Smaller Hospitals Reach CT Dose Reduction Through Education, Collaboration

Published on the Aug. 26, 2011, DiagnosticImaging.com Website

By Whitney L.J. Howell

Smaller hospitals might worry they don’t have enough staff or time to effectively reduce CT dose exposure for patients, but one hospital’s success proves it can be done.

By changing protocols for CT angiographic imaging, Gundersen Lutheran Health System, a physician-led, La Crosse, Wis.-based health system serving 19 counties, endeavored to reduce dose exposure after purchasing a dual-source CT system in 2006. Rather than use a generic protocol for all patients receiving CT angiographic imaging, radiologists and technicians determined proper dosage based on patients’ body mass index. The result: a 29 percent drop in dose exposure.

This accomplishment prompted radiologists to apply reduction efforts to all protocols.

“Expanding the dose reduction plan fit with our overall strategy at Gundersen Lutheran to provide the highest quality services and protect patient safety,” said Mary Ellen Jafari, Gundersen’s radiation safety officer and medical radiation physicist. “The program fit nicely into the organization’s goals, and we had a lot of administrative support to make this happen.”

To read the remainder of the article online: http://www.diagnosticimaging.com/low-dose/content/article/113619/1936917

Physician Self-Referrals Can Hurt Radiology

Published on the Aug. 11, 2011, DiagnosticImaging.com Web site

By Whitney L.J. Howell

Cuts to reimbursement payments are looming thanks to health care reform measures. No doubt, they have you and other specialty providers scrambling to identify strategies to compensate for the lost revenue.

For some physicians — those who either own or have a vested financial interest in imaging equipment — self-referring patients could be a convenient way to off-set any drops in reimbursement. But, according to one radiologist, the practice should be stopped because it hurts radiologists in other health care settings.

“Physician-owned imaging equipment diverts dwindling health care resources especially away from non-profit hospitals that still scan the poor and indigent but no longer get the revenue from the insured patients,” said Sidney Roberts, M.D., president of the Texas Radiological Society and radiation oncologist at the Arthur Temple, Sr. Regional Cancer Center. “This drives up the cost of care for everyone.”

Some in health care support self-referral both as a convenience for patients and as a way to pre-authorize more imaging studies. It’s a false argument, though, Roberts said. Diagnostic imaging studies are rarely conducted the day they’re ordered, and there is no guarantee the location to which a patient is referred will be more easily accessible on another day than a hospital or imaging center.

Curtailing physicians’ ability to self-refer for imaging studies will require national buy-in, he said.
“Self-referral needs to be addressed on a national level rather than individual states enacting legislation in a piecemeal way,” he said. “The federal government has a role to play in banning the practice.”

To read the story on the original Web site: http://www.diagnosticimaging.com/practice-management/content/article/113619/1926298?CID=rss&cid=dlvr.it

What Health Reform Means for Radiologists

Published on the Aug. 11, 2011, DiagnosticImaging.com Web site

By Whitney L.J. Howell

The health care system as you’ve known it will look drastically different within the next few years, and the radiology industry is set to change with it. If you want to stay afloat and have a competitive practice, you must know which parts of the health reform legislation will affect you and how to handle them.

That’s the message from Robert Still, MD, practice manager for Lancaster Radiology Associates Ltd. in Auburn, Pa. Speaking at the AHRA: The Association for Medical Imaging Management annual meeting in Dallas next week, Still says accountability will be the most important thing to remember as health reform legislation comes online.

“The ways we measure quality in health care and radiology will change. The focus will be higher quality at lower cost,” he said. “As accountable care organizations are introduced, all payments will be bundled and reimbursements will be value based.”

This bundling means you will no longer be reimbursed separately for your services. Instead, your payments will be part of a larger one that includes facility, technical, and physician charges. It could also mean you start assuming a more consultative role in patient care, offering input and making recommendations about which imaging studies are most appropriate, Still said.

This change has industry leaders concerned. They fear policymakers are following MedPAC’s lead in considering bundles or cuts to all the payment codes you use.

“There will be a huge impact in reimbursement if every code is up for grabs,” said Maurine Dennis, senior director of economics and health policy at the American College of Radiology. “Diagnostic radiology is behind the 8-ball and is feeling the biggest impact from reform.”

