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Letter from the Editor
October 2023

Letter from the Editor
Title: The Impact of Millennials, Generation X, and Baby Boomers on the Future of Radiology


The field of radiology has undergone significant advancements over the decades, with each generation playing a unique role in shaping its future. Millennials, Generation X, and Baby Boomers have each left their mark on the practice of radiology, influencing everything from technology adoption to patient care. In this article, we will explore how these three generations have impacted the field of radiology and discuss their ongoing contributions to its evolution.

  1. Baby Boomers: Pioneers of Modern Radiology

Baby Boomers, born between 1946 and 1964, witnessed the birth of modern radiology and its rapid growth. They were the first to embrace technologies like CT scans, MRI, and ultrasound, which revolutionized diagnostic imaging. As the largest generation in history, they played a pivotal role in the widespread adoption of these technologies, making radiology an essential part of modern healthcare.

Their experience in the field helped refine diagnostic techniques and improve patient care. Baby Boomers also contributed to the development of subspecialties within radiology, such as interventional radiology and nuclear medicine, which have become integral in the treatment of various medical conditions.

  1. Generation X: Bridging the Gap with Technology

Generation X, born between 1965 and 1980, saw the emergence of digital technology and played a crucial role in its integration into radiology. They were the first to fully embrace Picture Archiving and Communication Systems (PACS) and Radiology Information Systems (RIS), which streamlined workflow and improved image management.

Moreover, Generation X radiologists were instrumental in adapting to the digital era, incorporating teleradiology into their practice. This technology allowed for remote reading of images, expanding access to radiology services in underserved areas and improving turnaround times for patient diagnoses.

  1. Millennials: Embracing Artificial Intelligence and Telemedicine

Millennials, born between 1981 and 1996, are at the forefront of the latest radiological innovations. Their tech-savvy nature has led to the rapid adoption of artificial intelligence (AI) and machine learning in radiology. AI algorithms can assist radiologists in tasks like image interpretation and lesion detection, leading to faster and more accurate diagnoses.


Additionally, Millennials have championed the use of telemedicine in radiology, which gained significant traction during the COVID-19 pandemic. Telemedicine allows patients to consult with radiologists remotely, reducing the need for in-person visits and improving accessibility to healthcare services.

Collaborative Efforts and the Future

While each generation has made its unique contributions to radiology, it’s important to note that the field’s evolution has been a collaborative effort. Baby Boomers, Generation X, and Millennials have worked together to advance patient care and diagnostic accuracy.

Looking ahead, the future of radiology will continue to be shaped by ongoing collaboration among these generations. The integration of AI and telemedicine will become more sophisticated, allowing for even faster and more precise diagnoses. Radiologists from different generations will bring their expertise to enhance the application of these technologies, ensuring that patient care remains at the forefront.


The field of radiology has evolved significantly over the years, thanks to the contributions of Baby Boomers, Generation X, and Millennials. Baby Boomers pioneered the use of modern imaging technologies, Generation X integrated digital solutions, and Millennials are harnessing the power of AI and telemedicine.

As these generations work together, the future of radiology looks promising, with continuous advancements in technology and patient care. The interplay of experience, innovation, and adaptability among these generations ensures that radiology will remain an essential component of modern healthcare, serving patients with increasingly precise diagnoses and treatment options.

CHATGPT Series #3

Edem Chen, MD
Secretary, FRS


Letter from the Editor
February 2023

Greetings everyone!

2023 is here, with the first month already in the books, and the FRS continues to be active with the FRS winter board meeting to be held at the end of this month on Saturday, Feb 25th. Some related items to share:

The 2023 Annual Meeting of the FRS/FRBMA will be held July 14-16 (Friday through Sunday) at the Ritz-Carlton Sarasota. Once again, there will be a fantastic slate of speakers to attend. Also like before, there will be a research agenda for the meeting with poster presentations from across the state. If you are a trainee or mentor to trainees, please disseminate information about the poster sessions to encourage participation. There are also several committees within the FRS. If you are interested serving on of these committees, please do not hesitate to let us know. We appreciate your interest in improving the society! More information on the meeting, including the brochure and registration details, may be found here:

FRS members:

FRBMA members:

In a similar vein, the 2023 ACR Annual Meeting will be held in Washington, D.C., at the Washington Hilton May 6-10. This year will kick off the celebration of the ACR’s Centennial – 100 years of quality, integrity, leadership, and innovation. Meeting and registration information can be found here:

ACR 2023 Annual Meeting | American College of Radiology

Other news and notes:

Dr. Bill Thorwarth, CEO of the ACR, has released 2022 ACR Annual Report in his new Voice of Radiology blog, which can be found here:

Providing Value to Members and Patients | American College of Radiology (

The ACR remains in the forefront in offering potential solutions to the Centers for Medicare and Medicare Services for the surprise billing payment dispute process. You can read more about this effort here:

ACR Offers Plan to Improve Surprise Billing Independent Dispute Resolution Process | American College of Radiology

For those of you who may be looking for a change in your radiology career in 2023, please visit the ACR Career Center to see what opportunities are available. For those of you looking to expand your practice, you may post job offerings here as well. See the link below:

Radiology Jobs – American College of Radiology Career Center (

February is Heart Health Month. If you need to keep up to date with the latest cardiac imaging techniques, check out the ACR Education Center for courses offered on Coronary CTA and Cardiac MRI in the next month at the link here:

Education Center In-Person Courses | American College of Radiology (

If you have not already, I encourage all of you to pledge to Image Wisely in 2023. The link to complete the pledge can be found here:

Home | Image Wisely

Thank you for your attention and all that you do for your patients and your profession!

 Andrew Bowman, MD, PhD
Secretary, FRS

Letter from the Editor
November 2022

A few quick notes for everyone now that fall is full swing:

In the latest ACR Bulletin, ACR BOC chair Jacqueline Bello has announced that the ACR has partnered with the American Cancer Society and the GO2 Foundation for Lung Cancer, asking our imaging centers to open their doors on Saturday, Nov 12, specifically to grant patients access to lung cancer screening. Further details about this and other lung cancer screening initiatives can be found here:

BOC Chair | American College of Radiology (
Improving LCS Adherence | American College of Radiology (

In other news, the ACR CT and MRI Accreditation Committee has recently modified requirements for IV contrast media supervision, recognizing that there is a large range of responsible providers who may manage an acute hypersensitivity reaction under the general supervision of a radiologist. The following may now provide direct supervision of IV contrast under such general supervision:

-Non-radiologist physicians (MD/DO)
-Advance practice providers (nurse practitioners, physician assistants)
-Registered nurses following a symptom- and sign-driven treatment algorithm

This welcome change should increase the flexibility of our practices while continuing to ensure appropriate safety for our patients. Further details for this announcement may be found here:

ACR Changes CT and MRI Accreditation Contrast Media Supervision Requirements | American College of Radiology

Lastly, as I suspect most are aware, Tuesday, November 8th is election day. I would encourage all members to take the time to cast your ballots then if not done earlier where allowed. This is our opportunity to choose who will lead and represent Florida in the near term. Please take advantage of it!

Thank you!

