Quality and Safety Letters

Practice Parameters & Technical Standards

Appropriateness-Criteria.

Quality Measurement

Radiology Safety

Contrast Manual

Additional Quality & Safety Resources

Radiation Safety Officer Training Materials

February 2017

FRS President’s Message

With Donald Trump assuming office of President and the forming of a new government administration comes many changes including healthcare policy. Since it is not possible to determine how things will play out, our best strategy may be to proceed by meeting the challenges of current policy with anticipation of healthcare policy evolution and intent to adapt as appropriate during these times of change. With this perspective in mind, a few currently salient items in the news are as below:

Recently in the news:

The lengthy process of finalizing membership to the roster of the US House of Representatives is currently underway. The ACR government relations office has been working closely with both the Ways and Means Committee and the Energy and Commerce Committee due to their direct jurisdiction over healthcare issues and policy to include Medicare related legislation. To read more on recent house nominations click here to link to the ACR article entitled “Key U.S. House Committees Announce New Members”.

The Centers for Medicare & Medicaid services (CMS) released an article in mid-December highlighting changes to payment policies to take effect in the calendar year 2017 Medicare Physician Fee Schedule (MPFS). To review changes affecting radiology and telehealth click here to access the ACR article entitled “CMS Summarizes 2017 MPFS Policy Changes”.

CMS provides several different options for eligible clinicians to the weight the Advancing Care Information (ACI) performance category in the Merit-based Incentive Payment System (MIPS) to zero, effectively exempting the participant from reporting ACI. To read a summary of these options click here to access the ACR article entitled “ACR Clarifies ACI Options in MIPS”.

At its January 13th meeting, the Medicare Payment Advisory Commission (MedPAC) considered options for raising Medicare payments for primary care physicians while reducing reimbursement for specialty physicians. MedPAC commissioners were largely unsupportive of the proposed options and instead most favored a complete overhaul of the Medicare Physicians Fee Schedule. MedPAC however does recognize the possibility of a future shortage of primary care physicians and therefore has determined to continue exploring potential solutions in future meetings. To gain more insight on this topic click here to access the ACR article entitled “MedPAC Targets Specialty Reimbursement”.

As this E-brief goes out, we will have recently conducted our annual winter board meeting. I would like to take this opportunity to thank all board members, FRS members, physicians in training and staff who not only participate in board meetings but also donate time and resources throughout the year working tirelessly volunteering for various committees and serving as officers to develop and implement FRS initiatives that help fulfill our society mission. Your support is instrumental in making the Florida Radiologic Society one of the strongest and most well-respected state chapters in the ACR.

B. Nicholas Hatton, M.D.
President, Florida Radiological Society

October 2016

FRS President’s Message
The practice of radiology is continuously evolving with new regulations and standards constantly on the horizon. Two such issues on the near horizon are a new Food and Drug Administration (FDA) mammography quality improvement program and upcoming Centers for Medicaid and Medicare (CMS) mandated consultation of appropriate use criteria as discussed below.

The FDA unveiled a new program on September 16, 2017 at the National Mammography Quality Assurance Advisory Committee (NMQAAC) in an effort to address mammographic MQSA quality standards.

The new program referred to as Enhancing Quality through the Inspection Process (EQUIP) is intended to address the MQSA requirements for Lead Interpreting Physician (LIP) oversight of quality, the Interpreting Physicians’ (IPs) responsibility to follow facility corrective action procedures if asked to interpret poor quality images, and a facility’s responsibility to continuously comply with the clinical image quality standards established by its accrediting body.

To implement EQUIP, the FDA will be including questions in its facility inspection addressing image quality assurance procedures, IP feedback and LIP oversight. The FDA is planning go live of EQUIP in November/December 2016.

For more details regarding the FDA EQUIP click here:

CMS will soon require referring physicians to consult specified appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services (ADIS) in order for the furnishing provider to receive Medicare reimbursement. CMS has designated qualified Provider-Led Entities (qPLEs) to specify AUCs under the Medicare Appropriate Use Criteria Program.

Radiologists will be directly impacted by this regulation, anticipated to be implemented by January 1, 2018. Providers of ADIS (CT, MRI and nuclear medicine, including PET) will not receive Medicare reimbursement if the referring physician has not documented which specified AUC was consulted prior to placing the order.

The ACR was named in June as one of the 11 qPL’Es approved to specify AUC for advanced diagnostic imaging. Referring physicians will be able to consult ACR appropriateness criteria to fulfill AUC consultation requirements.

With the ever changing landscape of health care delivery, providing imaging and therapeutic services to our patients presents ongoing challenges. It is paramount that we support of FRS and ACR RADPAC to enable them to work in our best interest on critical legislative issues that will directly impact our ability to deliver care to our patients. I strongly encourage everyone to contribute to RADPAC today.

B. Nicholas Hatton, M.D.
President, Florida Radiological Society

September 2016

Letter from the Editor
As the past few weeks have flown by since our highly successful Annual Meeting of the FRS/FRBMA in Amelia Island, I have tried to educate myself a little more on upcoming planned changes in our health reimbursement system. This was discussed at the meeting, in many ways raising more questions than answers in my mind. As we were made aware, MACRA, the Medicare Access and CHIP Reauthorization Act is an extremely important piece of literature and is thought to be the most significant reform in healthcare since the Accountable Care Act passed and one of the most significant industry developments since the creation of Medicare in the 1960’s. In essence, MACRA will act as a CMS catalyst to create payment reform in all commercial health care markets. I am truly not an expert in MACRA or health care reform, but would like to pass along to FRS membership some informative links that were provided to me by our Chairman of Radiology at Mayo Clinic Jacksonville, Dr. Mark McKinney. Please use these links to educate members of your radiology practices in order than we can be best prepared for these upcoming changes. These links are as follows:

ACR MACRA Resources Everything you need to know about MACRA but were afraid to ask by Katharine Krol MD FSIR
Why the MACRA start date debate misses the point | Health Data Management

Thanks for joining me in this process of education and preparation. These initiatives should provide radiologists, the best stewards of radiologic imaging, a unique opportunity to set the bar on imaging quality for all practices in medicine that utilize and perform radiologic procedures.

Pat Mergo, MD, FACR
Secretary, Florida Radiological Society
Mergo.patricia@mayo.edu

April 2016

FRBMA President’s Message
As I have talked with a number of different groups this past couple of months, I am always surprised at how many issues we have in common. When it comes to concerns that most of us are concentrating on this year, there is no shortage of topics. For the purpose of initiating discussion in these areas, I have listed some of the hot issues I am hearing from FRBMA members here in Florida this month.

  1. How to make sure that their practice avoids any penalty with the new PQRS measures.
  2. How to measure and compile quality data for your hospitals
  3. XR-29 standard compliance
  4. How to market a Low Dose CT lung Cancer Screening Program
  5. Should we consider an “early out” billing program?
  6. How can we maintain IT security? How to protect against ransom ware
  7. Medicaid mammography billing issues due to changes in G- Codes
  8. Lawsuits against radiology practices due to patients being billed after a notice of attorney representation that was never sent to the practice, or for billing patients who have a worker’s compensation claim that was never communicated to the practice.

Do any of these sound familiar? Do you have any success stories you would like to share? Let’s keep a dialogue going on the FRBMA forum. Also, please check your calendars to make sure you are available to attend the FRS/FRBMA meeting at the Ritz Carlton at Amelia Island August 5th through the 7th. This will be a great opportunity to discuss some of these and so many other issues with your colleagues.

