Published on the July 27, 2012, DiagnosticImaging.com website
By Whitney L.J. Howell
Last October, the U.S. Food and Drug Administration (FDA) held a meeting to examine the biggest MRI safety concerns and outline best practices to reduce injuries associated with the scans. So far, however, the industry has received no national guidance on how to accomplish this goal.
But the lack of official instruction at the federal level doesn’t mean the push toward greater MRI safety — being recognized this week during MRI Safety Week — has stalled. Advancements are underway at the state level and in the accreditation process to prevent another tragedy, such as the 2001 Colombini case when a 6-year-old boy died when an oxygen tank flew across the room and struck him during the imaging process.
“Any protection that is implemented will benefit the 30 million Americans who get MRIs on an annual basis,” said Tobias Gilk, president and MRI safety director at Mednovus and senior vice president at the design and architecture firm Rad-Planning. “People are beginning to look harder at MRI risk factors as the power of our magnets continue to increase.”
Many states and the Joint Commission have implemented new regulations that strictly govern the design and construction of new MRI suites. These requirements do not mandate retrofitting existing installations.
“There are a growing number of states that are adopting this building code,” Gilk said. “Anyone who does MRI suite work — renovation, upgrade, equipment replacements, anything with a building permit — in virtually every jurisdiction must follow these state standards.”
To conform to the building regulations, health care engineers must meet eight standards, Gilk said. They must follow the American College of Radiology’s (ACR) 4-Zone Principles that addresse integrated access controls and screening practices. There must also be a clear line-of-sight between the operator’s console and patient inside the MRI machine, and designers must include demarcation lines to keep individuals with implantable medical devices far enough away. The presence of ferromagnetic-only detectors is required, and new MRI suites must also have exhaust fans and other protective measures to eliminate any cryogen that escapes into the imaging area.They must include an always-illuminated sign to remind staff that the MRI magnetic field is always active even without a patient.
These new design codes also require a clearly marked safe zone in which staff can use MR conditional equipment. Most importantly, Gilk said, designers and engineers must remember there is no cookie-cutter model for MRI suites. Each site is different and requires individual planning.
In a switch from years past, Gilk said, the Joint Commission is requiring far more documentation to prove you are making your MRI suite as safe as possible for patients. As part of the ACR’s 4-Zone Principles, the Commission now requires proof that you have established access control and provide proper staff supervision. You must also produce documentation that you have adequately trained your MRI personnel in safety procedures and protocols, he said.
“The Joint Commission wants to see evidence of screening protocols for implants and devices, clinical contraindications, and physical screenings,” Gilk said. “They want to see what you’re doing to make sure visitors aren’t carrying objects that will become dangers in the magnet room and what processes or tools are in place that accidents don’t occur.”
Requiring these measures — from an accreditation standpoint — is a giant step forward, he said.
To read the remainder of the story at its original location: http://www.diagnosticimaging.com/mri/content/article/113619/2092918
Published on the July 24, 2012, DiagnosticImaging.com website
By Whitney L.J. Howell
In the wake of the latest proposed radiology reimbursement cuts from CMS, documentation is more important than ever. And experts say your poor documentation may be to blame for your leaving rightfully-earned money unclaimed.
In fact, it’s common for radiologists to forego as much as 10 percent of overall legitimate revenue, according to Richard Duszak, MD, FACR, a radiologist with Mid-South Imaging and Therapeutics in Memphis and regular coding and billing columnist for the Journal of the American College of Radiology. While coders are your partners, they can only file for reimbursement based on the information you provide. It’s your responsibility, he said, to be vigilant.
“Each report must answer three questions: why, what, and how,” he said. “Not the clinical questions, but why did you do the exam, what is the clinical history of the body part imaged, and how was it imaged. Did you use plain films, was contrast present, how many views?”
Problem Areas to Watch
Incomplete documentation in three areas account for approximately 75 percent of unclaimed reimbursement, Duszak said. By addressing documentation problems with clinical history, the use of contrast, and ultrasound, you will likely see your revenue grow.
First, work with your hospital partners to examine how information is documented in the emergency room. Often, referring physicians relay information verbally, and it isn’t recorded in the patient record. Without a properly recorded clinical history, coders must code for the lowest level of reimbursement, and radiologists won’t receive proper payment.
Second, pay close attention to documenting when you use intravenous contrast agents with a CT or MRI study. Failing to notate when you do use contrast reduces both technical and the professional reimbursement.
“Simply failing to mention the introduction of contrast in a CT scan will lead to a loss of legitimate revenue – often as much as 20 percent,” Duszak said. “That adds up over time. Radiologists, as a rule, do a lot of these, so it becomes very significant.”
