Facility Management

A cost-effectiveness study performed by Thomas Jefferson University researchers indicates cardiac CT angiography makes financial sense in nonemergent cases if the price is appropriate.

MI techniques recommend against unnecessary surgeries and monitor therapy

Pending changes to Medicare in the Deficit Reduction Act of 2005 call for nonhospital outpatient technical fee reimbursement to be the lesser amount of either the Hospital Outpatient Prospective Payment System (HOPPS) or the physician fee schedule.

Historians may look back on May 8, 2006, as a turning point in the history of molecular imaging. Before then, FDG-PET was chronically tangled in political problems that slowed its entry into the clinical mainstream.

The truce over cardiac CT between cardiologists and radiologists showed signs of strain last week at the Society of Cardiovascular Computed Tomography meeting in Washington, DC, when several radiologists charged that the endorsement of clinical guidelines by the society favored cardiologists.

The imaging community pleaded with Congress July 18 to delay cuts in Medicare reimbursement mandated by the Deficit Reduction Act of 2005 and scheduled to take effect Jan. 1, 2007. Representatives of providers and vendors presented testimony extolling the virtues of imaging and bewailing the legislation that could exact as much as $8 billion from Medicare reimbursements annually.

Various representatives of the imaging community got a chance yesterday to plead their case before Congress for a two-year delay on Medicare reimbursement cuts slated to take effect Jan. 1, 2007.

Volumetric MR scanning can accurately track structural changes preceding the onset of autosomal dominant polycystic kidney disease, according to a study by the National Institute of Diabetes and Digestive and Kidney Diseases. MR could sound the alarm on disease progression earlier than standard blood and urine tests.

Primedix Health Systems has signed a definitive merger agreement to acquire Radiologix. If the deal, valued at $208 million (including net debt) goes through, it will create the largest owner and operator of fixed-site outpatient imaging centers in the U.S. with 132 locations. Primedex owns and operates 62 facilities. Radiologix owns or operates 70.

The government surprised a few imagers with a change in Medicare reimbursement that was not as draconian as expected.

Few diseases pose as many diagnostic challenges as ovarian cancer. Unlike other gynecologic cancers, in which patients can present with tell-tale conditions while the disease is still at an early stage, two-thirds of ovarian cancer cases are advanced when first detected. Identifying postsurgical recurrence is also difficult. According to several studies presented at the 2005 RSNA meeting, PET/CT may have an important role to play in detecting and evaluating this silent killer.

A cost-effectiveness study by Thomas Jefferson University researchers indicates cardiac CT angiography makes financial sense in nonemergent cases if the price is appropriate.

In this issue, legal columnist Thomas Greeson wades squarely into one of radiology's hottest topics today: cardiac CT overreads by radiologists. Under such scenarios, cardiologists interpret images of the heart and related vessels and leave the rest of the chest to radiologists. These marriages of convenience are strongly promoted in some quarters as avoiding destructive turf battles and assuring that patients get the best possible care following a chest CT scan.

Prostate imaging can be a lonely, thankless line of work for radiologists. Specialists are scarce, and urologists have the upper hand. Cancer screening is controversial, and imaging research has yielded a mixed bag of results. Nevertheless, prostate guru Dr. Ethan Halpern is bullish about the future.

Buoyed by highly promising preliminary results, radiologists and cardiologists are lining up to learn coronary artery CT. Interest is growing in new CCT fellowships and medical conferences offering CCT training. Record sales of cardiovascular 64-slice CT scanners, many installed in the first half of 2006, are fueling the demand.

I believe myself fortunate to have a soapbox-this column in DI-from which to opine my views on the legal and regulatory issues encountered in my practice representing radiologists. Few issues have been as nettlesome, or as hot politically, as the one involving shared arrangements for radiologists and cardiologists to interpret cardiac CT angiography studies. It is my strongly held view that there are significant regulatory issues with many of these shared reading or overread arrangements between cardiologists and radiologists. If such arrangements are not structured correctly, I am concerned radiologists could face legal exposure.

Congressional bill would delay DRAAgfa formalizes splitGE opens clinical center in India

Nearly four dozen members of the House of Representatives have signed on to a bill that calls for delaying cuts in Medicare reimbursement for two years. Lawmakers, who were kept in the dark about last-minute provisions affecting imaging, insist on knowing the impact reductions of up to 50% will have on access for Medicare recipients.

Diffusion kurtosis imaging (DKI), a new MRI-based technique, may help find hard-to-detect lesions in patients with mild traumatic brain injury, according to a study presented at the 2006 International Society for Magnetic Resonance in Medicine meeting. DKI could help understanding of persistent post-traumatic disorders affecting these patients.

Several stocks jumped yesterday on the release of what wire service reports called good news for freestanding radiation oncology centers: a change in Medicare reimbursement that was not as draconian as expected.

The third phase of clinical PET adoption appears imminent and Integrated Cardiac Solutions intends to be ahead of the curve.

GE’s Infinia Hawkeye defines the value end of SPECT/CT devices. Until this spring, the Infinia was a single-slice. Now it’s a quad-slice hybrid that delivers thick-slice CT data competitors refer to as “nondiagnostic.” The middle ground is held by Siemens and Philips scanners sporting 16 or fewer slices. The high end of the spectrum is populated by a rarified breed of scanners more theoretical than real. Among these is Philips’ Precedence 64, cleared by the FDA but not likely to enter production until next year at the earliest.

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.”

Once again, it’s time for leadership change in the American College of Radiology.

The future of PET instrument design is likely to follow the pattern of past developments, with incremental improvements to sharpen resolution and increase sensitivity to physiological aspects of disease.

Siemens Medical Solutions USA announced today that Heinrich Kolem, Ph.D., has replaced Thomas McCausland as president of its Customer Solutions Group. In an exclusive interview with DI SCAN, Kolem discussed how his experience in the MR business will shape his now broader agenda, his early plans for the company’s U.S. operations, and how Siemens’ pending acquisition of Diagnostic Products might change the character and approach of Siemens Medical Solutions USA.

Most of the poor revenue performance confronting radiologists and radiology business professionals originates from weaknesses in the overall base design of the billing system. So, although much has been written on the micro aspects of radiology billing and reimbursement, this article takes a macro view. We’ll look at the revenue-generating infrastructure of radiology practices to explain the basic design requirements that should be incorporated into every radiology billing system.

The 2006 meeting of the Academy of Molecular Imaging occupied the middle ground between meetings of its two sister societies, the eminently scientific Society for Molecular Imaging and the clinically oriented Society of Nuclear Medicine.

Florida is home to a large aging population at risk for dementia. Palm Harbor, not far from St. Petersburg and Tampa, is also close to a retirement town. There are many nursing homes and extended care facilities throughout the region, and the reimbursement climate includes sizable expenditures for Alzheimer's disease care.

As the diagnostic CT side of hybrid imaging adds new clinical potential for nuclear practices, some sites are facing questions about how to bill properly for the procedures. While practitioners in Germany and the Netherlands have encountered no problems with reimbursement, the situation outside of Europe is different.