Ed Goodemote PhD, RN President, FRBMA
Chief Executive Officer Radiology and Imaging Specialists
Lakeland, Florida
EGoodemote@risimaging.com
863-577-0303

March 2016

FRBMA President’s Message
After attending a recent meeting where Dr. Steve Miles discussed the CMS Value Modifier Program, I was prompted to learn more about the program and the impact on our practice reimbursement. The Value Modifier program is designed to compare each practice group based on the quality of care and the cost of care. This past year, the program was phased in starting with groups of 100+ radiologists, using the 2013 PQRS results for each group.
In September of 2015, CMS made the first Quality and Resource Use Reports (QRUR) available to every group practice and solo practitioner nationwide, based on their taxpayer identification number. These reports are constructed from your 2014 PQRS reports and CMS calculated outcomes and cost measures. There is a Quality Composite Score and at Cost Composite score. Each score is analyzed based on the standard deviation above or below the national mean score. The combined cost and quality scores are then displayed on a scatter plot where you can see how you performed compared to a representative sample of groups. This program will ramp up through 2018 when all practitioners will be subject to potential upward and downward payment adjustments.

There are many details to this Value Modifier Program which I cannot begin to address in this brief article. However, it is most important for each practice to check out their QRUR score, and begin to understand the program and how it works. This could have a significant impact on your future CMS reimbursement. For more information on how to obtain your practice QRUR score, visit the CMS site and enter the QRUR score. The process takes a few minutes and does require that you first set up an Enterprise Identity Management System Account (EIDM) before you can gain access.
As you begin to review your scores, please don’t hesitate to share your questions and comments with your colleagues at FRBMA.
Reminder: It‘s not too soon to begin planning to attend this year’s FRS/FRBMA meeting at the Ritz Carlton on Amelia Island August 5- 8, 2016. Once again this promises to be a great learning and networking opportunity.

Ed Goodemote PhD, RN President, FRBMA
Chief Executive Officer Radiology and Imaging Specialists
Lakeland, Florida
EGoodemote@risimaging.com
863-577-0303.


November 2015

FRBMA President’s Message
Well, so far so good on ICD-10! I have talked with a number of medical practice administrators and everyone seems to be coming to the same conclusion. So far, it is a non-event, and we are all incredibly grateful. The CMS Grace period seems to have really helped.

On another important subject, CMS is expected to soon release its final rule updating payment rates and quality requirements for services in FY 2016. These rules are particularly important because this is the first look at expected changes since the repeal of the Sustainable Growth Rate (SGR). The SGR is being replaced by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which was signed into law in April of this year.

MACRA is going to have a number of important impacts on our practices and we need to pay close attention to the details. First, it will now dictate the Medicare Physician Fee Schedule (PFS) updates. From 2016 until 2019, payments are expected to increase by .05% annually. Second, it defines two new value-based payment tracks for physicians; the Merit–Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). A detailed discussion of these is certainly not within the scope of this article, but I hope this brief mention will encourage you to further explore this topic.

MIPS includes the Physician Quality Reporting System (PQRS), the EHR Incentive Program and the Physician Value Based Modifier. Starting in 2019, each radiologist will receive a MIPS score. The MIPS score is a combination of four categories (Quality, Resource Use, Clinical Improvement and EHR). A threshold will be set and if a radiologist has a lower score, there will be a financial penalty, while a higher score will result in a higher payment. The MIPS score will be available to the public on a site called Physician Compare.

If a radiologist receives a certain percentage of revenue from Alternative Payment Models, he or she will be able to opt out of MIPS and also be eligible for a bonus. APMs are basically those programs which require physicians to take on some financial risk. These are programs like Accountable Care organizations (ACO’s) and other innovative models.

As CMS moves reimbursement away from Fee-For-Service, we need to pay very close attention to the impact of MACRA on our practices. Take some time and visit the ACR or RBMA sites to learn more about this important new approach to value-based reimbursement.

Finally, I want to remind everyone to attend our FRBMA Winter Retreat in Orlando at the Reunion Resort January 28-29, 2016. It promises to be a great networking and educational event.

Ed Goodemote PhD, RN
President, FRBMA
Chief Executive Officer Radiology and Imaging Specialists
Lakeland, Florida
EGoodemote@risimaging.com
863-577-0303

September 2015

FRS President’s Message
As summer winds down and kids go back to school the FRS kicks into full gear. We are already hard at work planning next year’s annual meeting at Amelia Island and strategizing for the upcoming political “adventures” the state legislature will have in store for us, including possible redistricting which could affect many of our members.
As many of you know, the Joint Commission changed many of its requirements July 1st of 2015, many of which directly affect radiology services. It is important that you be familiarized with these new requirements at it applies to any of your facilities that are Joint Commission certified. A few of the important changes include:

  • A patient’s CT radiation dose index must be recorded and made available in a retrievable format (It does not however; need to be inserted directly into the patient’s interpretive report).
  • Patient identifiers/parameters must be verified prior to imaging (verify the correct patient, correct imaging site, correct patient positioning and for CT the correct imaging protocol and scanner parameters). This rule applies to organizations that provide CT, MRI PET or nuclear medicine services.
  • Organizations must create and adopt protocols that include how much radiation patients are expected to be exposed to for each CT examination.
  • CT exam standards must be periodically reviewed for radiation dose optimization and the patient’s age and prior imaging (radiation exposure) must be considered.

To view the full document click here.
During the next year I will try to keep our members informed of important business and legislative issues that affect your practice as well as updates on the leadership work and accomplishments. It should be a very busy year.

In closing, I would like to ask every member to strongly consider contributing to the FRS PAC. These funds ran dangerously low the past few months and are vital to supporting the political mission of the FRS and the practice of radiology in Florida. YOUR radiology practice depends upon it and allows Alison Dudley to have an impact at the state capitol protecting the best interests of our patients and practices. Any size contribution is welcomed and vital to our future. Contributions can be made through the FRS website as well as further information on this vital political action committee at: http://flradpac.org.

Jeffrey Stone, MD, FACR
President, Florida Radiological Society
stone.jeffrey@mayo.edu

August 2015

Letter from the Editor
As we welcome a new slate of FRS officers in this bulletin, radiologists in Florida are faced with 3 things they can count on: death, taxes, and uncertainty over how they are going to get paid in the future. At the recent ACR Annual Meeting and Chapter and Leadership Conference in Washington, DC, the Deputy Director from CMS gave a talk in which he outlined that by 2016, HHS expects that 85% of Medicare payments will be linked to quality or value and that by 2018, 90% of payments will be value-based. That includes fee-for-service (FFS) payments, on which most of us still depend to pay our bills. Additionally, CMS plans to shift 30% of its FFS payments to alternative payment models such as Accountable Care Organizations (ACOs) and bundled episodes of care by 2016, rising to 50% by 2018.

All of this is occurring in the setting of marginal success at best for CMS programs introduced to help move Medicare towards its goal of purchasing “higher value” health care in the future. The first CMS-promoted ACOs, termed Pioneer ACOs, had fairly a high percentage of organizations drop out of the program secondary to poor financial performance. Paying for bundled episodes of care so far sounds a lot like capitation by another name and we all know how that experiment turned out last time it was tried.

In the current FFS system, the Physician Quality Reporting System (PQRS) has not particularly added value or improved care in radiology to date, rather adding additional reporting requirements and additional practice expense. Indeed, many smaller practices have made the business decision not to participate in PQRS. Many practices report implementation of the meaningful use (MU) program as a net financial loss and some practices have not even received MU payments they thought they were qualified to receive.

What happens in the future is anyone’s guess. My guess is all near term solutions in radiology will look more like further reductions in fee-for-service than not. These issues are not lost on the American College of Radiology. The ACR is hard at work protecting the House of Radiology in future payment models, including its Imaging 3.0 program and its exceptional lobbying efforts in Washington. While success is not guaranteed, failure is almost a sure bet without the efforts of the ACR. These efforts stand to benefit all radiologists, not just the ACR membership. Yet a significant number of practicing radiologists in Florida are not current members of the ACR. Maybe it’s time for all radiologists in Florida to seriously consider an active membership in the American College of Radiology and Florida Radiologic Society.

