Radiology is fast becoming an ancillary service. And Chang admits that his people - the IT guys, the informatics fanatics - helped cause the problem. “The constraints of the immaturity of these systems … facilitates pigeonholing us into commodity level service,” he said.

But Chang said new technology can set the specialty free and put radiologists back at the center of the medical universe. “We should be embracing IT to virtually collaborate and be everywhere,” he said. “In every OR, in every ICU, in every clinic and [in collaborating] with our patients.”

At the University of Chicago, Chang has helped implement this is a couple of ways. One pilot program applies workflow improvements to scanning equipment, treating a modality as an IT device. “The CT scanner programs itself,” he said. “The injector programs itself. After the scan is done, it knows about all the post-acquisition workflow requirements - sending stuff to PACs and 3D work stations, notifying transport.”

That pilot paid off across the enterprise. “These efficiencies are realized as improvements not only in radiology, but also length of stay, hospitalization, throughput in the clinics. We were able to realize about a 66- to 70-percent improvement in cycle time in our CT scanner by automating procedures that originally were done by humans,” he said.

Another program automates the process of lesion tracking for oncology. Deep integration automatically identifies prior lesions and associates them with the new ones. That system reduced the time it took radiologists to do these measurements by 50 percent. “More importantly,” Chang said, “it improved efficiency and accuracy downstream for the oncologist as well.”

And that just scratches the surface of what new technology can do, because radiology itself is woefully behind the times. “My kids have 10 ways to talk to each other, from Skype, Twitter, Facebook, Foursquare… and they can articulate intelligently why they need all of these,” Chang said. “And yet, as a radiologist, I basically have the report and a phone call. We have to do better.”

How much of a difference can it really make? Well, think about how you interact with the Web at home. “We expect a certain level of deep, sophisticated, elegant integration when we’re buying music or watching the web, and yet when we go to the hospital we live with static reports,” Chang said.

Instead, consider the potential of multimedia reports that use hyperlinks to give clinicians - and patients - more information. “Most of our physicians are going to consume reports electronically anyway,” Chang said. “Instead of saying I used this much of contrast, have it as a hyperlink.”

If you’re worried about increasing your workload, Chang wants you to relax. “You can actually create these multimedia reports faster than you can create a static report. Value is optimized, quality as well as efficiency.”

“Technically, this is easy,” he continued. “The real challenge is changing ourselves.”
 

CHICAGO - Radiology is woefully behind the times in its use of informatics, said Paul Chang, MD, who detailed how systems can improve efficiency and accuracy.

Informatics: The Cause of - and Solution to - Radiology’s Problems

CHICAGO - Do you feel like a marked man? Are you flinching at noises, skirting around shadows, waiting for that bullet with your name on it?

You’re not being paranoid. They really are out to get you - or at least your reimbursements, you cushy schedule and your professional esteem. That was the sobering message Sunday from the RSNA 2012 session “Saving Our Profession: How Radiologists Can Thrive in the Era of Health Care Reform.”

Radiologists themselves are part of the problem, according to Lawrence R. Muroff, MD, CEO and president of Imaging Consultants Inc. in Tampa, Fla., who spoke at the session. “When radiologists are asked to look to the future, they look to the past,” he said.

It’s understandable. The past has been good to radiologists. “The fact is that for the period 2000 to 2006, imaging costs rose faster than anything else in the Medicare system,” said Bruce J. Hillman, MD, who also spoke.

And that good fortune makes radiologists are target, because medical payments are a zero-sum game. “If somebody gets more, it means somebody else gets less,” Muroff said. To put it bluntly, he said, “We are prime targets because we make so damn much money and because we have such great quality of life.”

This doesn’t mean that radiology itself will be any less vital. On the contrary, imaging studies are becoming more and more integral to the practice of medicine. But Muroff said there’s a difference between the technology and the specialist: “I believe that the future for radiology is bright. The future for radiologists is far less certain.”