Andrew Bowman, MD, PhD
Secretary, FRS

Letter from the Editor
October 2022

As I am writing this, Hurricane Ian is making its way across the Florida peninsula. I am sure I speak for all of us at the FRS when we express our thoughts and hopes to those most affected by this devastating storm. I would encourage anyone with the ability to support recovery efforts by whatever means you have at your disposal. Links to organizations I have supported myself in the past can be found here:  Click Here or Click Here

As we look past the storm, many of us are planning our 2022-2023 calendars. Please be on the lookout for upcoming events listed below:

October to May – ACR Parameters/Standards and ACR Annual Meeting – In-person

The ACR Annual Meeting will be held May 6 to May 10, 2023, at the Hilton Washington in Washington, DC.  Like the 2022 meeting, this is currently planned as an in-person meeting. The comment period for Practice Parameters and Technical Standards has begun, and the ACR is actively cycling through the documents on their portal in order to receive member comments. Please Click Here to access the documents and make your comments. Please contribute to these parameters and standards! The more that members draw attention to proofreading errors, issues on content, and omissions, the more that the parameters and standards can be ready for full review by the Council at the Annual Meeting. Many members feel blindsided or rushed at the time of the Annual Meeting with unexpected inclusions or exclusions within these documents, so this is a very good opportunity to review the documents (or have your local subject-matter expert review the document) so that comments can be made now or reserved for discussion at the Annual Meeting.

October – ACR Quality & Safety and Informatics Summit – In-person or virtual

The ACR Quality & Safety Conference and the ACR Informatics Summit are both being held as hybrid in-person or virtual events this year, from October 20 to October 22, 2022 and October 22 to October 23, 2022, respectively. The in-person components of both meetings will be held at the Grand Hyatt Washington in Washington, D.C. Registration links here: 2022 ACR Quality and Safety Conference and ACR 2022 Imaging Informatics Summit | In-Person and Virtual

The Quality and Safety Conference focuses on the broad range of endeavors that can improve patient care, from informatics solutions to communication improvements to error analysis and mitigation to workflow and ergonomic initiatives. The Q&S Keynote Lecture is “Radiology at the helm of high value care transformation” by Pamela Johnson, MD, FACR. The Informatics Summit is a conference intended for all ACR members, not just the computer-science majors in the crowd. The course is therefore practical in nature — how can radiologists best deploy and integrate informatics solutions into their daily practice and generate concrete gains for their practices and their patients. Keynote lectures are “Disrupting traditional healthcare models with distributed networks”, by Daniel Durand, MD and “Embracing an AI-enabled future for diagnostic medicine by Geraldine McGinty, MD, MBA, FACR.

November – RSNA – In-person

Like last year, the RSNA annual meeting will be held in person in 2022. RSNA dates are November 27 to December 1, 2022, at McCormick Place in Chicago, IL. 

Andrew Bowman, MD, PhD
Secretary, FRS

December 2021
FRS President’s Message

Value based health care in Radiology

The COVID-19 pandemic has heightened the need for quality healthcare at an affordable cost and access to all. Radiology plays a critical role in advancing quality care at an affordable cost for disease detection, management, therapy, monitoring and prevention.  We understand our role to provide specialized expertise to patients, referring physicians, and the community.

To achieve these goals, the impact of radiology services on patient outcomes and quality of life will dominate the dialogue about legacy and novel current and future technologies for imaging and image guided therapies.  Diagnostic and technical efficacy will dominate diagnostic and therapeutic impact, patient outcome, and socio-economic benefits. Radiologists are champions for health equity and are recognized for democratizing our services while embracing innovation that brings imaging advances to the population at large.  Personalized imaging care integrates diagnostic data from all sources and leverages predictive analytics to anticipate and remedy future in health and well-being.

Owing to the relatively high cost of radiology services and rapidly rising health care costs, we must develop methods to ensure that imaging and image guided therapy services are used appropriately based on evidence-based guidelines.  Tools that will help us to uniformly adopt these is by automation/ semi-automation with AI. Adoption and use of the tools necessary to achieve these goals must be embraced by all members of the medical community, especially those who interact with patients primarily and direct their care.

Ref: Plenary Session: Radiology in the Value-Based Healthcare Arena: Player or Pawn? RSNA 2021 JA Brink

Raj Kedar, MD FACR
President, Florida Radiological Society
Professor of Radiology, Univ. of South Florida – Morsani College of Medicine
Chief -Dept. of Radiology, Tampa General Hospital
Director- Body Imaging Education and Fellowship

October 2021
FRS President’s Message

We can’t let this happen!

During the COVID -19 initial wave followed by resurgence, many patients were hesitant to get their diagnostic and screening examinations done especially if symptoms were minor or non-acute, for follow-ups, and screening examinations such as mammography. This can be potentially disastrous as this may lead to delayed diagnosis and unnecessary deaths. We as radiologists can create awareness in this regard by patient and referring provider education, allocating resources, and marketing.

During October’s breast cancer awareness month, this is an opportunity to drive this message for promoting mammography and preventing early detection of cancer.

On another note, various committees of the FRS have openings that include subspecialty committees, as well as, several others. You can go to the FRS website to see various committees that we have and email Lorraine Roger to express your interest.

I would love to see newer, younger, and enthusiastic people getting involved in the FRS committees for newer and fresher ideas and to make the FRS more vibrant. 

Stay safe and stay healthy!

Raj Kedar, MD FACR
President, Florida Radiological Society
Professor of Radiology, Univ. of South Florida – Morsani College of Medicine
Chief -Dept. of Radiology, Tampa General Hospital
Director- Body Imaging Education and Fellowship

Letter from the Editor

Now that the academic year has started and fall has begun, many of us are planning our 2021-2022 calendars. Many events continue to be disrupted due to coronavirus, and we would like to update you on several of those fronts.

October to April – ACR Parameters/Standards and ACR Annual Meeting – In-person

The ACR Annual Meeting will be held April 24th to April 28th, 2022, at the Hilton Washington in Washington, DC.  This is currently planned as an in-person meeting. The comment period for Practice Parameters and Technical Standards started in August, and the ACR is actively cycling through the documents on their portal in order to receive member comments. Please Click Here to access the documents and make your comments. Please contribute to these parameters and standards! The more that members draw attention to proofreading errors, issues on content, and omissions, the more that the parameters and standards can be ready for full review by the Council at the Annual Meeting. Many members feel blindsided or rushed at the time of the Annual Meeting with unexpected inclusions or exclusions within these documents, so this is a very good opportunity to review the documents (or have your local subject-matter expert review the document) so that comments can be made now or reserved for discussion at the Annual Meeting. We are currently in the third Field Review Cycle (Oct 4 – Oct 22) for 10 different documents.  

October – ACR Quality & Safety and Informatics Summit – Virtual-Only

The ACR Quality & Safety Conference and the ACR Informatics Summit are being held as virtual events this year, from October 14th to October 16th, 2021 and October 16th to October 17th, 2021, respectively. They are coming up soon, but no travel is needed as they are virtual. Registration links here: and The Quality and Safety Conference focuses on the broad range of endeavors that can improve patient care, from informatics solutions to communication improvements to error analysis and mitigation to workflow and ergonomic initiatives. The Q&S Keynote Lecture is “The Role of Radiology in Population Health Management” by Syed Zaidi, MD. The Informatics Summit is a conference intended for all ACR members, not just the computer-science majors in the crowd. The course is therefore practical in nature — how can radiologists best deploy and integrate informatics solutions into their daily practice and generate concrete gains for their practices and their patients. Keynote lectures are “Welcome to the Radiology Team, AI Bot”, by Dr. Greg Moore (Microsoft/Nuance) and “The Return on Investment of AI” by Dr. Melissa Chen (MD Anderson). In the spirit of full disclosure, I am one of the co-chairs for the Informatics Summit this year, along with Dr. Tessa Cook from the University of Pennsylvania, and so I personally look forward to perhaps seeing you there. 