Steven DePrima, MD
Secretary, Florida Radiological Society
sjd_md@bellsouth.net

June 2015

Letter from the Editor
First I would like to say kudos to all our members for winning the ACR’s Excellence Award for State Chapters. Thank you to everyone who worked tirelessly to showcase our many accomplishments. It is an honor to represent our state at the national meeting, this year more than most.

This year’s all member ACR meeting was a success. Looking back, Dr. Ellenbogen’s presidential address left a lasting impression. Sure, Colin Powell’s keynote was awesome, but Dr. Ellenbogen’s seemed more practical. He cleverly asked what the world would be like without the ACR. In exploring this scenario, he highlighted the past accomplishments of ACR and the critical roles the ACR plays in our current profession. Maybe I liked his speech the most because it addressed the constant questioning of the ACR from our friends and colleagues. He makes a few good points we can take back to our practices. Did you know that the ACR influenced Congress to make Radiology part of Medicare B, ensuring our survival as independent physicians and not hospital services? Did you know the ACR created the relative value system preventing DRG’s for physicians? The ACR is continually adapting in an environment of constant change. This should be applauded and communicated to all radiologists. As he stated, the ACR “empowers us to advance the practice, science and profession of radiological care.” Through their foresight, they are ensuring that radiologists are universally acknowledged as physician leaders in the delivery of advanced, high quality healthcare, thus preserving our profession from the many external threats.
A video of his full speech is on the ACR website. It’s worth watching again and sharing with other radiologists unable to attend the meeting.
Click here to view video
Daryl Eber, MD Secretary, Florida Radiological Society daryleber@gmail.com


FRBMA President’s

How is your strategic plan coming? What? You don’t have one or it seems to be a moving target. Well join the club. I realize there have been many times of uncertainty in the world of radiology, but this time it seems to be over the top. It is becoming very difficult for practices to operate in a time of so much ambiguity. Let face it, we are receiving so many mixed messages.

On one hand, we are trying to plan for alternate payment models as we are told that our future is moving from volume to value–based payments. On the other hand, we are told that no one really knows what that value-based payment system will actually look like, except that we will all be paid less. When considering relationships with our hospitals, some tell us that all radiologists will be employed by hospital systems, while others say radiologists will be employed by national investor owned radiology companies. Another camp believes that large radiologist owned mega groups will control all of the hospital contracts.

How about planning for your imaging centers? I am hearing from consultants and speakers that all groups should immediately sell their imaging centers to hospitals. Others predict that there will be a major shift back to outpatient work and that radiologists should hold on to those centers.

I could go on and on with a list of contradictions that we are hearing throughout Florida and the nation. Although I certainly don’t pretend to have any better answers than the next guy, I do believe that there are a couple of fundamentals that will keep groups moving in the right direction. First is that we need to continue to focus on providing the highest quality care and service at all levels. Second, we need to stick together. It is time to step up and meet with other groups and to carefully monitor what is going on. I’m not sure what radiology practices will look like in the future, but to quote Abraham Lincoln, “The best way to predict the future is to create it.” Let’s make sure we don’t just stand by and let it happen to us.

I hope to see everyone at the FRS/FRBMA meeting in Key Biscayne on July 17-19. It will be a great opportunity to network and hear from some of the top speakers in the field of radiology. Create your future!

Ed Goodemote PhD, RN
President, FRBMA
EGoodemote@risimaging.com
863-577-0303

March 2015

FRBMA President’s Message
Each year at this time, I find myself trying to determine if this is going to be a good year for our practice. We have completed the first two months and we are starting to get an early picture of volumes and collections. Obviously these are the most critical indicators, but over these past few years I have come to realize that the foundation of success for any radiology practice is the quality of our service. So, my question to all of our FRBMA and FRS members is “How are you measuring and improving the quality and safety of care for your patients?”

The literature today is packed with articles about how important it is to measure and improve quality and safety. This is especially true with the Affordable Care Act requirement for future value–based payments. But when it really comes down to measuring the quality of your service, the process is not as simple as it may seem. Most all of us in hospital based practices are measuring inpatient and ED turnaround time, peer review, communication of critical findings, patient satisfaction, medical staff satisfaction and radiation safety. If you are not at least attempting to measure these, you ought to be. These performance indicators have emerged as the minimum standard in hospital based radiology groups.

As I talk with Administrators of other practices, the complexity of the measurement of radiology service levels seems to be in both the data collection methodology and the development of standards. Everyone seems to be approaching it from a different direction and no one seems to be pleased with the process. As we all continue to grapple with this, FRBMA is here to serve as a clearinghouse for your questions or ideas. Send us your ideas and we will share them through this Forum and at our summer meeting in Key Biscayne in July. Let’s make quality improvement a key focus for 2015.

Ed Goodemote PhD, RN
President, FRBMA
EGoodemote@risimaging.com
863-577-0303

January 2015

FRS President’s Message
On December 16th, the Food and Drug Administration (FDA) strongly discouraged the use of over-the-counter (OTC) fetal ultrasound and doppler imaging for creating fetal keepsake images and videos, as well as Doppler ultrasound heartbeat monitors – click here to view the article. The FDA endorsed the performance of these procedures only by trained professionals under clinically necessary circumstances. The article mentioned the potential side effects of sonographic tissue heating and soft tissue cavitation, with unknown long-term effects upon the babies. The FDA is aware of several companies in the United States that are commercializing sonographic imaging by making fetal keepsake videos. The government agency voiced its concern, since the ultrasound machine may be used for as long as an hour to obtain the video, and the keepsake video offers no medical benefit. In creating fetal keepsake videos, there is no control on how long a single imaging session will last, how many sessions will take place, or whether the ultrasound systems will be operated properly.

Respectfully Submitted,
Laura W. Bancroft, MD
President, Florida Radiological Society
Laura.bancroft.md@flhosp.org

October 2014

Letter from the Editor

Change is coming. Technology has revolutionized so many industries including medicine, but the pace seems to be getting faster. We are all familiar with the breakthroughs over the last century, but a new type of technological change is taking place. This change is directly affecting health care consumers and in many ways is similar to the disruptive uber-type technologies that some of us use. Case in point is that a company called Theranos is redefining lab testing. They perform blood tests with a single fingerprick that draws only a tiny drop of blood. With that single drop they run hundreds of blood tests far more quickly and cheaper than could be done with a whole vial of blood. More importantly, they just signed a deal with Walgreens pharmacy for consumer friendly distribution. The tests can be done without going to the doctor, saving health care dollars by eliminating doctor visits. Even more disruptive, they display the pricing for the blood tests on their website and at the test facility, a “test menu” as they call it (http://www.theranos.com/test-menu?ref=our_solution).

The newly minted billionaire behind Theranos stated that she targeted lab medicine because it drives almost 80% of clinical decisions made by doctors and it was incredibly inefficient. I have to admit, I got a little nervous after reading her story. A few Frank Lexisms started running through my head. He’s been radiology’s canary in the coal mine for quite some time. We often like to jest that radiology drives 100% of clinical decisions, especially in the ER, and we always complain how inefficient things are. If this is the case, we have a giant target on our head, just like lab testing. Look no further than the $400 million Thanos raised at a $9 billion valuation. I guarantee that there is a 19 year old Stanford drop out looking at medical imaging right now. The impact of this change to radiologists is unknown, but in all other industries costs have gone down and quality, or customer satisfaction, has gone up.

Daryl Eber, MD
Secretary, Florida Radiological Society
daryleber@gmail.com

September 2014

FRS President’s Message
ACR’s Clinical Data Registries

For Florida radiologists participating in the American Board of Radiology’s (ABR) Maintenance of Certification (MOC) program, the ACR offers several national database registries which will fulfill requirements for the Centers for Medicare and Medicaid Services (CMS) Physician Quality Reporting System (PQRS). These growing databases are CMS-approved entities that collect information from radiology practices for the purpose of patient and disease tracking, with the intention of improving the quality of care for patients. In 2014, CMS approved the ACR National Radiology Data Registry (NRDR) as a Qualified Clinical Data Registry (QCDR). Currently, the ACR offers several programs to its members – the Dose Index Registry (DIR), General Radiology Improvement Database (GRID) Registry, IV Contrast Extravasation (ICE) Registry, National Mammography Database (NMD) Registry and CT Colonography (CTC) Registry. The ACR also collaborates with the American College of Radiology Imaging Network (ACRIN) and Academy of Molecular Imaging (AMI) to offer the National Oncologic PET Registry (NOPR).

