August 2012 E-Brief

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Letter from the Editor
I would like to start out this edition of E-Brief by extending my sincere gratitude and thanks to the outgoing editor, Dr. Laura Bancroft who now assumes the role of Treasurer for the Florida Radiological Society. She has done an outstanding job and it is a privilege to follow in her footsteps. I will continue to keep the membership informed of important issues affecting the practice of Radiology and welcome any input or commentaries the membership would like to share with our readers particularly those experiences that may help our readership in the constant and ever changing Florida medical environment.

Many of you have received recent correspondence from the ACR Advocacy Site regarding a letter to your senator to support co-sponsorship of bill S.2347: Diagnostic Imaging Services Protection Act of 2012. This bill would block the 25% multiple procedure payment reduction to the professional component for CT, MRI and ultrasound services. Passage of this bill would ensure that that the reduction NOT be applied to services either furnished on or after 60 days after date of enactment and before January 1, 2013, or furnished in 2013 or a subsequent year unless the reduction is based on an analysis of an expert panel on diagnostic imaging services convened by the Institute of Medicine. Thank you to all those who have already participated in this letter writing endeavor, and I encourage every member who has not yet participated to log onto the ACR website and send a letter to your representative. It is an easy process of utmost importance.

I also encourage members to sign in to the ACR website in August to play a role in improving radiology care to your patients through participation in the ACR Practice Guidelines and Technical Standards. The first comment period for 2013 is August 6th through the 24th.

A final observation I would like to share is the recent article published by David Lee and Frank Levy in the August 2012 issue of Health Affairs entitled “The Sharp Slowdown in Growth of Medical Imaging: An Early Analysis Suggests Combination of Policies was the Cause”. It is noted that the use of CT in the Medicare population decelerated to 1.4% in 2009 down from 14.3% between 2000 and 2005 and 7.1% in 2006. The growth of MRI declined to 2.6% per year between 2006-09 compared to 14% growth between 2005 and 2009. Sampling of 47 employer-sponsored plans showed similar results with a reduction in CT and MRI growth rates to 3.1% and 1.1% respectively compared to 20.4% CT growth and 16.6% MRI growth between 2002 and 2006. Several factors appeared to contribute to this trend including prior authorization, increased cost sharing, reimbursement reductions in the deficit reduction act of 2005 and fear of radiation. The effect on patient outcome is not clear at this time, but it was noted that part of this slowdown included studies of potentially limited medical value. An apparent by-product of this declining growth trend was a weaker market for radiologists.

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

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The FRS and FRBMA hosted another successful meeting this month in Sarasota at the Ritz-Carlton. This meeting kicked off with a social golf tournament Friday morning followed by lectures in the afternoon. Maintenance of Certification (MOC) was addressed in the afternoon by David Laszakovits, M.B.A. Over the next few years, practices will have to address the issue of residents graduating without board certification and the new challenges this will bring not only to the individual but also to the group that hires them. This was the first FRS meeting to offer ACR Radiology Leadership Institute (RLI) credits. For more information or to enroll visit www.radiologyleaders.org. Saturday morning the president of the ACR Dr. Paul Ellenbogen gave an update on the college’s activities. Later in the morning, Dr. Gunderman provided the Self Assessment Module (SAM) for the course. This was his first time speaking at the FRS and many of us find his lectures to be much more than facts or updates. His lecture on Money, Ethics and leadership was not only insightful but asked questions that would make any radiologist in the room pause and reexamine not only what it is we do but also how and why we do it. The Residents and Fellows Section (RFS) had record attendance this year and held its own series of lectures and the number of poster presentations continues to increase every year. Congratulations to Dr. Harry Greditzer as the new chair of the RFS. The Radiation Oncology Program provided a strong series of lectures on Saturday including EBRT and Immunotherapy in addition to addressing breast, pancreatic, prostate, brain and lung cancers. Mark your calendars for next year’s meeting as we hope to see you July 19-21 in Palm Beach.

