Steven R. Renard

>Declining reimbursements in outpatient diagnostic imaging pose significant challenges for center operators across the county. What was once a fairly easy business to operate has in many ways become a challenge, especially during the past two years. Finding a good technologist was, and still is to a certain extent, a hardship for some radiology departments, but hiring a skilled manager is proving to be like finding a needle in a haystack.

As a consultant, I have the opportunity to speak with many operators, vendors, payers, analysts, and banks about the future of outpatient imaging. In our conversations, I share trends, numbers, and perceived areas of growth. What they want to talk about most is financials, particularly what 2008 will bring. It’s a curiosity that these folks, no doubt, share with vendors.

In keeping with family tradition, my niece has entered the radiology business. She is getting ready for her first RSNA meeting and asked me, “As a potential customer, what would you want to see or hear at our booth this year?”

In keeping with family tradition, my niece has entered the radiology business. She is getting ready for her first RSNA meeting, and one day she asked me, “As a potential customer, what would you want to see or hear at our booth this year?” Her question, simple as it seemed, was hard to answer.

If the Deficit Reduction Act of 2005 wasn’t enough of a blow to the imaging industry this year, just wait. Congress has a surprise awaiting us in 2008.

Over the past year, many payers and utilization management companies have been looking at accreditation and certification. Large payers, such as United Healthcare, Aetna, and Blue Shield (and soon Blue Cross), require the outpatient facility and its equipment to meet the American College of Radiology requirements at the risk of losing their contracts. These requirements can be demanding, as seen in the Blue Shield list for MRI or CT, according to Guidelines for Providers Performing Imaging Procedures: Blue Shield of California.

As imaging centers across the country fall behind on equipment payments, they are getting calls from workout groups. We’re not talking gym memberships here. These groups try to recoup lost revenues from notes in default and are being used more than ever in the radiology finance world. During the past few months, I have spent a good portion of my time speaking to finance vendors involved in attempting to salvage centers. It is frightening to see the washout of once-profitable centers, as they fall victim to the draconian cuts in Medicare reimbursement resulting from the Deficit Reduction Act.

Pressure to go filmless has been mounting for years. Rising chemical costs and reimbursement cuts under the Deficit Reduction Act have compounded the pressure on outpatient centers such as ours to rein in escalating expenses. To make a serious dent in

Two months ago, a seasoned vendor told me that he hadn’t sold a single piece of equipment in six months. He had built his business serving entrepreneurs within the medical imaging marketplace. As a long-time friend, I could tell he was frustrated and at the same time, scared of the unknown.

For the better part of a year, imaging industry analysts have been studying and hypothesizing about the impact of the Deficit Reduction Act. I considered myself an optimist throughout most of last year, believing that an idea this bad would not make it into practice, at least not in 2007.

As the Super Bowl and college basketball’s March Madness draw near, bookies in Las Vegas are narrowing their picks and setting the odds. They have a matrix for choosing winners and losers. Season records, players, injuries, home team advantage, time off between games, and even expected weather conditions all play a part in their picks.

At the RSNA meeting this year, I found that customers are focusing on upgradeability and low-cost entry rather than the latest and greatest 3T MRI. I surmise that many vendors at the RSNA are sensing this change of heart and mindset.

I was caught off guard last week by the barrage of news reports that stemmed from a study regarding lung screening for early cancer detection. Every news channel in my area was reporting it with the same vigor they use to convey news of North Korea and the Iraq war. PBS even had a special on it. What many of us in the imaging community already knew, and those in Congress seem to forget, is that medical imaging saves lives and money.

Practical tips from one early adopter demonstrate dos and don'ts of transitioning to 3T MR imaging

Three-T MR, 64-slice CT, PET, and PACS -- each represents a marked advance in clinical capability, just as each has widened the gap between what can and what might be done. A major factor in the size of this gap is continuing medical education.

Hard though it is to believe, there is another issue facing outpatient imaging centers besides the Deficit Reduction Act, information technology, and turf wars. It’s the multimodality revolution, which encompasses plain film x-ray, ultrasound, and yes, even mammography.

Only yesterday, PET was the talk of the town, and outpatient centers were clamoring to get their hands on it. I remember that day vividly and can recall the resources needed to get an outpatient PET center off the ground.

By now, most everyone involved with outpatient imaging of Medicare patients has lost sleep worrying about how the Deficit Reduction Act will affect the bottom-line performance of their businesses. Sustaining profitability will depend on a center’s ability to increase its efficiencies. In some cases, this translates into making capital expenditures and investing in new technology.

After a late night congressional session in December, Congress passed the 2005 Deficit Reduction Act, sending a shock wave that’s still reverberating through the radiology community. Referred to by many in this community as “reduction without proper representation,” this draconian act targets the so-called “freestanding advantage.”

Understanding the rules and regulations as they apply to purchased diagnostic testing and professional courtesies is necessary if vendors are to appreciate the pressures that providers -- especially those in outpatient settings -- must face. In my experience as a consultant, I see vendors book orders that get canceled months later because their customer lacks the proper legal structure to qualify for Medicare’s safe harbor rules.

Outpatient imaging centers have long been in hot pursuit of emerging technology. What separates information technology from imaging technology in this environment is the relative experience that outpatient imaging centers have garnered with the tools of these disciplines. Whereas radiologists and center staff typically have expertise in MR and CT, they seldom understand IT, let alone have the ability to anticipate IT needs that may arise in the future, particularly as they apply to RIS/PACS.