Third, when performing a complete abdominal ultrasound, be sure to document the eight components required for full reimbursement — the liver, gallbladder, bile ducts, pancreas, spleen, kidneys, abdominal aorta, and inferior vena cava. Missing one immediately downgrades the procedure to an incomplete ultrasound, and, based on the 2011 Medicare Physician Fee Schedule, your reimbursement drops by up to $25.
There are other areas where you could potentially be losing money, said Stacie Buck, president and senior consultant at Rad Rx, a coding consulting company that specializes in diagnostic and interventional radiology services. Fortunately, she said, the fixes are easy.
Always document the number and types of views in the body of the report to avoid having a claim down-coded. And, when documenting 3D reformatted images, note the medical necessity for obtaining them as 3D reformatting isn’t standard for MRI or CT exams.
The Coder’s Perspective
In most cases, Buck said, coders know radiologists are performing services that don’t appear in the documentation, but without written evidence, they can’t help you claim the revenue.
“It is very frustrating to coders when they receive conflicting documentation or incomplete documentation,” she said. “It forces coders to down-code encounters, which, of course, costs a practice or facility money.”
Although it can cause a delay in reimbursement, coders also have the option to come back to you for additional information, said Shirley Breslin, client education and coding training manager for AdvantEdge Healthcare Services, a leading radiology billing company. The length of the delay, however, is up to you.
“Delays in payment depend on how willing a physician is to help us. Having to go back to the radiologist can slow down payment anywhere from three days to a couple of weeks,” she said. “Some radiologists are very conscious of the fact that it’s important to get documentation done and done right. But it really comes down to how well the doctor receives hearing that additional information is necessary.”
To read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2092203
Published in the July 16, 2012, Raleigh News & Observer and Charlotte Observer
By Whitney L.J. Howell
There’s no doubt humans top the evolutionary food chain. But people are, by no means, the most genetically hefty beings on Earth.
Recent research from a North Carolina site of a global plant-development company revealed the tomato has at least 7,000 more genes than humans. And, decoding that genome could make picture-perfect, grocery-store tomatoes taste as good as deformed, homegrown ones.
Since 2008, researchers at Syngenta’s biotechnology hub in Research Triangle Park, along with other scientists worldwide, have analyzed the genetic sequence for two tomato varieties – Heinz 1706, the tomato used in ketchup production, and its closest wild relative, Solanum pimpinellifolium, found in Peru. These investigations revealed tomatoes boast 31,760 genes, many of which scientists are analyzing to determine how they control the fruit’s growth.
“Tomatoes are a model crop that, in many ways, is well understood,” said Bob Dietrich, Ph.D., senior research scientist at Syngenta. “Our main reason for conducting this research is so we have enough information to develop the tomatoes we want.”
Why the tomato?
Although the genetic structures are different, tomatoes are closely
related to potatoes, tobacco plants, peppers, eggplant and nightshade – a toxic member of the potato family. According to Rebecca Cade, a Syngenta research scientist, studying the tomato genome can increase the knowledge base around these and many other plants.
“The tomato is an excellent archetype for fruiting plants,” she said. “There’s been lots of research on how it grows, and scientists and breeders will be able to apply the knowledge gained from studying its DNA to other fruiting crops.”
Syngenta’s team has a multifocused goal with this research, looking for genetic answers to the tomato’s shelf-life, size and firmness. However, the company’s chief concern is helping farmers bring a better-tasting product to market.
“Once we have the finished genome sequence, we’ll be able to tell the differences between a beefsteak tomato and a cherry tomato,” Dietrich said. “With that information, we’ll be able to make a beefsteak with a cherry flavor or vice versa.”
Ultimately, Cade said, the goal is to allow breeders to do predictive breeding.
“In this scenario, someone would say, ‘I need a tomato with this maturity date, this sugar content, and resistant to this pathogen,’” she said. “By looking at our tomato genomes, you can take various seed lines, cross them, and get this type of desired outcome.”
Sequencing the code
According to Dietrich, efforts to decode the tomato genome began in 2009. The work was initially geared toward creating a rough draft of the genetic map that would eventually help breeders create more marketable versions of the fruit. In 2010, Syngenta and its partners teamed up to use different technologies that build upon each other’s strengths and weaknesses, he said.
Syngenta’s global collaborators sequenced 70 percent to 80 percent of the tomato’s DNA using technology that focused on longer reads – segments of DNA long enough to identify when gene components (the bases adenine, guanine, cytosine and thymine) begin to repeat. Scientists were able to identify significant differences among cultivated tomato lines with this amount of data.