For interested radiology groups, it’s not too late to participate in the 2014 data collection. The ACR’s program supports 15 PQRS measures, but each group only needs to measure 9 that are of interest to you. Data submitted to CMS cover quality measures across multiple payers and is not limited to Medicare beneficiaries. Each of the registries aggregates data in order to establish national benchmarks for optimal radiology practice, such as CT dose, patient turnaround times, wait times, incident rates, intravenous contrast extravasation during CT, breast cancer detection rates, positive predictive value rates and recall rates. For more information, please refer to the ACR website at: www.acr.org/Quality-Safety/National-Radiology-Data-Registry/Qualified-Clinical-Data-Registry.

Respectfully Submitted,
Laura W. Bancroft, MD President
Florida Radiological Society
Laura.bancroft.md@flhosp.org
407-303-8178

May 2014

Letter from the Editor
The American College of Radiology continues to be a strong advocate of our specialty on several fronts.  On April 7, the ACR submitted a written response to the Centers for Medicare and Medicaid services (CMS) request for information (RFI) on specialty payment models. The ACR response highlighted imaging 3.0 as well as ACR plans to develop episode of care payment models. For further discussion of the ACR’s response, read the ACR article entitled “Role of Radiology Highlighted in ACR Response to Payment Model RFI”

Additional comments by the ACR were submitted to CMS on April 8 further describing how imaging 3.0 maybe applied in the transition from volume-based to value-based practices. To read more about these additional comments read the ACR article entitled “ACR Urges CMS to Consider Imaging 3.0 a Transformational Clinical Practice Model”

The Imaging 3.0 Initiative scored positive points when the ACR hosted a unique New Payment Model Discussion Forum April 14, 2014. The event brought together radiologists, imaging administrators, economists, and public policy experts to brainstorm constructive responses to proposed value-based models of care. To learn more about this forum this recent ACR forum read the article entitled “Payment Model Forum Affirms ACR Strategy”

These and other initiatives by ACR are instrumental in affecting positive change for our specialties cumulative benefit. We should also keep in mind that we as FRS and ACR diplomats must be involved and do our part through grass roots efforts through society generated email campaigns and support of state and national RADPACs along with other efforts. With a united front, our voice will be heard.

Many of our Florida colleagues and myself are participating in the ACR 2014 AMCLC Meeting in Washington, DC at the time this letter is penned.

I am proud to announce that the Florida Radiologic Society won ACR Chapter Award in Quality and Safety. Additionally Dr. Cody Odell (Second-year radiology resident from Florida Hospital Orlando Program) won first place in the ACR Resident and Fellow section Poster Session for their poster entitled “Instituting Governmental Regulations and Advocacy into the Radiology Resident Curriculum: a Pilot Study”.

More on this year’s AMCLC meeting will be discussed in the next Ebrief issue.

B. Nicholas Hatton, M.D.Secretary,
Florida Radiological Society
nhattonfrs@gmail.com

February 2014 

FRS President’s Message
The FRS is pleased to release the results of our January Membership Pulse Survey. The survey was designed by our Past President Joe Cernigliaro. Joe is now on the ACR Council Steering Committee. The survey results were presented at the Council Steering Winter Retreat in January. The results of our Florida membership survey opened the minds of many in attendance.

The question as to the likelihood of hiring a new resident or fellow with the 15 month window raised much discussion. Although most of us in practice are not surprised with a high percentage indicating “no” many in leadership of the ACR were surprised and now recognize the need to review this situation. Our Florida survey will be of value to all in radiology in order to better prepare for the future.

The question regarding the likelihood of hiring in the near future was a pleasant surprise. It is good for all of us to recognize that the job outlook may now be improving for our well trained residents. The residents from Florida that I have met are exceptional, well trained, and are ready and willing to become an integral part of our Florida practices. Many have done very well and are well thought of by groups in other states. Most would prefer to stay in Florida and now we can anticipate some improvement in hiring.
Download Survey Results Here

I would like to thank all of you who participated in this first survey. You can see that this did not require much time to complete …60 seconds at most. The FRS will continue with more surveys to come and will share the results with all once they are completed. Hopefully, with more of our memberships involved, we can better address and find answers to the increasing pace of changes to our practices and education environment.
Respectfully Submitted,

Dan Singer, MD, FACR
President, Florida Radiological Society
d44sing@gmail.com
(239) 734-0434

January 2014 

Letter from the Editor
As 2014 begins, changes in the medical imaging environment continue to evolve. Since the Accountable Care Act is now recently implemented and we can expect significant increase in the number of insured patients, presumably imaging utilization will increase. We are faced with the issue of over utilization causing fiscal problems to the health care system and the potential of unnecessary radiation exposure to our patients.

Our colleague clinicians are beginning to appreciate the issue of over utilization, evidence by other specialty society Initiatives. As an example, the American Board of internal medicine developed the Choosing Wisely initiative implemented April 2012, which is now widespread and has been adopted by 26 non-radiology societies with the aim of decreasing diagnostic testing over-utilization. A recent article entitled “Radiologist must engage with Choosing Wisely initiative” was published on AuntMinnie.com elucidating this topic in relation to radiology services. To read more click on the following link: Radiologists must engage with Choosing Wisely initiative

The ACR is addressing over-utilization with their appropriateness criteria initiative. The ACR Appropriateness Criteria® are evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. To learn more about this ACR initiative click on the following link: http://www.acr.org/Quality-Safety/Appropriateness-Criteria

Our specialty will thrive if we embrace change and adapt with a value added mentality.
 
B. Nicholas Hatton, M.D.
Secretary, Florida Radiological Society
nhattonfrs@gmail.com
  

October 2013

Letter from the Editor

With current headlines in the news revolving around health care reform, it is not yet clear how radiology will fare. There is no doubt that with the implementation of the affordable healthcare act that the business of medicine is changing. Our delivery of medical imaging must evolve in order to flow with the tide of change.

At the American Hospital Radiology Administrators (AHRA) annual meeting in July 2013, Bob Maier, president and CEO of Regent Healthcare Resources provided insight into the challenges medical imaging may experience as healthcare reform is implemented.

According to Maier, “Healthcare providers are transforming into new interconnected systems and the old relationships that drove patient referrals in the past may no longer work. Reimbursement is morphing from fee for service to population-based managed-care models and risk-based bundling payments.”

It is critical that medical imaging maintain a defining role in improving patient care quality and outcomes. This may be achieved through strategic planning that supports the overall goal of the parent organization, whether that is a hospital, healthcare system, or imaging center.

The current iteration of health care reform is exemplified by Accountable Care Organization (ACO). “Although payers are still firmly entrenched in fee-for-service model, they are preparing for capitation and population health models – ACO”

“Quality is the subjective measure of service provided and how it compares to competitors. Outcome is the measure of effectiveness of that service and the resulting effect on the health of the patient.”

Maier suggest that radiologist may measure quality and outcome in several ways as follows.

Measure quality by:

  • Using automated appropriateness evaluations
  • Performing the correct test the first time, every time
  • Communicating appropriately with referring physicians      and patients
  • Making previous images available for comparison from      any location

Measured outcome by:

  • Make cost of the exam clear
  • Transmitting diagnosis immediately
  • Offering interpretations early and accurately

To read more click http://www.auntminnie.com/index.aspx?sec=sup&sub=imc&pag=dis&ItemID=104166.