November – RSNA – In-person

The RSNA Board of Directors met in mid-September and reconfirmed its plans to hold RSNA 2021 in person. The Board “recognized the challenging circumstances that many are in and extends its sincere appreciation for your commitment”. RSNA dates are November 28th to December 2nd, 2021, at McCormick Place in Chicago, IL.  For those interested in the health and safety policies, please Click Here. Faculty with travel restrictions or conflicts will be presenting via recorded video, so portions of the program will be virtual. 

Ongoing – ACR Education Center – Virtual-Only

The ACR Education Center in Reston, VA, will remain closed for the remainder of 2021. The ACR anticipates opening the center for in-person education in early 2022. For now the ACR is offering virtual “micro-courses” that allow access to the datasets for the courses paired with recorded lectures by the faculty. Please see the ACR’s education center page for the full list of courses:

July – Florida Radiological Society Meeting – In-person

The 2022 FRS Annual Meeting will be held in-person July 15th to July 17th, 2022 at the Ritz-Carlton, Amelia Island, near Jacksonville, FL. Please check back later this year at for details on registration. We look forward to seeing you there!

Thank you!

Juan Batlle Secretary, FRS

August 2020

Letter from the Editor
We are living through extraordinary times as a result of the Covid-19 pandemic that will have a lasting impact on health care and the economy. This is further amplified by the formidable crisis that links our social and health care systems with the need to support diversity, inclusion and health equity. The cross-section of radiation oncology and therapeutic radiology has never been more apparent as the medical community struggles to provide timely access to diagnosis, evaluation, and treatment of cancer patients.

At the start of the pandemic, most non-emergent healthcare was halted, including cancer screening. Unfortunately, cancer incidence does not stop with the pandemic. For some patients, decreased screening will delay diagnosis or worsen outcome. As a radiation oncologist, these circumstances put us in the position to redefine our practice while navigating cancer care. Many centers rose to the challenge of maintaining treatment delivery while ensuring the safety of staff and patient. Expanded telehealth was quickly employed by many centers to allow safe access to providers. In addition, rapid dissemination of research to guide treatment recommendations as well as the increased use of hypofractionation (shorter radiation therapy regimens) allowed many patients to receive the cancer care they needed.

While the field of radiation oncology is responding to the call and adjusting as necessary to provide the best care for our patients, uncertainties remain. Rapidly increasing unemployment levels may be expected to produce growth in the number of uninsured and Medicaid patients as the work-age population transitions out of commercial insurance coverage. This may be exacerbated by pressures on state budgets to curtail Medicaid reimbursement and private payors adjusting their coverage resulting in decrease revenue even if overall patient volumes recover. The ACR is working with more than 50 other national medical societies to avert reimbursement cuts due to the Medicare Physician Fee Schedule evaluation and management code changes. The ACR has provided members a free webinar where experts discuss major changes they anticipate to their diverse business and practice models. Click Here

The resilience demonstrated by radiation oncologists and radiologists will hopefully mitigate the short and long-term impact on our fields. It is evident in both radiation oncology and radiology in times of crisis our colleagues continue to innovate. Radiologists are able to diagnose early signs of Covid-19 on chest CT scans and radiation oncologists are researching new ways to identify the characteristic Covid-19 pneumonia concerns on CT Simulation scans (otherwise used for radiation treatment planning) and daily cone beam CT scans (otherwise used for daily set up alignment). Radiation oncologists are also investigating the use of low dose lung radiotherapy to treat some Covid-19 patients.

As we begin the process of resuming clinical practice, the ACR has multiple resources to help make informed decision during the Covid-10 pandemic and guideline to help practices safely resume providing important non-urgent care. Click Here  and Click Here

The Covid-19 pandemic has disrupted all aspects of health care, spotlighted health disparities, and devastated the economy. The stress of our current situation highlights the intense need for self-care. Wellness is now more important than ever as we navigate current challenges and face the uncertainty of the future. The ACR has provided extensive wellness resources. Click Here

We face unique opportunities and challenges, as we work to prioritize safe and quality patient care while we navigate this pandemic. During these challenging times the FRS is responding to the call and continues to work on your behalf to help you and your practice recover from Covid-19.

I would like to send the FRS community my best wishes and hope that all of you and your families are well and safe.

Laura Vallow, M.D.
Secretary, FRS

July 2020
Letter from the Editor

When we thought we were now entering a new normal, Florida became the new epicenter for Covid-19. Our hospital systems are near capacity, as I write this e-brief. Everyone should be taking all the precautions to minimize the spread and again use ACR resources if you need guidelines on how to operate your radiology departments or offices. ACR Coronavirus (COVID-19) Resources

Additionally, CMS has released new guidelines: –Re-Opening America: What Patients Should Know About Seeking Healthcare

The 2019 ACR commission on Human Resources Workforce Survey shows that Radiologists as a Corporate Employee trend is relatively flat from 2012 to 2019. The majority of Radiologists surveyed are part of the Private Practice at 49%.

Medicare and Medicaid Programs: CY 2020 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates. Price Transparency Requirements for Hospitals To Make Standard Charges Public

Beginning in 2021, hospitals will be required to post both payer-specific negotiated charges and discounted cash prices in a machine-readable file. Hospitals will also have to publicly post these charges in an easily accessible manner for 300 “shoppable” services.

It will be interesting to see how this will impact consumer/patient behavior.  Who knows, this list may eventually make it to shopping services like Amazon and other similar retailers.

This is my last E-brief and I would like to leave you with one quote that pertains to all of us:

Life is C (Choice) between B (Birth) and D (Death).” As French philosopher Jean-Paul Sartre once said, we get to make numerous choices during our lifetime; For us as Radiologists we have to choose between B (Being involved in our organizations) OR D (Do nothing). Making the right choices will keep us united and have our voices heard.

Thank you and Stay Healthy.

Chintan Desai, MD
Secretary, Florida Radiological Society

June 2020
Letter from the Editor

As our country reopens after a short period of near complete shutdown, we all have learned to adjust with the new so-called “Normal”. Wearing masks in public places and Zoom video conferencing has become a new reality. Even though there was a sharp decline in imaging volumes, the patients are coming back and the imaging volumes are rising. We all hope this trend continues.

We had a first time ever successful virtual ACR 2020 Annual Meeting. In case you missed it, the ACR has provided online access to the election results, review of the actions of the Council, and much more. This information can be found at: ACR 2020 Annual Meeting

Radiology practices around the country are adjusting to the new environment and the ACR is providing multiple resources to help us manage through the pandemic. ACR Coronavirus (COVID-19) Resources

Artificial Intelligence Update: AI continues to make major advancements in the field of Radiology.