But the gaps in the genome still left unanswered questions about which genes could control a plethora of tomato characteristics, he said. Using technology from the genetic-analysis company Illumina, Syngenta analyzed the final one-third of tomato genes using a technique that looks at smaller segments of DNA. In this case, Cade said, this short-read sequencing examined DNA strips with up to 800 bases.
“DNA sequencing is really like a puzzle – it takes a lot of work to make sense of it,” she said. “If you have short reads, you can have billions of pieces and maybe 1,000 of them look exactly the same. With longer-read technologies, you can have bigger pieces that show repeat and unique sequences. So, you need long reads to complement the short reads to get a full picture.”
This long/short sequencing technique is beneficial, Dietrich said, because it opens the door for other tomato varieties to be sequenced more easily. Researchers will now be able to analyze the DNA many other types of tomatoes in far less time and for less money.
While knowing which genes could improve the taste and appearance of tomatoes in the grocery store, understanding the fruit’s DNA and how to manipulate it could impact the global food supply, said Jim Giovannoni, Ph.D., plant geneticist at the Boyce Thompson Institute for Plant Research associated with Cornell University. The majority of Giovannoni’s work is also focused on decoding what part of the tomato genome is responsible for ripening.
Toward a ripe future
“Understanding and potentially controlling the ripening process genetically could increase food security for people in other countries who, at certain times, have a lot of food available but can’t eat it due to rot,” he said. “They don’t have the infrastructure and money to store food like we do, so a genetic solution could have a real effect on food security in the developing world. It would also make our First World issue of shipping food around a less expensive process.”
Specifically choosing certain traits that alter taste, color, texture, and ripening does present trade-offs, however, he said. For instance, a tomato bred to last longer on the shelves might not taste as good. Or one bred for a more home-grown flavor might not have a uniformly-colored skin.
“The reality is that, with this research, we understand more about what genes are responsible for what characteristics, and we can give breeders the tools for selecting certain traits,” Giovannoni said. “There can still be negative outcomes, no matter how small, but breeders can now take the selection of characteristics in their traditional breeding programs to a different level.”
Published on the July 12, 2012, DiagnosticImaging.com website
By Whitney L.J. Howell
A new round of potential cuts to radiology reimbursement has many in the industry expressing anger and frustration. Radiology leaders have called the proposals “arbitrary” and “unfounded,” and all agree the reductions will negatively impact practice management and patient care.
CMS this week released its proposed Medicare Physician Fee Schedule for 2013, calling for a 4 percent to 19 percent drop in radiology reimbursement rates. The proposal would also extend a contentious policy that governs imaging conducted by a single physician during one patient encounter.
“The most important thing to remember is these are the latest in a series of arbitrary cuts to radiology reimbursement that started with provisions back in 2006,” said Geraldine McGinty, MD, chair of the American College of Radiology (ACR) Commission on Economics and the ACR Board of Chancellors. “We’ve long argued that CMS has flawed data, and they continue to single out radiology based on the perception that imaging is a growing market with run-away costs. That’s simply not the case. Imaging and the associated spending levels are back to early 2000s levels.”
According to the proposed rule, many radiology services would see reimbursement levels drop: 19 percent in radiation therapy centers, 15 percent in radiation oncology, 8 percent in diagnostic testing facilities, and 4 percent in nuclear medicine. These cuts would be reallocated as 7 percent reimbursement increases to family medicine physicians and other primary care providers.
The quality of patient care, particularly in outpatient radiation therapy centers, could decrease if these proposed reimbursement cuts take effect as-is, McGinty said. Many of these centers would likely close their doors, limiting patient access to this type of high-quality, cost-effective care.
The industry’s strongest outcry, however, stems from a measure to expand the current 25 percent multiple procedure payment reduction (MPPR) on provider services for CT, MRI, and ultrasound. Currently, the MPPR applies to imaging services rendered by the same physician to the same patient during the same encounter. The new proposal would extend the MPPR to other physicians within the same group practice who performed subsequent procedures in those same patient encounters.
If this proposal becomes permanent, it will have a chilling effect of how providers work together, said Paul Ellenbogen, MD, FACR, chair of the ACR Board of Chancellors.“These cuts discourage doctors from working as a team and pull the rug out from under the very physicians working to save these people’s lives,” he said in a written statement.
There’s also a chance expanding the MPPR will have a significant, negative impact on work flow, said Mike Mabry, executive director of the Radiology Business Management Association. It’s unclear whether smaller or more rural radiology practices would be able to effectively and efficiently change their billing strategies.
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/news/display/article/113619/2090032
Published in the July 2012 Hospitals & Health Networks Magazine
By Whitney L.J. Howell
Risks rise for moms, newborns with elective deliveries
Evidence is mounting that both mothers and newborns are at heightened risk of health problems following nonmedically necessary early-term deliveries. In response, hospitals nationwide are instituting policies to eliminate the procedure.