The ACR has developed the Radiology Leadership Institute (RLI) to help radiologists hone leadership skills that will better equip them to evolve and succeed in the ever changing environment of health care delivery.

To learn more about RLI click http://www.acr.org/Education/RLI.

B. Nicholas Hatton, M.D.
Secretary, Florida Radiological Society

September 2013

Letter From the Editor
In this issue of E-Brief, I would like to focus on some changes the American Board of Radiology is making to the credentialing process.  Graduating residents enter into a new era as the American Board of radiology discontinues oral examinations and begins computer-based testing.  Many practicing radiologist are now faced with maintenance of certification (MOC) projects and re-examination that is “a work in progress” by the ABR. CMS offers incentive to Radiologists participating in an approved Physician Quality Reporting System (PQRS).  The last major ABR oral examination for diagnostic radiology was recently given in June 2013 in Louisville, Kentucky. It was one of the largest oral examinations, with 2,042 candidates and 415 examiners in diagnostic radiology, medical physics, and radiation oncology.

In September to October 2013, the first class of diagnostic radiology trainees will sign in to the ABRs Chicago and Tucson examination centers to take the first computer-based Core Examination. According to Gary Becker, MD, ABR Executive Director, the new exam format will help to maintain the public’s confidence in the skills and knowledge of ABR diplomats while providing a higher level of examination standardization to ensure fairness in the evaluation of candidates. For more information on the transition from Oral Exams to the new ABR Core and Certifying Exams, see www.theabr.org/transition-to-EOF-Exams.

Things are also evolving for some of us who are faced with maintenance of certification (MOC) projects and re-examination that is “a work in progress” by the ABR. Beginning in 2014, there will be changes to the MOC examination. A new section has been added to the practical profile portion of the exam that will be a general category aimed toward candidates in a general practice who do “a little bit of everything”. As before, a candidate may choose three separate areas to be tested, three areas of the same discipline to be tested, or a combination of two disciplines to be tested in.

To review the MOC Study guide: www.theabr.org/moc-dr-study

In a recent email blast, the ABR stated for ABR Time-Limited Diagnostic Radiology, Radiation Oncology, and Subspecialty Certificate Holders the Center for Medicare and Medicaid Services (CMS) has given the American Board of Radiology (ABR) final qualification to participate in the 2013 Maintenance of Certification Physician Quality Reporting System (MOC: PQRS) Program Incentive, clearing the way for ABR MOC participants to have access to the additional payment incentive again this year.

Effective for calendar year 2013, physicians who meet specified requirements may have their applicable PQRS quality incentive for 2013 increased by 0.5%.

You may opt in to MOC: PQRS and attest to meeting the 2013 requirements through my ABR at no charge. Log in at https://myabr.theabr.org and then click on the “Optional Programs” link found in the box on the left. Click on the “Go” button next to “2013 MOC: PQRS” and then follow the instructions to enroll and accept the Participation Agreement.”

To read more about these and other salient issues: ABR NEWS AND UPDATES http://www.theabr.org/news-landing#newsletter

B. Nicholas Hatton, M.D.
Secretary, Florida Radiological Society
nhattonfrs@gmail.com

May 2013

Letter from the Editor
 May has arrived and summer is fast approaching. As this issue of E-Brief comes your way, many of the FRS councilors and alternate councilors have returned from Washington, DC having attended the AMCLC. This meeting once again culminates with visits to our congressmen and senators on Capitol Hill. We will highlight the events in the June issue of E-Brief for those who did not attend.

In March, I had discussed efforts to repeal and replace the sustainable Growth Rate (SGR) used by CMS. This in part was started in January via a National Journal policy forum held and underwritten by the AMA. In the absence of federal legislation, we once again face extreme cuts in Medicare reimbursement come January 1, 2014 of 24.4% due to the SGR. On April 15th, Paul Ellenbogen, MD, FACR; Chair of the ACR Board of Chancellors, submitted a letter to the House Committees on Ways and Means and Energy and Commerce in response to a request for comments on their April 3rd memorandum regarding elimination of the SGR and institution of a system that rewards “quality care” provided to patients. The House proposal includes three phases in which the SGR would be eliminated with providers receiving a period of stable payments while weaning physicians off the fee-for-service model and instituting a system that rewards value driven care using a base payment plus variable payment based on outcome and performance measures. There are still a lot of details to be worked out and I encourage members to bookmark the ACR website at http://www.acr.org/Advocacy/Legislative-Issues/SGR to keep abreast of this issue.

Also in April, the battle over Medicaid expansion for Floridians continued and the House rejected a plan that would accept billions of dollars of federal aid to cover about 1.1 million residents. Instead, a proposal by Rep. Travis Cummings, R-Orange Park moved forward relying on $237 million in state funds to cover about 116 K residents. This plan would offer $2,000 in subsidies to low-income parents and the eligible disabled and would require a $25 monthly enrollee contribution. Many critics of this plan support a second proposal authored by Sen. Joe Negron, R-Stuart that would use about $55 billion in federal funds over the next decade available through the Affordable Care Act to cover about 1.1 million residents. At the time of writing, this newsletter this proposal is gaining momentum in the Senate with resistance from many house Republicans who point out our $16 trillion national debt. The Medicaid issue obviously has significant impact on access to health care for many of our states under-served and impacts many of our members. Not sure there will be much compromise; but, hopefully there will be further progress over the next several weeks.

On a closing note, we are only about 2 months away from the FRS/FRBMA annual meeting to be held July 19th-21st at the Ritz Carlton in Palm Beach. Please consider joining us for another exciting opportunity to learn from many of the experts in our field and share your thoughts directly with the FRS leadership and colleagues from around the state.

Jeffrey A. Stone, M.D.
Secretary, Florida Radiological Society
stone.jeffrey@mayo.edu

April 2013

Letter from the Editor
For this month’s editorial, I would like to focus on the Choosing Wisely campaign, which is an initiative of the American Board of Internal Medicine Foundation. As many of you may have seen in major media sources including the New York Times, Boston Globe and Cleveland Plains Dealer there has been a lot of attention to this campaign much of which focuses on imaging. The initial recommendations came from 26 national medical societies representing over 500K physicians and were developed based on specific, evidence-based recommendations in an effort to engage physician-patient dialog and improve care while eliminating unnecessary tests and procedures. It is important that we as radiologists be familiar with the recommendations being made to our colleagues. Click here for a list that summarizes those that are directly related to Radiology and the society that submitted the recommendation. A full listing including references can be found at www.choosingwisely.org.

Jeffrey A. Stone, M.D.
Secretary, Florida Radiological Society
stone.jeffrey@mayo.edu

March 2013

FRS President’s Message
The ACR and FRS continue to help unify the family of radiology as we face new challenges. The ACR committee of small and rural practices has been challenged with forming a subcommittee that is composed of two representatives from each state to facilitate communication. Groups around the country are facing many of the same challenges including reimbursement and patient safety issues. Committees such as these will provide a brain trust of ideas that groups across the country can share. These challenges are especially difficult in smaller groups with less resources and manpower. The house of radiology will be stronger collectively through sharing ideas than any group individually. If you or your group has had success in facing the current challenges such as meaningful use, please feel free to share these ideas with the FRS so that we may help others.

The AMCLC is fast approaching May 4-8. The FRS will again represent you in Washington by meeting with our representatives and Congressmen. Anyone from the state is welcome to attend. If you are interested, please let us know so that we can help get you involved.

Our state meeting occurs every summer and this year it is July 19-21 in Palm Beach. We look forward to seeing many old friends and meeting new ones.

Thank you for your continued support of the FRS.