InformAI Classifies Conditions from Sinus and Brain Scans

Houston-based InformAI is stepping in to help reduce fatigue and stress of radiologists by building deep learning tools that can help analyze medical scans faster by using a 3D CNN(not our regular CNN news channel but “Convolutional Neural Networks). InformAI is developing a tool that analyzes brain MRI scans to detect whether a tumor or lesion is present, and can classify an abnormal scan as one of four conditions: glioblastoma, metastatic brain tumor, multiple sclerosis or lymphoma.

Corporatization in Healthcare has been on a rise for the last decade but the future for them is uncertain. KKR-Backed Envision Healthcare to Consider Bankruptcy Filing

Highly leveraged conglomerates like Envision Healthcare which has over 900 radiologists is contemplating a bankruptcy filing.

“If you are depressed then you are living in the past. If you are anxious then you are living in the future. If you are at peace then you are living in the present.” —Lao Tzu

Chintan Desai, MD
Secretary, Florida Radiological Society

March 2020

Letter from the FRS President
It has been a very active 2020 to date with several important legislative items up for consideration. At the forefront is Florida House Bill 607, which would allow Advanced Practice Registered Nurses (APRNs) and physician assistants (PAs) to practice independently without any supervision by licensed physicians. Please see the attached link to Florida Patient Protection Coalition,, which will provide information for contacting your representatives for input on this bill. This is an important issue that needs the attention of each and every member! The FMA has been very active on this issue.

In thinking on a deeper level about this issue, we should feel challenged as a medical specialty to evaluate ways in which we as physicians in radiology can provide our services in a more accessible manner to patients in need. The reality is that even at present there is inadequate patient access to quality medical care. If physicians do not work diligently to improve access, other providers will step in. We would be foolish to think that this would not eventually occur within the specialty of radiology. Machine learning and AI are tools which we can use to integrate our specialty back into routine patient care. We must plan carefully our path as an integral part of the patient care experience, connecting not just with the images on the screen and the data in the AI algorithms, but also with the patient.

We have the framework and the bandwidth to make this happen. It requires continued education, thought and leadership. Along these lines, we continue to educate our future leaders. The FRS Foundation is happy to announce that the scholarships for residents to attend that AMCLC will be expanded to a total of 10 scholarships, in order that each program in the state will have the opportunity to send a resident to the AMCLC in the future. Please support our FRS Foundation in order that we can provide continued support to our residents, as this has a tremendous impact on our future efforts and leadership.

In a note on housekeeping, a survey has been sent out to FRS members for voting on our new officers for 2020-2021. 1890 members were sent a survey and only 179 have replied. If you received the survey please cast your vote via the survey so our officers can be confirmed for 2020-2021. Thank you for your attention to this matter.

The AAWR and 12 state chapters are sponsoring a proposed ACR resolution for paid family/medical leave in radiology and radiation oncology practices. The resolution reads as follows: “That the American College of Radiology (ACR) recommends that radiology and radiation oncology practices, departments and training programs strive to provide 12 work weeks of paid family/medical leave in a 12-month period for radiologists, radiation oncologists, nuclear medicine physicians and medical physicists of all genders, including members in training.”. The FRS has not signed on as a sponsor to date but has been asked to consider this resolution. Please contact me with your thoughts regarding this resolution if you would like to express your opinion. We will likely be asked to vote on this at the upcoming ACR meeting in May.

On a note regarding the annual FRS meeting, the job fair is scheduled to take place on Sunday July 19, 2020 at our annual meeting in Ft. Lauderdale from 11:15 AM until 2:00 PM. This is an exciting new development for this year’s meeting. If you have a group or organization that id looking to hire individuals and would like to participate in the job fair, please contact the FRS office to sign up for this event.

Finally, hoping that all stay healthy as we are faced with the emergence of COVID-19 in the state of Florida. I am attaching the link to a e-publication in Radiology that provides useful information for identifying Chest CT findings of the COVID-19 infection: . The conclusion of this article is that the sensitivity of Chest CT was higher for the diagnosis of COVID-19 infection when compared to the reverse-transcription polymerase chain reaction (RT-PCR) swab samples in the epidemic in China. Stay informed, prepared, hopeful and healthy!

Patricia Mergo, MD, FACR
President, Florida Radiological Society

Janaury 2020

Letter from the Editor
Happy New Year!! Here comes 2020 – Is your Organization or Facility ready for Advanced Imaging Clinical Decision support?

For Radiologists, this will be the year when CMS will enforce AUC (Appropriate Use Criteria: Program)

Beginning January 1, 2020, a provider must use a qualified CDSM and report appropriate use criteria consultation information on the professional and facility claims for service. The claims will include:

  • Ordering professional’s NPI.
  • Which CDSM was consulted (such as R-scan created by the College of Radiology).
  • Whether the service ordered would or would not adhere to consulted appropriate use criteria or whether it was not applicable to the service ordered.

 CMS has determined the following exceptions to the reporting requirements:

Emergency services when provided with certain medical conditions, inpatients and for which Medicare Part A payment is made, and ordering professionals when experiencing significant hardship such as insufficient internet.

January 1, 2020 is educational year. • While consultation of AUC will be required, adherence to AUC recommendations is not required during this initial phase. • Reimbursement denials begin Jan 1, 2021. • In the future, CMS will require ordering clinicians with exceptionally high rates of non-adherence to ordering guidelines to obtain pre-authorization of advanced imaging studies for Medicare patients.

While this may be for Medicare patients only, it’s important to note that as Medicare goes so does the rest of the industry.

Check the CMS website regularly for Updates:

 List of CMS approved CDS

  • AgileMD’s Clinical Decision Support Mechanism
  • AIM Specialty Health ProviderPortal®*
  • Applied Pathways CURION™ Platform
  • Cranberry Peak ezCDS
  • EviCore healthcare’s Clinical Decision Support Mechanism
  • EvidenceCare’s Imaging Advisor
  • Inveni-QA’s Semantic Answers in Medicine™
  • MedCurrent OrderWiseTM
  • Medicalis Clinical Decision Support Mechanism
  • National Decision Support Company CareSelect™*
  • National Imaging Associates RadMD
  • Reliant Medical Group CDSM
  • Sage Health Management Solutions Inc. RadWise®
  • Stanson Health’s Stanson CDS
  • Test Appropriate CDSM*

Protecting Patients:

Surprise insurance gaps are causing patients to walk away with unexpectedly high medical bills. What causes this, and how can radiologists help?

Chintan Desai, MD
Secretary, Florida Radiological Society

December 2019

Letter from the Editor
Hope everyone enjoyed spending time with their loved ones for the Thanksgiving Holidays. For those who worked through the holidays, I hope you had some free time to relax with your family and friends as well.

Below is an interesting technology that allows automatization in tumor mapping for treatment planning.

InnerEye is a research project that uses state-of-the-art machine learning technology to build innovative tools for the automatic, quantitative analysis of three-dimensional radiological images. Project InnerEye develops machine learning techniques for the automatic delineation of tumors as well as healthy anatomy in 3D radiological images.

InnerEye technology may enable the following:

 1. Extraction of targeted radiomics measurements for quantitative radiology
 2. Efficient contouring for radiotherapy planning
 3. Precise surgery planning and navigation.

In practice, Project InnerEye turns multi-dimensional radiological images into measuring devices.

For Radiation Oncology Colleagues, Microsoft offers a software called InnerEye, which it claims can visually identify and display possible tumors.