Radiology will face many challenges as it does every year, and it is unclear what impact the presidential election will have on our profession. The need for your volunteerism and donations has never been greater. The FRS executive committee will do its best to ensure the continued success of our profession and help ensure that your concerns and issues are heard. The e-brief will continue to serve as our vehicle for timely communication to the FRS and FRBMA members. Please remember the e-brief also provides op-ed opportunities to all members through the Member’s Viewpoint: please feel free to contribute to this section.

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

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FRBMA President’s Message
As I travel through Tennessee with my family, headed to yet another college tour for my soon to be senior, I am reflecting on the much-discussed word we have used frequently in radiology and our family life. The word is change. In business, we tend to say the word with apprehension and sometimes-even fear. In everyday life, we have no other option but to embrace it. Preparing for change when you have no alternative is easier than trying to keep things the same as they’ve always been.

My son is excited to embrace challenges and is looking forward to the uncertainty of his changing future with excitement. As hard as I try, his mother and I can’t turn the clock back to the “golden years” of when he was five. Instead, we’ve had to accept the reality of his uncertain future and attack it with the resources we know have proven themselves successful.

As I reflect on radiology and our just finished FRS/FRBMA meeting in July, I can’t help but think how similar radiology and healthcare as a whole is to everyday life. We listened to excellent speakers discuss Meaningful Use, ACO’s, the changing reimbursement system, the economy and many elements that could make the “perfect storm” for radiology. However, as someone who has been in radiology for many years, I’m not so sure we haven’t been down this path before. Radiology shortages, surpluses, reimbursement battles and technology changes have all been paths we’ve walked down in the past. In fact, they’ve been paths that radiology has been valiant trailblazers and champions for change.

Yes, we are facing challenging times; however, I for one know we have the best-organized specialty when it comes to adapting to change. Let’s not let the noise of the fearful group drown out the spirit of our great history. We can adapt, change, and continue to be trailblazers for the next set of healthcare challenges. I believe we can survive and even thrive.

As I take over the position of FRBMA President, I encourage all to think strategically, share unselfishly of your knowledge and work together to position our practices as beacons of light and champions of success. Yes, the future is going to be challenging, however, we can meet the challenge with innovative solutions as we have always done.

Please feel free to email me with any suggestions or ideas you may have. I would like to dedicate future briefings to innovative ideas and successes your practices are adopting in our new environment.

Sincerely,

Troy E. Purcell, MSF
President, FRBMA
tep363@aol.com

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Legislative Update
The Primary Season is rapidly coming to a close with Primary Day being August 14. Early voting in many counties has started. Please remember to go out and vote. If you have any questions, on which candidates the FRS supports please contact me directly at: alisondudley@dudleyandassociates.com.

Please go out and vote!

Alison Dudley, Lobbyist
Florida Radiological Society

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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

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Become a PAC Member Today
Attention FRBMA Members! Please support the cause. We encourage you to be PAC members and supporters; you do not have to belong to the FRS.

Donations can be made online through our PAC website www.FLRADPAC.org.

We would like to recognize the following contributors to the FRS PAC in July: Drs. Agles, Burkett, Carbonell, Carroll, Cartwright, Cernigliaro, Cox, DePrima, Eber, Francavilla, Gianini, Greditzer, Green, Harris, Hayden, Jones, Klioze, Levy, Middlebrooks, D. Miles, S. Miles, Parikh, N. Patel, S. Patel, Roberto, Scales, K Scherer, Schiering, Sevigny, Shamlou, Siragusa, Stone, Tocci, Tonkin, Turetsky, Vihlen, Yates and Yuschok.

It is critical that we support both our Florida PAC and RADPAC in order to bolster our voice in Tallahassee and Washington, respectively. Please join FRS lobbyist Alison Dudley in her special appeal for all Florida radiologists to become Florida PAC members. If you would like to help FRS defend radiology against untoward legislation and introduce bills that have a positive impact on our practices, we need your financial support to re-elect our friends in the state House and Senate. The FRS can also show you simplified ways on how to sign up your radiology group as a whole. Contact Lorraine Roger at lroger@flrad.org or contact Alison Dudley at alisondudley@dudleyandassociates.com for more information.

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