To read the entire story: http://www.diagnosticimaging.com/healthcare_reform/content/article/113619/1926311?CID=rss&cid=dlvr.it

 

Business Intelligence: Key to a Hospital’s Sustained Success

Published in the Aug. 10, 2011 Billian’s HealthData/Porter Research Hub e-newsletter

By Whitney L.J. Howell

Good patient outcomes might be the goal of healthcare, but the byproduct of these efforts is an avalanche of data. As healthcare reform implementation marches forward, providers are under increasing pressure to use collected information to improve quality and drive down costs.

But for an industry focused on diagnoses and plans of care for multiple service lines, aggregating, analyzing and repurposing patient data doesn’t come naturally. Some providers have, however, found a way to use these records to pinpoint spots for quality improvement, potential cost savings and enhanced patient care.

As a result, they are on target to abide by the mandates of the 2009 Patient Protection and Affordable Care Act and are better prepared for the advent of health information exchange (HIE) and accountable care organizations  (ACOs). They credit their successes with business intelligence (BI) solutions.

Make it Meaningful
Whether it’s a tool to create a cost-effective and efficient work place or one that measures physician performance through key indicators and metrics, BI solutions endeavor to help hospitals make decisions that will keep them competitive within the industry. Simply putting a BI system in place isn’t enough, however. Using these tools well requires a strong partnership between provider and vendor.

“In this reform era, business intelligence has given healthcare organizations a critical understanding of their performance in both cost and quality at both the individual encounter and episodes of care levels,” says Ken Lawonn, senior vice president of strategy and technology at Alegent Health, a faith-based health ministry that operates 11 facilities in Nebraska and southwestern Iowa. “In doing so, it’s useful to get outside expertise to assist you in developing your strategy and plan.”

According to Lawonn, Alegent is laying the groundwork for using BI technologies. The health system is currently developing its data warehouse  – a repository for storing, integrating and, at a later date, accessing patient information. Its nascent data governance model and executive steering committee will help determine who in the system owns the data and how best to use it as an asset.

In addition to useful technology, Lawonn says providers must develop the data management, data administration, and business analytics skills that, to date, healthcare as an industry has been slow to adopt.

Other members of the industry, such as Arkansas Blue Cross and Blue Shield, are using medical and drug claims data, as well as provider information, to identify best practices opportunities for cutting costs and improving operations.

Lean on the Experts
Under the ACO model, set to launch in early 2012, facilities and providers will be equally responsible for patient outcomes. For this goal to become a reality, all parties must share information freely to enhance the care provided and avoid duplicating procedures that waste money and resources.

Electronic health records (EHR) will make this cooperation much easier. As the database responsible for storing patient information from all service lines, EHRs hold the details providers need to make system-wide decisions as ACOs, says Ken Perez, Senior Vice President for Marketing at MedeAnalytics, a California-based company that develops and delivers performance-management solutions to hospitals, physicians and payers. These records also play a role in supporting HIEs in the effort to limit costs, errors and delays in care.

Delving into data through EHRs will allow hospitals to set benchmarks for measures they wish to track. As talk of cost cutting and reducing Medicare reimbursement continues, Perez explains, it will be increasingly important for providers to show how well they are performing.

Larger hospitals can choose to build their own BI solutions, including a data warehouse and report templates, but purchasing a system from a BI vendor can make the process easier.

“Providers don’t need to do all the work themselves,” Perez says. “A vendor can deliver the software they need to stay on top of any measures they want to track, such as outcomes for cardiac patients. The prebuilt report analytics and performance management can easily be considered a long-term investment.”

Buy-In Essential to Successful Implementation
Having the proper technology in place is essential, but it’s only part of the battle. Hospitals and providers must have a plan before they can turn volumes of disparate data into actionable information, according to Tom Simas, Managing Director for Arizona-based BI vendor Midas+ Solutions, a Xerox company.

“The most important thing for a client to succeed is to have the engagement of the leadership at the top,” he says. “Without that buy-in, it’s possible to spend time and resources learning a technology and then have it go nowhere. And the best way to get that support is to show how a BI solution can provide quantifiable data that will help you achieve your objectives.”

For example, a hospital can use BI to gather and analyze outcomes data for all the diabetic patients seen annually in the facility. Using the technology to create a bell curve allows providers to study why some patients responded exceptionally well and why others did not. This knowledge, Simas says, will not only help providers optimize the quality of care, but can also help them eliminate the costs of treatments that don’t work.