A software tool that Radiologist can use in the near future. Now machines can detect intracranial hemorrhages in a CT scan. Deep learning algorithms for detection of critical findings in head CT scans: a retrospective study; The Lancet, published October 11, 2018. This technology can detect intracranial bleeds, fractures, strokes, and more prioritize those studies in the PACs worklist and even prepopulate the radiology report with the findings detected by AI software embedded into the DICOM viewer.

For another year of cuts, please see the 2020 Fee Schedule update. The Centers for Medicare & Medicaid Services recently released the final Medicare Physician Fee Schedule for 2020, which will take effect on Jan. 1. One aspect of the now finalized rule has drawn fire from the American College of Radiology, which estimated that changes could cut radiology payment by $450 million in one year alone, and $5.6 billion over the next decade.

 Chintan Desai, MD
Secretary, Florida Radiological Society

November 2019

Letter from the Editor

As we all await our future and how we will collaborate with machines, I came across an interesting fact that machines will change healthcare. Diabetic Retinopathy, is usually diagnosed by careful examination by an Ophthalmologists. Instead now machines can do the same thing without the doctor with an IDx-DR system. This the first autonomous AI device to receive FDA approval for reaching a diagnosis without physician input. The IDx-DR system uses the Topcon NW400 robotic retinal camera to take high resolution images which are then interpreted by Artificial Intelligence software.

Knowing that we will one day be able to use deep learning algorithms and AI to make our lives better, some Residency programs have already started offering specialized education to residents in AI. For Example, University of Washington Radiology offers Deep Learning Pathway which is an immersive and rigorous experience that trains residents to apply cutting-edge deep learning techniques to medical imaging research. This unique resident training path is the first of its kind to bridge the gap between medical imaging and AI education.

As we worry and stress with our daily work load and lives, I hope everyone reading this gets a chance to visit

This screening tool allows you to better understand your overall well-being and identify areas of risk compared to your peers across the country. This is 100% anonymous—your information will not be shared with anyone, including the ACR.

I would like to share the link below;

Leading with Humor  — According to research, every chuckle brings with it a host of business benefits. Laughter relieves stress and boredom, boosts engagement and well-being, and spurs not only creativity and collaboration but also analytic precision and productivity.

Maybe we can have a running blog of ideas on how to integrate Humor- Anyone??

Reminder for all of us who provide services to Medicare patients:

Starting Jan. 1, 2020 – the Protecting Access to Medicare Act (PAMA) requires referring providers to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging services (ADIS) — CT, MR, Nuclear Medicine and PET — for Medicare patients.

Chintan Desai, MD
Secretary, Florida Radiological Society

August 2019

FRS President’s Message 
Greetings! Thanks to all who attended the summer FRS/FRBMA annual meeting at the Ritz-Carlton in Naples, Florida. The meeting was a great success and we had a particularly fantastic and notable radiology and radiation oncology resident presence with 66 residents attending! Thanks to Dr. Steven DePrima for his outstanding leadership as the outgoing FRS President. Dr. DePrima’s endless hours of work were evident to all who attended the meeting. Congratulations also to Dr. Juan Batlle, as the program committee chair on putting together an outstanding and flawlessly run program.

For those who were unable to attend this year’s meeting, a few highlights include discussions on the ever-increasing influence of artificial intelligence on our profession, corporatization of radiologic practices and amazing lessons in leadership learned from Dr. Charlie Williams presented by Dr. Larry Muroff. If you could not make it, please consider marking it on your calendar for next year. The meeting next year will be at the Westin Ft. Lauderdale Beach Resort, July 17-19, 2020.

From a legislative standpoint, it is very disappointing to note that Telemedicine licensing legislation in the state of Florida has been signed and put into law. The FRS remains committed to voicing our concerns for quality assurance for radiology practice in the state of Florida with regards to Telemedicine implementation and expansion. We will be discussing these and other legislative highlights in the upcoming FRS/FRBMA Fall 2019 Focus newsletter.

I am excited to take on the role as your FRS President this year. Please feel free to email me with comments or concerns. I am looking forward to serving the FRS and continuing the efforts of our past outstanding leaders.

Patricia Mergo, MD, FACR
President, Florida Radiological Society

August 2019

Letter from the Editor
Radiologist Burnout has been a hot topic of discussion. This was also one of the topics at the 2019 Annual ACR meeting. I decided to think about burnout among the radiologist that I know or work with. Let’s start with some facts, ACR 2018 HR Commission Workforce Survey, 78% radiologists and physicists reported burnout being a significant problem in their workplace; only 19% reported having mechanisms for assessing it, and only 21% said they had effective ways of addressing it. The facts indicate that prevalence of burnout is very high within the radiologist and physicist communities. We can probably self-reflect about the practices that we work in and the demands that are placed on all of us to provide continuous optimal performance. Additionally, several studies clearly show the link between physician distress, in terms of burnout and depression, and the effect on patient care, especially medical errors. 

One question, is stress related to burnout? The answer is yes. When levels of stress become too high, performance decreases. Stress inversely impact cognitive processes like attention, memory, and problem-solving. That stress increases, a person’s ability to function diminishes, ultimately leading to symptoms of anxiety, anger, frustration, disruptive behavior, depression and the syndrome of burnout. Over a longer time period this adversely affects the health and wellness of the individual. 

It has shown that burnout can have personal impact that can be devastating and can lead to depression, substance abuse, divorce and even suicide. Burnout may manifest as destructive behavior, including verbal outbursts and physical threats, as well as passive activities such as refusing to perform the same tasks or quietly exhibiting uncooperative attitude. 

Maybe it is time for us to integrate and invest in wellness programs into our own practices and institutions. For example, the Canadian Medical Association has a dedicated center for physician health and well-being, and every provincial medical association in Canada has a physician wellness portfolio. Are we ready to commit to including physician wellness and well-being as a quality or key performance indicator? 

Chintan Desai, MD 
Secretary, Florida Radiological Society

March 2019

Letter from the Editor
Performance Measures for 2019

Performance measures are a crucial component in healthcare quality. They serve as a mechanism to evaluate cost-of-care performance and quality. They drive improvement, allow patients to make informed decisions, and are used to influence provider payment. These measures can also provide an objective assessment of how well and how appropriately healthcare is delivered compared to recognized standards. 

Recent measures in play that were approved and finalized in May 2018 are:

Measure 1: Use of Structured Reporting in Prostate MRI – For improvement in Communication and Care Coordination and Effective Clinical Care

Measure 2: Follow-up Recommendations for Incidental Findings of Simple – Appearing Cystic Renal Masses – For improvement in Communication and Care Coordination, Efficiency and Cost Reduction and Patient Safety

Measure 3: Surveillance Imaging for Liver Nodules < 10 mm in Patients at Risk for Hepatocellular Carcinoma (HCC) – For improvement in Communication and Care Coordination, Effective Clinical Care and Efficiency and Cost Reduction

Measure 4: Use of Quantitative Criteria for Oncologic FDG PET Imaging – Communication and Care Coordination and Effective Clinical Care

Measure 5: Use of Low Dose Cranial CT or MRI Examinations for Patients with Ventricular Shunts – Effective Clinical Care and Patient Safety

Measure 6: Use of Low Dose CT Studies for Adults with Suspicion of Urolithiasis or Nephrolithiasis – Effective Clinical Care and Patient Safety

Source: ACR

 Quality and Safety


Joint commission (TJC) will now require all individuals who use fluoroscopic equipment and perform diagnostic CT examination to participate in ongoing education that includes annual training. Although ACR is not developing new resources specifically to meet these requirements, one can engage medical physicist for training and guidance. Image Wisely and Image Gently are good educational sources. There are also commercially available radiation safety products and training material.