Respectfully,
Jesse Davila, M.D.
President, Florida Radiological Society
jessedmd@yahoo.com

March 2013

Letter from the Editor
At the time of writing this article, the Medicare pay cut of 2% will now take effect with services provided April 1st and onward and is part of broad cuts required under the Budget control Act of 2011 which also cuts funding to domestic and defense spending to eliminate $1.2 trillion from the federal budget over 10 years.. While medical leaders agree that the current Medicare system under the Sustainable Growth Rate (SGR) is unsustainable, there has been little response from congress. Forward momentum may however; be slowly growing. In late January a National Journal policy forum was held and underwritten by the AMA. Many national thought leaders participated in panel discussions and included physicians, health care executives, congressional staff experts and other key players. The consensus once again was that the Medicare system needs to focus on quality of care rather than volume of services provided. This would require greater collaboration between physicians and focus more on team based care rather than individual physician or specialty care. This might be achieved through multispecialty medical groups, accountable care organizations, hospitals and independent physician associations. This will be no easy feat but a recent report by the Congressional Budget Office may indicate the time is getting closer. This report showed that lower than expected Medicare physician spending would equate to a cost of $138 billion to repeal the SGR, down from $244 billion in 2012. It was noted on the AMA wire that this is now below the $146 billion already spent by Congress for short-term patches to preserve the formula. At the time this comes to press hundreds of physicians from around the country will have called on members of Congress to repeal the SGR during the AMA’s national Advocacy Conference in Washington, D.C. It will be interesting to see how this all plays out.

Also of note, CMS has released its final rule for drug, device and biologic manufacturers known as the “Sunshine Act”. This will require manufacturers to annually report to CMS payments and gifts made to physicians and teaching hospitals and will include consulting fees, gifts, food, entertainment, travel and charitable contributions and more. This rule will preempt similar state laws and these items will be posted on an online database easily accessible to the public. Industry must begin collecting data on August 1, 2013 and report it to CMS by March 31, 2014. The rule also provides the ability for physicians to ensure the accuracy of the data during a 45-day period.

Several recent past E-briefs have focused on Meaningful Use (HITECH act) and how to navigate the system. Many physicians however; still do not understand the rationale behind bonus/penalty system and what it is trying to achieve. I encourage members to read the recent article entitled “Means to and End” by Chris Hobson in the February 2013 issue of the ACR bulletin. This provides an excellent overview of Meaningful Use and how it impacts radiology. It can be found on-line at: http://www.acr.org/News-Publications/News/News-Articles/2013/ACR-Bulletin/201302-Means-to-an-End.

I hope everyone has a great start to spring. Please note the dates for the FRS/FRBMA annual meeting at the Ritz Carlton Palm Beach taking place July 19-21, 2013. We hope everyone will attend. The official brochure can be found at: http://www.flrad.org/wp-content/uploads/2013/01/FRS13.pdf.

Jeffrey A. Stone, M.D.
Secretary, Florida Radiological Society
stone.jeffrey@mayo.edu

February 2013

Letter from the Editor 
As most of you know, the new year came and America did not fall off the fiscal cliff due to last minute efforts of Congress. Both houses passed the American Taxpayer Relief Act (ATRA) of 2012 and the bill included provisions to avoid the 26.5% reimbursement cut to Medicare participants as part of the sustainable growth rate (SGR) formula. While we have grown accustomed to this recurring theme, this year’s main event had a hidden devastating blow to imaging. Since this action on the SGR will cost an estimated $25 billion over 10 years, Congress also slashed $800 million from advanced imaging services (CT and MRI) and $300 million from hospital reimbursement for radiation oncology services, both to begin January 1, 2014. The devil is in the details as the $800 million in advanced imaging services is tied to a higher equipment utilization rate of 90% as compared to the 75% rate currently in effect. As many of you might recall, a 90% rate was previously proposed in 2010 but through much hard work of societies like ACR the prior rate of 50% was increased to 75%. A rate of 90% was recommended by MEDPAC assuming that medical practices use their equipment 45 hours of a standard 50-hour week and thus established a utilization rate of 90%. Spreading out the purchase price of this equipment over greater time (higher utilization rate) decreases the technical component fee reimbursement which typically accounts for about 83% of the fee.

Keep in mind this cut is in addition to the multiple procedure payment reduction (MPPR) passed last year that implements a 25% reduction in the professional component of imaging studies performed on the same patient in the same day. ATRA also included a 2.3% excise tax on medical device manufacturers and one can only assume that will be passed on to the consumer, mainly us. To make matters worse, the bill passed on January 1st did not include the proposed $1.2 trillion mandated by the Budget Control Act of 2011, rather postponing it until March and if these go into effect there will be an across-the-board 2% cut in Medicare funding. We will continue to keep our membership informed over the next few months as the final outcome is yet to be determined but does not look encouraging. Please pay attention to future emails from ACR as continued requests for your support by contacting and educating your elected officials is likely and of utmost importance to ensure that Medicare patients continue to receive the high quality, affordable care they deserve.

On a separate note, reports came out in early January that Florida is proposing a new payment model for Medicaid patients. The Agency for Health Care Administration (AHCA) proposes a new system based on diagnosis related groups (DRG) that are based on type and severity of an illness. This is similar to the program used under the Medicare program for hospital reimbursement that utilizes a flat daily rate based on illness category rather than the variable rates used across different hospitals as used in the current Florida Medicaid program. It was reported that AHCA hopes to start using the new rates in July of 2013. More information is available at the AHCA website.

Finally, previous issues of E-Brief have discussed the Meaningful Use Incentive Program and how to participate to avoid future penalties. On January 8th, CMS released further guidance in regards to the Significant Hardship Exception that may be of use to some FRS members. In the stage 2 final rule published in September 2012, several significant hardship exception options were established to avoid Medicare payment adjustments (“penalties”) in 2015 including any physician whose primary specialty is listed in the Provider Enrollment Chain and Ownership System (PECOS) as radiology, anesthesiology or pathology. Since there was not a single PECOS code for the whole of radiology, CMS clarified this issue and defined radiology as the PECOS medical specialty codes for diagnostic radiology, interventional radiology and nuclear medicine but did not include radiation oncology. One needs to apply for this hardship option by July 2014. Keep in mind however; that CMS prohibits granting of a significant hardship for more than 5 years and CMS could also modify or remove the hardship exemption in the future prior to 2020. CMS notes on their website that the current ACR guidelines for interventional radiology indicate that both face-to-face patient contact (pre and post procedure) and follow-up care (longitudinal care) are an expected scope of practice and therefore CMS “may need to revisit this issue in future rulemaking.” Details can be found at the CMS website (https://questions.cms.gov/faq.php?id=5005&faqId=7731).

Jeffrey A. Stone, M.D.
Secretary, Florida Radiological Society
stone.jeffrey@mayo.edu

October 2012

FRS President’s Message
The field of radiology is influenced by many factors, most of which are not driven by people involved in radiology. There is at least one area that we can control and help develop on a local level at our hospitals and at the state and national level. This area deals with quality and safety of patient care.

The ACR has taken a proactive and aggressive approach to assisting radiologists with improving the quality and safety at our hospitals. Their approach is multi-factorial and includes at least eight ways we can implement change. The changes include accreditation, ACR appropriateness criteria, practice guidelines and technical standards, quality measurement, national radiology data registry, radiology safety, radpeer and many other resources relating to various topics in radiology. The ACR website is a great resource to learn more about improving care at your hospital.

The radiology literature also has publications on how to develop a quality and safety program. Dr. Johnson et al in Radiographics-May, 2009 provides a primer on how to implement such a program including the four main areas of safety, process improvement, professional outcome, assessment, and satisfaction.

The FRS recognizes the importance of continuous improvements to both the quality and safety of patients in our state. We have added a dedicated section to our website that includes useful information about this topic. You can find articles and lectures on this topic that were presented in previous newsletters, ebriefs or lectures. We believe that by creating this resource on the website it will benefit all radiologists in the state especially those that could not attend the lectures or may have missed prior publications.

Your comments and feedback are always welcome as we continue to provide you with information that you can use to improve your practice.