It’s also important for providers to select a BI solution that everyone can use, he adds. With quality no longer being the sole charge of one department under the ACO model, these tools can support providers and facilities in the effort to share responsibility for patient outcomes.

Future Thinking Critical to Success
So far, most BI solutions have focused on retrospective analysis of collected data. As patterns and trends in care and outcomes begin to appear, however, these tools will have a more real-time impact.

“I believe these technologies will be increasingly applied to the analysis of the effectiveness of care both retrospectively and at the point of care,” Lawonn says. “This will help identify best practices in care, as well as give care givers more assistance at the point of care to follow guidelines and avoid errors.”

Simas agrees that understanding old data is important and contends that providers will soon be able to use care and outcomes patterns identified in retrospective analyses to anticipate future results. In the next phase of BI solutions, vendors are working to offer predictive analysis abilities that can potentially be used to assist providers in designing new care plans or making proactive business decisions.

However, not every provider will succeed in analyzing the data to improve quality and control costs. The stakes are high for those who fail. It’s likely they will be marginalized in the industry within the next decade, Simas says.

“In the long term, we’ll start seeing a considerable number of smaller facilities being acquired by larger hospitals that do a better job of analyzing data and remaining competitive,” he said. “Although it’s impossible to say a specific number, there is a significant percentage of the 5,000 acute care hospitals in the United States that will be gone in five to 10 years.”

To read the article in its original form: http://www.porterresearch.com/Resource_Center/Blog_News/Industry_News/2011/August/Business_Intelligencex_Key_to_a_Hospitalxs_Continued_Success.html

Reducing Tube Current to Manage CT Radiation Dose

Published on the Aug. 8, 2011, DiagnosticImaging.com Web site

By Whitney L.J. Howell

Using lower fixed-tube current or automatic exposure control techniques when performing adult and pediatric head CT scans can reduce radiation dose and ease concern about cancer risk, according to a recent study published in the Journal of the American College of Radiology.

Head CTs account for 28 percent of all CT scans performed annually nationwide, but there is still a lack of data about the long-term effects of the radiation associated with them. This uncertainty makes it your responsibility to limit the amount of radiation you use to only what is absolutely necessary, said Mahadevappa Mahesh, PhD, associate professor of radiology and cardiology at Johns Hopkins Hospital.

“Across the board, there’s no uniform protocol for head CTs or perfusion head CTs,” said Mahesh, the study’s lead author. “Controlling tube current is the most straight forward way to manage radiation because it has a linear relationship with the amount of radiation you use.”

For example, previous research from the American Journal of Neuroradiology found a radiation dose reduction of 47 percent accompanied a 50 percent cut in tube current. Image quality at this dosage is relatively unchanged.

To read the remainder of the article: http://www.diagnosticimaging.com/low-dose/content/article/113619/1923193

U.S. Radiologists Dispute BMJ Mammography Study

Published on the Aug. 2, 2011, DiagnosticImaging.com Web site

By Whitney L.J. Howell

Calling the results flawed, many in the radiology community are protesting a study released last week that suggested mammography hasn’t played a major role in the drop in breast cancer-related deaths.

The research, published in the July 28 British Medical Journal, compared the reduction in breast cancer deaths from 1989 to 2006 in several Northern European countries and concluded that improved disease management – not mammography – could most likely be credited with the decrease in deaths.

“Our study adds…to the evidence of studies that have used various designs and found that mammography screening by itself has little detectable impact on mortality due to breast cancer,” wrote the study authors, led by research director Phillippe Autier from the International Prevention Research Institute in Lyon, France.

Industry leaders in the United States, however, disagreed. According to them, these results are flawed and contradict proven research on the efficacy of using screenings to catch early-stage breast cancer.

“Improvements in therapy have, likely, played a role in the decrease of breast cancer deaths, but therapy cannot cure advanced cancer,” the American College of Radiology (ACR) and the Society of Breast Imaging (SBI) said in a joint statement. “Early detection via mammography is clearly the major reason for the decrease in deaths in the U.S.”

To read the article in its entirety: http://www.diagnosticimaging.com/womens-imaging/content/article/113619/1917528