Raj Kedar, MD, FACR 
Radiology Associates of Florida 
Associate Professor of Radiology, Morsani College of Medicine, Univ of South Florida 
Tampa, Florida 

December 2018

FRBMA President’s Message

The American College of Radiology (ACR) and the Radiology Business Management Association (RBMA) hosted its annual ACR-RBMA Practice Leaders Forum on January 11th – 13th in Houston, Texas. Some of the topics covered included practice models to accommodate changing medical reimbursement, leadership development and transition planning, solving workplace conflict by harnessing emotional intelligence, the nuts and bolts of the Quality Payment Programs in 2019, artificial intelligence and radiologists’ involvement, and online reputation management.

Practice Models to Accommodate Changing Medical Reimbursement

David L. Waldman, M.D., Ph.D., FSIR, FACR and James Forrester, MS, CTO discussed how scale is essential if radiologists expect to assume risk and manage patient populations. The premise is creating greater scale leads to gains in operational efficiencies and allows entities to spread overhead costs across a larger base. Regional expansion is a viable alternative and, to be successful, expansion must be coupled with integration. Options for achieving scale include affiliations and practice acquisitions. The goal is to develop a data flow where physicians are all working within a single workflow, regardless of physical location. Developing a 24/7 communication desk to give access to the radiologists was cited as one important tool in ensuring successful integration. 

Leadership Development and Transition Planning

It is commonly understood there is much civilians can learn by studying military styles of leadership. Mohammad Naeem, M.B.B.S., M.D. Colonel, Medical Corps, U.S. Army Fort Belvoir Community Hospital, described various formal and informal methods and techniques used to evaluate the leadership potential of military radiologists. According to Dr. Naeem, “leadership is the process of influencing people by providing purpose, direction, and motivation while operating to accomplish the mission and improving the organization.” Some believe great leaders are born; however, a case was made that leaders who inspire and influence people to accomplish organizational goals are more commonly cultivated. They are effective in motivating people to pursue actions and shape decisions for the greater good. Some of the things the profession of radiology can do to develop future leaders include a focus on leadership topics during residency, dual radiology-MBA residency programs, and continued leadership training post-residency and through the American Board of Radiology (ABR) certification. 

Solving Workplace Conflict by Harnessing Emotional Intelligence

An awareness of one’s emotions and communication styles are critical in the workplace and the ability to manage emotions is an important component of being a great radiology leader. Larry Muroff M.D. FACR, Adjunct Clinical Professor University of Florida and University of South Florida Colleges of Medicine, made a case that having charisma is helpful, but having only charisma is not enough. Continually learning and implementing what is learned allows for the development of great leaders and for leadership to be taught. 

The Nuts and Bolts of the Quality Payment Programs in 2019

The third Performance Year (PY) of the Quality Payment Programs (QPP) is 2019 and a majority of clinicians, including radiologists, are participating through the Merit-based Incentive Payment System (MIPS). The highlights for PY 2019 include a re-weighting of the Quality performance category to 45 percent; an increase in the Cost performance category to 15 percent; an increase in the exceptional performance threshold to 75 points; an increase in the Composite Performance Score (the threshold to avoid penalties) to 30 points; and exposure in 2019 to “topped-out” measures that will be capped at seven points (versus 10 points for non-topped out measures). A topped-out measure is one with consistently high performance such that meaningful distinctions and performance improvement can no longer be made. Topped-out measures will first be reduced in point values and then subject to elimination in future years. Measure 225, reminder system for screening mammograms, is a good example of a measure that is topped out in 2019 and will likely be eliminated in 2020. The impact of topped-out measures is that achieving exceptional performance scores becomes a moving target and clinicians are encouraged to query their billing databases for non-topped-out measures they can report on in future years. 

Artificial Intelligence (AI) and How Radiologists Will be Involved

Keith Dreyer, D.O., PhD., FAACR, FSIIM, introduced Medical Imaging Artificial Intelligence with a discussion about how artificial intelligence may affect clinical practices and AI’s inherent challenges and limitations. Jonathan W. Berlin, MD, MBA, FACR, followed with a point-counterpoint by analyzing the purported benefits of AI in clinical practice and cautioned the audience to be careful of what one wishes for. For example, a purported benefit is that AI in radiology will decrease errors. Why are we sure this will happen? Are computers error-free? His analogy was autonomous vehicles and automakers who have been claiming autonomous vehicles (AVs) will start filling the roads by 2020 and take over by 2030. And yet, some prototypes would still flunk a driver’s education course. And what if AI does not decrease errors? What if AI just simply has overly high sensitivity and low specificity? Additional potentials benefits Dr. Berlin discussed and challenged included AI will a) increase efficiency, b) serve as a solution to declining reimbursement, c) add value to the radiology report, and d) ensure the future of radiology by adding expertise and standardization. 

Online Reputation Management

A case was made that online reviews of radiology practices can have a profound impact on a practice and that improvements in reviews can lead to improvements in revenue. Forty percent of people form an opinion simply by reading only three reviews and up to 88 percent of consumers trust online reviews. Actions groups can take to manage their online presence include optimize online profiles, increase the base of reviews and ask for more reviews, and monitor and respond proactively to reviews. There are online reputation management companies and while these services can be purchased, at the end of the day, a great reputation must be earned. 

Barbara Rubel, MBA, FRBMA
President, FRBMA

December 2018

FRS Editor’s Message

Time to submit data for MIPS measure for 2018

The CMS approved Qualified Clinical Data Registry (QCDR) for Merit-Based Incentive Payment System (MIPS) measure may be submitted by uploading it to MIPS portal of the National Radiology Data Registry (NRDR). Data collected between January 1, 2018, and December 31, 2018, should be submitted by the January 31, 2019 deadline.

Some of the measures in diagnostic radiology that can be submitted are:

  • Fluoroscopy Dose/Time for patient safety
  • Inappropriate use of “Probably Benign” category in Mammography screening for efficiency and cost reduction
  • Comparison of all existing imaging studies for all patients undergoing bone scans for communication and care coordination
  • Stenosis measurement in carotid imaging reports for effective clinical care
  • Reminder system for screening mammograms for communication and care coordination
  • Biopsy follow-up for communication and care coordination
  • Cardiac stress test not meeting appropriateness use criteria for preoperative evaluation of low-risk patients for efficiency and cost reduction
  • Cardiac stress test not meeting appropriateness use criteria for routine testing after percutaneous coronary intervention for efficiency and cost reduction
  • Cardiac stress test not meeting appropriateness use criteria for testing asymptomatic low risk patients for efficiency and cost reduction
  • Optimizing patient exposure to Ionizing radiation: Utilization of a standardized nomenclature for Computed Tomography (CT) imaging description for communication and care coordination
  • Optimizing patient exposure to ionizing radiation: Count of potential high dose radiation imaging studies: Computed Tomography (CT) and cardiac nuclear medicine studies for patient safety
  • Optimizing patient exposure to ionizing radiation: Reporting to a radiation dose index registry for patient safety
  • Optimizing patient exposure to ionizing radiation: Computed Tomography (CT) images available for patient follow-up and comparison purposes for communication and care coordination
  • Optimizing patient exposure to ionizing radiation: Search for prior Computed Tomography (CT) studies through a secure, authorized, media-free, shared archive for communication and care coordination
  • Optimizing patient exposure to ionizing radiation: Appropriateness: follow-up CT imaging for incidentally detected pulmonary nodules according to recommended guidelines for communication and care coordination
  • Appropriate follow-up imaging for incidental abdominal lesions for effective clinical care
  • Follow-up imaging for incidental thyroid nodules in patients for effective clinical care
  • Radiation consideration for adult CT: Utilization of dose lowering techniques for effective clinical care


There are separate interventional radiology and radiation oncology measures. CMS requires physicians and groups to report on all patients (Medicare and Non-Medicare) that apply to a measure. These can be reported as individual measures or group practice measures.