In late June, the American Hospital Association board of trustees issued a policy supporting those efforts.
Babies are considered full term between 37 and 41 weeks of gestation. Early-term deliveries occur during the first two weeks of this period. The number of elective early-term deliveries — either by induction or cesarean — nearly doubled to 22.5 percent in 2006, up from 9.5 percent in 1990, according to the most recent data available from the Centers for Disease Control and Prevention.
“Women who are induced in the 37th to 38th week have a significantly higher risk of having a cesarean section than mothers who have spontaneous labor,” according to the Leapfrog Group. “And, given low rates of vaginal births after cesarean sections, these mothers are likely to have additional cesarean sections with increasing risks.”
Citing other studies, the patient safety group goes on to note that babies induced during these early weeks are at higher risk of neonatal mortality and morbidity, including respiratory problems. Length of stay also typically increases for both moms and newborns, who are put in neonatal intensive care units.
To control inductions, Utah’s Intermountain Healthcare educates doctors and patients. A team of nurses, physicians and administrators designed a data-rich program to explain the risks of the procedure, says Teri Kiehn, R.N., operations director of Intermoutain’s women and newborns clinical programs.
“Our elective induction rate dropped from more than 30 percent to 2 percent,” she says. “We’ve made significant inroads, and it’s improving. We were at 1.2 percent, and we’d love to reach zero. It’s a work in progress.”
Physicians who ignore the policy meet with Intermountain’s medical director to review existing best practices and clinical evidence. The goal, Kiehn says, is to reinforce that pre-determining times is risky.
Health officials in Minnesota targeted unnecessary inductions in 2009, according to Jeff Schiff, M.D., medical director, Minnesota Health Care Programs, Department of Human Services. The state has a multistep plan to identify necessary inductions, and 70 out of Minnesota’s 90 hospitals participate.
Proposed inductions are reviewed to decide whether they’re necessary. Providers and patients are informed and talk about the risks of an early-term delivery.
“It’s important to stop thinking birth at 37 weeks is OK,” Schiff says. “Our goal is getting people thinking more than 39 weeks.”
To read the article at its original location: http://hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/07JUL2012/0712HHN_Inbox_birthday&domain=HHNMAG
Published on the July 5, 2012, DiagnosticImaging.com website
By Whitney L.J. Howell
It’s no mystery that today’s radiology job market is tight. Many recent graduates chose radiology before the economic collapse when jobs were plentiful, and now they’re struggling to get their foot in the door either in a hospital or a private practice. And, they’re not alone. Older job seekers are also struggling as practices are forced to downsize in an effort to cope with dwindling reimbursement. A recent informal Diagnostic Imaging poll found that only a quarter of groups are hiring, and 53 percent are still thinning the ranks.
At this point, it’s unclear how – or if – Thursday’s U.S. Supreme Court decision on the Affordable Care Act will impact the industry and its job pool, but there are a few tactics job seekers can use now to improve their chances of securing employment.
1. Create a detailed narrative for yourself. It isn’t enough to simply reply to a job posting with your CV and contact information, said Patrick Moore, president of Smart Physician Recruiting. Employers receive at least 20 to 30 applications per job, so you must tell your story to stand out from the crowd.
“Cover letters are a must when applying for a new position,” Moore said. “Tell your story about who you are, what your training was like, and why you are unique. Otherwise, you’re not likely to receive a phone call.”
2. Be willing to work outside your subspecialty. Many practices hire radiologists because of their training in a particular area. But in a growing number of cases, radiologists are being called upon to work outside their wheelhouse, said Geraldine McGinty, MD, chair of the American College of Radiology (ACR) Commission on Economics and the ACR Board of Chancellors.
“Indeed, there are some practices looking for someone to work entirely within their subspecialty,” McGinty said. “But, there are many who need someone flexible – someone who will do something other than what they learned during fellowship. Job seekers must have a willingness to pitch in.”
3. Pick your desired location wisely: If you’re applying for a job in a different geographic location, have and share the specific reasons why you chose it. It isn’t uncommon in this tight job market to see graduates from New England schools applying for jobs in the Southwest without any clear ties to that region, Moore said, and it’s easy for employers to spot someone who is applying wildly in the hopes of finding a job.
“If you do want to choose a different geographic region, seek out practices in that area while you’re in residency or during fellowship,” Moore said. “Make phone calls. Connect with them at conferences. Explain your reasons for wanting to come to their region because they’re looking to find people who will be long-term hires.”
To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/content/article/113619/2088125