Jesse Davila, M.D.
President, Florida Radiological Society
jessedmd@yahoo.com

 September 2012

FRS President’s Message 
Why should I join the FRS? This question was recently asked to me by a Florida radiologist that wanted to join the ACR but was informed that he had to also join the FRS. During these times of decreasing reimbursement radiologists are looking to cut costs and ensure they get the most bang for their buck. Here are a few reasons why I believe it is important to join the state society in addition to the national organization especially in this time of decreasing reimbursements.

Radiology continues to be threatened. These threats come in the form of turf issues from other specialties, decreasing payment, bundling of procedures and hospital acquisitions of groups. Of all the societies available to join there are only two that actively work to protect radiology turf and reimbursement while maintaining patient centered quality care. These two societies are your state society (FRS) and the American College of Radiology (ACR).

Many times radiology battles are specific to regions of the country and individual states. State societies help local radiologists and groups confront these threats. Issues can be brought to the state capital and bills can be passed to preserve radiology turf and help ensure quality patient care. The FRS works closely with a lobbyist in Tallahassee to assist us in keeping abreast of issues at the capital that can have a direct or indirect effect on our specialty. If issues are such that national awareness is necessary, contact with the ACR through the state society is the avenue of choice. The ACR then determines what kind of support they are able to provide. This support may be in the form of legal counsel, manpower, financial support and potential introduction of national legislation.

State societies also provide a useful means of communication among radiologists to share best practices and enlighten neighboring communities or cities within a state of potential threats or challenges. The FRS communicates to its members through its website and periodic newsletters including the E-brief and Focus. All members are welcome to contribute to these forms of communication for the benefit of the FL radiologists. In addition, the FRS provides a summer annual meeting to help inform radiologists in the state of current and upcoming threats and challenges to our specialty. A national leader from the ACR is invited to give lectures and answers questions from the audience about its representation to its constituents.

Issues that affect medicine within a state can be addressed through organized medicine on a broader scope than just radiology. State societies such as the FRS allow representation to other organizations such as the AMA. The importance of participating in societies outside of radiology to help ensure our concerns are heard cannot be overstated. This participation also allows us to better understand the issues affecting other specialties and hopefully come to an agreement on what is best for patient care.

Leadership is fostered through the FRS from the resident level through practicing radiologists. The state society provides volunteer opportunities to get involved in committees and potentially attain positions on the executive committee. In addition, state representation is needed at the national meeting in DC and counselors are selected each year to attend this meeting. Such leadership may continue to the national level by attaining positions on the board of chancellors or steering committee of the ACR. In mentoring residents and young physicians the state society is helping ensure the success of radiology for years to come.

There are many more reasons to join the FRS that I have not listed. Take pride in knowing that your membership in the FRS is valued and that you are represented by volunteers working hard to ensure that radiology thrives for you and generations to come.

Jesse Davila, M.D.
President, Florida Radiological Society
jessedmd@yahoo.com

June 2012

FRS President’s Message
Dear colleagues and friends,

As radiologists, radiation oncologists, and medical physicists, our primary mission is to provide safe, efficient, effective, respectful and compassionate medical care to our patients. As many of you are aware, the Image Gently (pediatric patients) campaign was launched during January 2008 and the Image Wisely (adult patients) campaign was launched during the RSNA 2010 meeting.

The goal of these campaigns is to increase awareness about radiation protection.

I invite each of you to visit the websites below and “take the pledge” today!

The Image Wisely pledge:

1.        “To put my patients’ safety, health, and welfare first by optimizing imaging examinations to use only the radiation necessary to produce diagnostic-quality images;

2.        To convey the principles of the Image Wisely program to the imaging team in order to ensure that my facility optimizes its use of radiation when imaging patients;

3.        To communicate optimal patient imaging strategies to referring physicians, and to be available for consultation;

4.        To routinely review imaging protocols to ensure that the least radiation necessary to acquire a diagnostic-quality image is used for each examination.”

The Image Gently pledge:

1.        “to make the image gently message a priority in staff communications this year

2.        to review the protocol recommendations and, where necessary, implement adjustments to our processes

3.        to respect and listen to suggestions from every member of the imaging team on ways to ensure changes are made

4.        to communicate openly with parents”

I also invite you to attend the Irwin L. Entel, M.D., FACR Legacy Lecture on Sunday, July 22, at the FRS/FRBMA annual meeting. Dr. Richard Morin will be presenting Radiation Dose in Medical Imaging – “What We Got Here is a Failure to Communicate.” See you in Sarasota!

Respectfully submitted,
Lori A. Deitte, M.D., FACR
President, Florida Radiological Society
deittl@radiology.ufl.edu

 July 2012

Letter from the Editor 
Radiologists should be aware of the implementation of Choosing Wisely®, the initiative of the American Board of Internal Medicine Foundation that is aimed at “helping physicians be better stewards of finite health care resources.” Choosing Wisely’s goal is to decrease the overuse of tests and procedures, and allow clinicians to make effective care choices with their patients. More than a dozen medical specialty societies and Consumer Reports have joined Choosing Wisely to help improve the quality and safety of health care in America. For its part, the American College of Radiology has compiled a list of imaging exams whose necessity and alternatives should be discussed before ordering. These include imaging for uncomplicated headache, suspected pulmonary embolism without moderate or high pre-test probability, admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam, computed tomography for the evaluation of suspected appendicitis in children prior to ultrasound being considered, and follow-up imaging for clinically inconsequential adnexal cysts. The American College of Radiology solicited expert opinion from the Board of Chancellors, then formed a working group of the chairs or vice chairs of 7 ACR commissions – including Quality and Safety, Appropriateness Criteria and Metrics. The Choosing Wisely list of topics was formulated by identifying common clinical scenarios in which imaging may be misused and should be reconsidered, then researched for the highest potential for improvement and availability of strong guidelines. Consumer Reports, the nation’s leading independent, non-profit consumer organization, has created patient brochures and is coordinating consumer-oriented organizations to help disseminate this medical information and educate patients. These consumer groups include the AARP, Alliance Health Network, Leapfrog Group and Wikipedia among others. Examples of patient brochures and more information can be found on the website at ChoosingWisely.org.

Laura Bancroft, M.D.
Secretary, Florida Radiological Society
Laura.Bancroft.MD@flhosp.org

 August 2012

Meaningful Use – Are You Ready – Can You Get Ready? 
The American Recovery and Reinvestment Act 2009 (ARRA), incorporates a “meaningful use” incentive payment to eligible professionals (EP) in hopes of improving quality and efficiency of care for the Medicare and Medicaid population utilizing IT (EHR) to help accomplish this.

In this brief note, we cannot offer you a complete roadmap, but rather a simplified overview to get you going. What do Radiologists have to do? For starters, it is believed that 90% of Radiologists are eligible, thanks to a change in the definition of a “hospital based EP”, which no longer includes the place of service (POS) code outpatient hospital (POS 22) to now only include inpatient hospital (POS 21) and emergency room (POS 23). This little bit of magic makes it possible to be an “EP”, instead of an excluded provider. The question is raised “why bother”? How about improving medical care and at the same time receiving incentive payment and ultimately avoiding penalties.

The steps that have to be taken are registration with CMS (www.cms.gov/EHRIncentivePrograms). Since this is not a facility registration, you the individual Radiologist will need your NPI number, username, and password. Once done, the CMS system will calculate from all of your 2011 service codes whether you are an eligible professional (EP) and whether you are deemed as hospital based.

The next is “attestation” and it is more complicated. You will need to have access to a certified EHR. Certified inpatient hospital EHR is not acceptable, only certified general or certified ambulatory are permitted. A list of all the vendors certified products could be found at http://onc-chpl.force.com/ehrcert. As of July 2012, several companies have certified EHR for radiology RIS and practice management products. Fortunately, for many of you, there is a simpler option – designating a third party to register and attest in your behalf.