Chief, Raj Kedar, MD, FACR 
Chief, Dept of Radiology – Tampa General Hospital
Radiology Associates of Florida
Associate Professor of Radiology, Morsani College of Medicine, Univ of South Florida|
Tampa, Florida


October 2018

FRBMA President’s Message
The 33rd Annual Economics of Diagnostic Imaging 2018: National Symposium was held in Washington, D.C. from October 11th through October 14th.  The most common themes threading their way through the four days of educational lectures included updates to the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (AAPMs); defining value in radiology; negotiating with managed care companies; perspectives on artificial intelligence; and Radiology’s 100 as published by the Radiology Business Journal.

The Merit-based Incentive Payment System (MIPS)

The discussions about MIPS and AAPMS focused on the reduction in the MIPS payment adjustments that became available on July 1st, 2018 due to the “targeted reviews” conducted by the Centers for Medicare and Medicaid Services (CMS).  Clinicians who earned a perfect score of 100 out of 100 were initially notified of a positive payment adjustment of 2.02%.  This adjustment has since been reduced to 1.88% and may be subject to further reductions once CMS finalizes a second targeted review which concluded October 31st, 2018.

A targeted review is a process where MIPS eligible clinicians may request a review of their 2019 MIPS payment adjustment factor.  For example, clinicians who believe there are calculation errors or data quality issues in the determination of their payment adjustment may submit supporting documentation which shows measures submitted and where they believe the errors have occurred.  CMS has published information about targeted reviews at the following website:

Defining Value in Radiology

Much of the conversation around defining value in radiology focused on how to achieve improved patient outcomes without raising costs or even better, at a lower cost.  Some of the obvious metrics include reducing unnecessary duplication of studies and making reports more useful to referring physicians.  But can radiologists collaborate with referring physicians in ways that lead to better outcomes and establish themselves as key team members?  Is there opportunity for radiologists to help referring physicians develop more appropriate treatments?

Negotiating with Managed Care Companies

An important take-away from the discussion about negotiating with managed care companies was the importance of recognizing there are opportunities to negotiate contract provisions beyond compensation and payment terms.  Radiologists are 50 percent of the relationship and many companies are willing to negotiate provisions such as length of the initial term and any subsequent renewal terms;  amending the contract; timely filing limits, which also address when the payer is secondary; who is responsible for obtaining pre-authorizations; complying with state laws regarding copies of medical records; and including any new products that are introduced under the already negotiated fee schedule. 

Artificial Intelligence

Many common applications in artificial intelligence (AI) are algorithmic, where evidence-based approaches are programmed by researchers and clinicians.  Humans essentially embed known data into algorithms so that computers can extract information and apply it to a problem.  AI approaches are already in use in radiology, for example use of natural language processing in automated coding products.  And the Federal Drug Administration (FDA) has approved marketing of Contact, a clinical decision support software that analyzes CT results and notifies providers of potential strokes.  It is generally agreed, however, that machines will not replace radiologists; but that radiologists who embrace the use of artificial intelligence technologies will be better than those who do not.

Radiology’s 100

Each year, just prior to RSNA, Radiology Business Journal presents the largest radiology practices in the United States which contains the rankings of the “Radiology 100.”  While the results had not yet been published at the time of the Symposium, they were recently released on October 22, 2018.  RBJ concludes that consolidation may be the single most “inescapable form of disruption” in radiology, considering seven “bellwether” radiology practices have completed merger and acquisition deals in the 18 months prior to July 2018.

With only one exception, the top 10 practices in 2017 have all remained in the top 10 for 2018.  TRA Medical Imaging Northwest has moved from #9 in 2017 to #11 in 2018 and Renaissance Imaging Medical Associates has moved from #11 in 2017 to #4 in 2018.  A different strategy was employed this year by asking for the number of full-time and part-time radiologists versus the number of FTE radiologists.  Based on input from those surveyed, RBJ indicates it will return to the number of FTEs methodology in 2019.

The top 10 practices for 2018 are:

#1 Radia (Lynwood, WA)

#2 Radiology Associates of North Texas (Ft. Worth, TX)

#3 Southwest Diagnostic Imaging (Phoenix, AZ)

#4 Renaissance Imaging Medical Associates (Northridge, CA)

#5 Columbus Radiology (Columbus, OH)

#6 Riverside Radiology & Interventional Associates (Columbus, OH)

#7 Texas Radiology Associates (Plano, TX)

#8 Advanced Radiology Services (Grand Rapids, MI)

#9 Austin Radiological Association (Austin, TX)

#10 University Radiology (East Brunswick, NJ)

Top priorities for those surveyed include keeping current with new technologies, avoiding penalties and optimizing opportunities for bonuses under CMS’ value-based payment programs, surviving reductions in reimbursement, protecting patient privacy and data security, making appropriate strategic decisions about consolidations, and preparing for increased pressures from the commercial payer market. 

The complete article can be found at

Barbara Rubel, MBA, FRBMA
President, FRBMA

Editor’s Message

Clinical Decision Support and PAMA compliance for Radiology: Conclusion

Expectations are CMS to issue a transmittal that will provide details as to the codes and method of submission, as they did to inform those participating in the voluntary reporting period for PAMA starting in July of 2019. During the voluntary period, the modifier “QQ” can be used to modify CPT codes to indicate that a consultation has been performed for said service and the furnishing provider is aware of the result. Expanded settings Independent Diagnostic Testing Facilities (IDTF) have been added as an “Applicable Setting.” For any services furnished or ordered, an IDTF is now required to submit evidence of consultation for a payable claim. CMS wants to ensure that as many Medicare services as possible are within scope for the program. Given the volume of Medicare Part B services furnished in standalone imaging centers, this expansion of coverage makes sense. This expansion to include IDTFs raises the bar for providers of these services and operators of these facilities to ensure the necessary infrastructure is in place for consultation and claims formation across all care settings. qCDSMs with web-based access points will be instrumental to enable these settings due to the diverse IT infrastructure. Exemptions CMS has outlined three circumstances where ordering providers are not required to consult AUC. These have been defined as  

  • Emergency Services
  • If the service is furnished under Medicare Part A
  • Hardship, this year’s proposed rule clarifies the proposed hardship exclusion and makes the ordering provider ‘self-report’ their exclusion from criteria. This year’s rulemaking proposed a definition of “Hardship”:
  • Insufficient internet access.
  • EHR or CDSM vendor issues
  • Extreme and uncontrollable circumstances.

