Facility Management

Pending tomosynthesis platform may stem price erosion seen with Selenia

Legislation proposing accreditation for most medical imaging modalities has been caught up in a fight between Capitol Hill and the White House over the renewal of federal healthcare insurance subsidies for poor children.

Radiologists could be shortchanged if Medicare goes through with plans announced Monday to end its long-standing policy of paying separately for imaging contrast media, radiopharmaceuticals, interventional radiology supervision, and interpretation.

Radiology and nuclear medicine are the focal points of proposed Medicare reforms that would bundle reimbursement in 2008 for seven categories of ancillary services covered by the Hospital Outpatient Prospective Payment System.

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.

Despite heated interest in cardiac CT, echocardiography continues to anchor the diagnosis and evaluation of coronary artery disease for most clinical practices. Echo possesses prognostic as well as diagnostic power, as demonstrated in a large Weill Cornell Medical College study. It found strong correlations between wall motion abnormalities detected during echocardiography and risk for cardiovascular death. On the cardiac CT front, more research investigating its clinical utility and radiation exposure was reported.

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To get reasonable reimbursement for cardiac CT, imagers need to collaborate, put sound data together, train staff to bill properly, and prepare to fight proposed Medicare reimbursement cuts for 2008.

Blue Cross Blue Shield of Michigan and Blue Care Network are partnering with Michigan hospitals to examine whether coronary CT angiography, under certain circumstances, can be used as a complement or replacement for cardiac catheterization.

Award-winning studies presented at the Society of Cardiovascular Computed Tomography meeting suggest that cardiac CT angiography may be more cost-effective than myocardial perfusion SPECT and a good financial choice when performed after a positive nondiagnostic stress test to weed out unnecessary cardiac catheterization.

The Centers for Medicare and Medicaid Services has initiated a national coverage analysis to evaluate the available evidence for coronary CT angiography. As part of the effort, the agency on June 13 asked practitioners to submit comments. If the remarks so far are any indication -- and if CMS listens -- coronary CTA will have no problem securing Medicare reimbursement.

Acting in their capacity as medicine's designated custodians for issues involving ionizing radiation, radiologists defined strategies this year to address the dangers accompanying the explosive growth in the number of medical procedures that require ionizing radiation.

After scoring high marks in a new cost-effectiveness study, virtual colonoscopy is poised to crawl out of clinical obscurity and boost colorectal screening rates.

Cosmetic medicine is bringing a fresh face to interventional radiology with new minimally invasive applications and opportunities to profit from this highly lucrative field.

Historically, the federal government has taken the lead in pursuing fraud claims against healthcare providers. Section 6031 of the recently enacted Deficit Reduction Act of 2005 (DRA), which provides a financial incentive for states to enact their own false claims legislation, is changing that.

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A suite of teleradiology products and services launched at the SIIM meeting will improve efficiency by intelligently routing studies, according to its developer, CoActiv Medical. The suite, called Exam-Net, focuses on image distribution, reading, and archiving. Its Acquire & Forward Server receives studies directly from multiple modalities or an existing PACS, automatically sending them for temporary storage to a hosted Exam-Net server at one of CoActiv's data centers, or to an onsite imaging location. The hosted server can be programmed for "intelligent" imaging forwarding, automatically routing studies to appropriate radiologists at any location.

Siemens Medical Solutions put its syngo Suite in the spotlight at SIIM 2007 as the means to an advanced level of interoperability and flexibility for imaging centers. The product, a hybrid IT that integrates RIS, PACS, postprocessing, and patient data handling, brings image management and practice management together in an easy-to-use package.

Last year, the Society for Imaging Informatics in Medicine attracted 24 essays from residents and other trainees vying to win travel reimbursement to the meeting. This year, the society received no essays, according to Dr. Barton F. Branstetter IV, chair of the SIIM education committee, who moderated a morning resident roundtable session.

The elderly patient was a major donor to the hospital. Intraoperative ultrasound revealed an unexpected liver lesion. Color Doppler showed vascularity. If the lesion was a cancerous tumor, the entire liver would need to be removed, the surgeon told radiologist Dr. Stephen Horii. Only histology would reveal actual pathology.

PET/CT continues to find new applications in detection and monitoring of breast, cervical, and ovarian carcinoma. An estimated 211,000 new cases of invasive breast carcinoma, with almost 41,000 deaths, are expected to occur in the U.S. during 2007. Breast carcinoma is the most frequently diagnosed malignancy in women and ranks second in terms of cancer deaths after lung cancer.

The trade-off between image noise and radiation exposure in low-dose multislice CT for kidney stone detection has not been kind to overweight patients. They are often excluded from low-dose studies, scanned at higher doses, or scanned repeatedly with normal doses.

Diffusion-weighted MR of the bone may indicate within days whether and how well patients with metastatic cancer of the bone are responding to treatment. The software to support such conclusions is now being developed for commercial release later this year by Cedara Software.

In a major departure for radiology, national and local programs have begun to address cancer risk from medical imaging radiation dose by monitoring medical patients' cumulative dose exposure.

Vendors are pouring money into R&D aimed at reducing radiation dose to patients when a simpler, more immediate answer might be at hand: positioning patients correctly before scanning.