The final step is near, you have to collect specific data (objectives and measures) on a specified percentage of all of your patients from whichever location that provides at least 50% of your outpatient service codes (POS 21 and POS 23 are excluded). There are 15 core objectives and 5 out of 10 menu objectives that have to be reported. Since most Radiologists will have “exclusions” for many, and an exclusion is equal to compliance, there are only a few measures that you will have to report to fulfill “meaningful use” and receive the incentive payment.

Remember if you can get started by October 2012, you will be eligible for the full incentive, assuming your allowable charges in 2011 exceeded $24,000. Otherwise, you will receive less on a sliding scale.

MIchael Levine, M.D.

Ref. Barbara F. Rubel
Article Link

Ref. KLAS – RSNA Meaningful Use Study2011. Copyrighted

May 2012

FRBMA President’s Message 
Annual Meeting and Chapter Leadership Conference (AMCLC) re-cap.

This past week I attended the 89th AMCLC in Washington, D.C.

Hot Topics included, Best Practice Guidelines, Radiation Safety, CTC coverage, and last but not least HR 3269 and S. 2347.

Best Practice Guidelines is a White Paper which was created in a joint effort by American College of Radiology (ACR) and the Radiology Business Management Association (RBMA) to curb the restrictive, burdensome obstacle which both the patient and the Imaging Community endures on a day to day basis from the Radiology Business Managers (RBMs). The Paper addresses the problems and steerage of care some patients ultimately endure. “The ACR and the RBMA believe that alternative processes, including order entry decision support and referring physician education, can provide a similar or greater economic and quality impact without the administrative complexities and economic burdens created by many of the RBMPs in place today.”

Radiation Safety”: The” American College of Radiology (ACR)” is urging patients and providers to visit “Radiology Safety”. The effort encourages Patients to keep a record of their X-ray history and what questions they should ask their physician before undergoing a scan: 

  • Why do I need this exam?
  • How will having this exam improve my health care?
  • Are there alternatives that do not use radiation which are equally as good?
  • Is this facility ACR accredited
  • Is my child receiving a “kid-size” radiation dose (for pediatric exams)?

Radiologists are one of the few health care providers in the medical community which are promoting efficiencies in healthcare. In addition ACR is encouraging members of the Imaging Community to become members of the Image Gently and Image Wisely campaigns.

On Capitol Hill day which was at the conclusion of the conference we went to the hill and met with Susie Ahn who is Senator Bill Nelson’s (D) Health Counsel and Sally Canfield who is Deputy Chief of Staff for Policy for Senator Marco Rubio.

The Florida Radiologists who represented the Florida Radiological Society lobbied on two issues:

Computerized Tomography Colonoscopy (CTC): This effort was driven by the lack of colorectal cancer screening in the much needed screening population of Medicare enrollees. Currently the “screening rates for colorectal cancer are just below 60%”. There are several factors of the poor screening rates, but with CTC being less invasive, and not requiring anesthesiology as well as being equally effective; “adding Medicare coverage of CTC could prevent unnecessary deaths”. The one page brief we handed the Members of Congress stated, if Medicare were to cover CTC screening as an option then CTC “would potentially close or eliminate the gap in colorectal cancer screening between whites and minority populations by providing a vital screening option that is less invasive.”

House Rule (HR) 3269 now has a Senate Bill S. 2347 which is gathering support, “This legislation prevents CMS from implementing this reduction until an expert panel convened by the Institute of Medicine conducts a study of professional component efficiencies.”

It was a blessing to work side by side with the radiologist and to participate in such a joint effort. We are a good team, and we will continue to advance our profession as we work together to a common goals of service and safety.

Sincerely serving,
Davis W. Graham
President, FRBMA
dgraham@manateediagnostic.com

April 2012

FRBMA President’s Message 
May in Orlando is the RBMA National Radiology Summit.

Florida Radiology Business Management Association members, be sure to attend the RBMA National Radiology Summit coming up in Orlando. The 2012 Radiology Summit, will be May 20-23, 2012 at the Loews Royal Pacific Resort at Universal Orlando®, 6300 Hollywood Way, Orlando, FL.

Some of the highlights which will guide us into the new era of a healthcare environment, which direction we will go remains to be seen.

The first to speak will be Dr. Steve Bedwell (click for a Youtube review) helps health care professionals boost patient quality scores, reduce diagnostic error rates and discover unexpected solutions to high-priority challenges. He will tickle your funny bone, so he can also rub some raw nerves. Expect a program that’s riveting, provocative and explosively funny…and then watch him exceed your expectations. Visit his website at http://www.stevebedwell.com.  

At the conclusion of this session the attendee will be able to:

  • Explain how to provide a working environment conducive to reducing radiological diagnostic error rates (it’s about more than installing PACS and speech recognition software)
  • Outline at least one strategy to improve inter-office relationships between radiology business managers and clinical staff (don’t kid yourself: when professional relationships are strained, your patients know)
  • List the immediately implementable, evidence-based strategies for solving problems and managing frustration so your department can take unflinching action toward high-priority goals.

ICD-10 will be discussed with the recent hold on implementation it will be interesting what the future hold for part 2 of the 5010 billing process. Then there is safety one of the most important parts of our care is making sure we are good stewards with what we use. Jef Williams will tell us “How to Prepare Your Organization for Radiation Safety and Dose Management”.

The state of California was the first to adopt radiation safety legislation with requirements for capturing dose by 2013. This measure will likely gain nationwide adoption. What are you doing to prepare for capturing dose? What will you do with the information once it is captured and reported? Find out how to create a radiation safety program that includes capturing, storing, and reporting radiation dose and what the ACR requires in reporting dose. Touch on the opportunities to leverage the benefits of an effective radiation safety program that improves patient care and positions the organization for success.

At the conclusion of this session the attendee will be able to:

  • Explain the current state of radiation dose and safety standards
  • List the ACR and dose reporting requirements
  • Explain how a radiation safety program can benefit your organization

The above are just a few of the speakers; ACR will be there as well as those who will help us with our marketing strategies. We will have Round Tables and learning Labs, so if you have questions be sure to write them down or email them in to RBMA before hand. These sessions are what RBMA is all about sharing and growing together.

FRBMA should be there in force so we can make this year one of the best, by sharing and hosting our knowledge into a bright future. Register and mark your calendar July 20th thru 22nd for the 2012 Annual Meeting of the FRS/FRBMA.

Sincerely serving,
Davis W. Graham
President, FRBMA
dgraham@manateediagnostic.com

 January 2012

Letter from the Editor
The American College of Radiology announced this month that the Centers for Medicare and Medicaid Services (CMS) will not apply the imaging professional component of the Multiple Procedure Payment Reduction (MPPR) to group practices beginning January 1, 2012. That means that CMS will not apply the professional component MPPR for inpatient and outpatient imaging services performed by separate physicians in the same group practice for 2012. Unfortunately, the 25% MPPR to the professional component of diagnostic imaging services will take effect on studies performed by the same physician, on the same patient, during the same session.

John A. Patti, MD, FACR, Chairman of the ACR Board of Chancellors stated: “I am proud of the tremendous effort exerted by more than 7000 ACR members to contact CMS and explain the flaws in its original ruling. I’m also very gratified and encouraged by the grassroots efforts of our members in gaining support from 150 members of Congress for H.R 3269.” The ACR will continue lobbying for legislative efforts to block the entire professional component MPPR through enactment of H.R. 3269 (Diagnostic Imaging Services Access Protection Act of 2011), for which there are now 159 co-sponsors. Thank you to Republican Florida co-sponsors Jeff Miller (1st District), Richard Nugent (5th District), Clifford Stearns (6th District), Gus Bilirakis (9th District), Bill Young (10th District), Dennis Ross (12th District), Vern Buchanan (13th District), Bill Posey (15th District), and Allen West (22nd District).

Laura Bancroft, M.D.
Secretary, Florida Radiological Society
Laura.Bancroft.MD@flhosp.org

 

           
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