So how do you counteract this? Norman Joseph Beauchamp, MD, of the University of Washington, said a certain amount of schmoozing is in your future. “If you position yourself as leaders in the organization, when the tough decisions are being made, they’re not going to see you as them, but as a part of we,” he said. “We found this to be a critical part of this strategy.”

That means volunteering for leadership positions within your hospital, in your accountable care organization, with your partners, and throughout your professional network. It means coming out of the office and developing lines of communication with clinicians and patients. It means showing that you add value to the organization.

And it means supporting innovation throughout the industry. Hillman urged radiologists to donate 1 percent of their income to programs that develop radiology research.

But this can’t be technological innovation without limits. “Innovations have to fall in line with policy needs of the country and the direction of medicine and health care in general,” Hillman said. “They have to produce the same or better care at lower cost. It’s not just that they improve the accuracy of what we do, they need to verifiably improve health.”

None of the presenters want you to give up hope. They just want to you be realistic about what’s coming. Yes, things will change, but, according to Beauchamp, “I would say is it’s a good change and it’s a necessary change.”

Murroff agreed: “The bottom line is that some people will have major problems with their practices and their livelihood, but there’s never been greater opportunity out there. Turbulent times offer unprecedented opportunities.”

CHICAGO - The future for radiologists is uncertain, but becoming leaders will help save the profession.

Radiology’s New Normal: Less Money, But New Opportunity

CHICAGO -  In the beginning, there was film, and it was good.

Now, it’s time for the cloud, and it could be better still for the storage of medical images - if the industry can work out standardization issues, privacy concerns and potential security problems.

A session at RSNA 2012 tackled the potential of storing and sharing images online in the session, “IHE: Getting Images from the Department to The Enterprise to The Cloud.” The verdict? Using the cloud could help reduce waste and inefficiency, but it takes work.

Why? “There’s no such thing as a one-size-fits-all model,” said Christopher Lindop of GE Healthcare, speaking at the session. Any organization is going to have to tweak the system to meet their needs. The industry is trying to smooth the way with IHE, or Integrating the Healthcare Enterprise. The goal is to use established standards to help everyone’s systems talk to each other. But there’s still a way to go.

The Cleveland Clinic is implementing a cloud-based imaging storage and distribution system that goes way beyond radiology. Albert Edwards, director of IT clinical integration and interfaces at Cleveland Clinics, joked that the project should be named “No image left behind.” That means radiology, cardiology, optometry, dental - the list goes on.

Some of those departments aren’t following the same standards as everyone else, Edwards said. While many departments capture DICOM images, others use MPEGs, JPEGs or even PDFs. These images don’t have the metadata to make them easily searchable.

And searching for images is the whole point, said David S. Mendelson, MD, chief of clinical informatics at The Mount Sinai Medical Center. “When a radiologist gets an abnormal exam, the first question they ask is where’s a historical exam I want to compare it,” he said. So the ideal cloud-based solution would let doctors call up those historical images quickly and easily.

Another area where cloud-based image management may help is in reducing unneeded and duplicate images. “The rising cost of healthcare can be attributed in part to extensive imaging, and we have to bring those costs under control,” Mendelson said. “There are some estimates that 20 percent of imaging performed in the United States is inappropriate. Part of it is due to lack of accessibility of an exam.”

Consider a patient who had a CT scan done two weeks ago. He shows up at another provider’s office, but he doesn’t have the original scan. So the clinician decides to do another scan right now, just because the original scan isn’t on hand.

Mendelson and his team at Mount Sinai are working on a cloud-based solution called Personal Health Records. It’s based on a banking model: the patient owns his records and can distribute them to new health care providers as needed. The patient has an access code, like an ATM card, and can retrieve his records from any computer. When he’s meeting with a new doctor, he can pull up the records quickly and easily.

This sort of solution needs work, Mendelson admitted. Vendors need to produce software and equipment to common standards, and the industry hasn’t agreed to that yet. Security is a concern, as are HIPAA regulations. But the promise of instant historical images anytime, anywhere is great enough that these obstacles won’t stop the move into the cloud.

 CHICAGO - Cloud-based image sharing and storage could be the new standard if the industry can work out standardization, privacy and security concerns.