These criteria add to the existing emergency services exclusion, where consultation is not required if it will cause undue harm to the patient. Future Rule-making and Next Steps Next year, CMS will undertake rulemaking to define how outliers are identified. Currently, outliers are defined as those providers who consistently do not adhere to AUC or fail to consult applicable AUC. Outliers will be penalized by being subject to additional authorization steps for Medicare Imaging services. With this rulemaking cycle, healthcare providers have all necessary information to begin implementation of a qCDSM. To prepare for the January 2020 deadline these implementations must begin as soon as possible. We continue to work with key stakeholders, including CMS, our partners, and the market at large to develop a compliance framework that creates cost savings opportunities, assures full claims payment, and minimizes the chance of being flagged an outlier by making AUC that cover all advanced imaging available through CareSelect, our fully qualified CDSM.


This year’s MPFS Proposed Rule:

January 1, 2020 – The Implementation Mandate This year’s MPFS Proposed Rule (the third of four rulemaking cycles) provides important implementation details related to the AUC provisions of the Protecting Access to Medicare Act. The rule will be finalized in November 2018 after a stakeholder comment period.

Program start Date January 1, 2020: Remains the formal start of the program. From this date forward, healthcare providers must consult a qualified Clinical Decision Support Mechanism (qCDSM) when ordering advanced imaging tests furnished under Medicare Part B. Under the program, consultations must occur across all advanced imaging, and evidence of consultation must be included on all claims.

The program starts with a one-year “Educational and Operations Testing Period.” During this period, AUC consultation must occur across all advanced imaging, and evidence of consultation must be included on the claim. Incorrectly formed evidence will not result in payment being withheld.

Proxy Consultation CMS has proposed to expand the personnel who can consult AUC at the time of order. In many organizations, proxies will often place orders on behalf of the physician. This year’s rule formalizes the option for these proxies while operating under the supervision of the ordering provider, to perform the consultation. As the provider requesting the order is subject to outlier calculation, any workflows leveraging this option must ensure that the ordering provider is made aware of non-adherent requests at the point-of-order. While this workflow option accommodates pre-existing order entry workflows, it also requires in-depth EHR integration knowledge to implement effectively. Consultation must take place at the time of order and under the supervision of the ordering provider. It is important to remember that this legislation focuses on the use of evidence-based AUC to manage utilization during the order entry process and emphasizes the educational impact of interactive AUC review when making care decisions. The statute also distinguishes between the ordering and furnishing professional, recognizing that the professional who orders an applicable imaging service is usually not the same professional who bills Medicare for that service when furnished. We interpret this to mean that ordering providers may have their staff (but not radiology staff) consult AUC on their behalf. Claims & Reporting CMS will accept all consultation data, as defined by the regulation, in the form of G-Codes with HCPS modifiers.

We expect CMS to issue a transmittal that will provide details as to the codes and method of submission, as they did to inform those participating in the voluntary reporting period for PAMA starting in July of 2019. During the voluntary period, the modifier “QQ” can be used to modify CPT codes to indicate that a consultation has been performed for said service and the furnishing provider is aware of the result. Expanded settings Independent Diagnostic Testing Facilities (IDTF) have been added as an “Applicable Setting.” For any services furnished or ordered, an IDTF is now required to submit evidence of consultation for a payable claim. CMS wants to ensure that as many Medicare services as possible are within scope for the program. Given the volume of Medicare Part B services furnished in standalone imaging centers, this expansion of coverage makes sense. This expansion to include IDTFs raises the bar for providers of these services and operators of these facilities to ensure the necessary infrastructure is in place for consultation and claims formation across all care settings. qCDSMs with web-based access points, including CareSelect Imaging, will be instrumental to enable these settings due to the diverse IT infrastructure. Exemptions CMS has outlined three circumstances where ordering providers are not required to consult AUC. These have been defined as • Emergency Services • If the service is furnished under Medicare Part A • Hardship, This year’s proposed rule clarifies the proposed hardship exclusion and makes the ordering provider ‘self-report’ their exclusion from criteria. This year’s rulemaking proposed a definition of “Hardship”: • Insufficient internet access. • EHR or CDSM vendor issues • Extreme and uncontrollable circumstances. These criteria add to the existing emergency services exclusion, where consultation is not required if it will cause undue harm to the patient. Future Rule-Making and Next Steps Next year, CMS will undertake rulemaking to define how outliers are identified. Currently, outliers are defined as those providers who consistently do not adhere to AUC or fail to consult applicable AUC. Outliers will be penalized by being subject to additional authorization steps for Medicare Imaging services. With this rulemaking cycle, healthcare providers have all necessary information to begin implementation of a qCDSM. To prepare for the January 2020 deadline these implementations must begin as soon as possible. We continue to work with key stakeholders, including CMS, our partners, and the market at large to develop a compliance framework that creates cost savings opportunities, assures full claims payment, and minimizes the chance of being flagged an outlier by making AUC that cover all advanced imaging available through CareSelect, our fully qualified CDSM.

Raj Kedar, MD, FACR 
Radiology Associates of Florida 
Associate Professor of Radiology, Morsani College of Medicine, Univ of South Florida 
Tampa, Florida 

August 2018

FRBMA President’s Message

The Centers for Medicare and Medicaid Services (CMS) released the 2019 Medicare Physician Fee Schedule Proposed Rule (MPFS NPRM) late in the day on Thursday, July 12th. The MPFS NPRM also proposes updates to the Medicare Quality Payment Program (QPP) for 2019 which includes the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (AAPMs).

The industry has been watching for the release of these proposed payment policies since February 2018 when Congress passed technical amendments to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) via the Bipartisan Budget Act of 2018 (H.R. 1892). H.R. 1892 gave CMS continued flexibility in implementing MIPS, most notably by a) allowing CMS to arbitrarily establish the Performance Threshold for 2019 – 2021 and b) granting discretion in the weighting of the Cost performance category for those same years. This continued flexibility in setting the performance threshold has caused (and will continue to cause) the creation of significantly lower penalty dollars, meaning those clinicians who excel under the program will realize only nominal increases in their fee schedules.

Highlights of the proposed updates to MIPS under the Medicare Quality Payment Program for 2019 include:

  • Performance Category weighting:
    • Quality: 45%
    • Cost: 15%
    • Improvement Activities: 15%
    • Promoting Interoperability: 25% (formerly Advancing Care Information)
  • Performance Threshold: 30 points vs. 15 points in 2018
  • Exceptional performance threshold: 80 points vs. 70 points in 2018
  • The MIPS reimbursement impact is +/-7 percent, which will impact 2021 Medicare payments
  • Data completeness for quality measures remains unchanged from 2018 at 60 percent
  • The low volume threshold remains unchanged from 2018 at +/- 7 percent, which will impact 2021 Medicare payments
  • Data completeness for quality measures remains unchanged from 2018 at 60 percent
  • The low volume threshold remains unchanged from 2018 at </=$90,000 in Part B allowed charges or </= 200 Part B beneficiaries. However, a third element, </= 200 covered professional services, has been added and clinicians may opt into MIPS if they meet or exceed one or two, but not all three, of the low-volume threshold criteria.
  • The quality reporting period mirrors 2018 at 12 months and there is no change in the reporting period (90 days) for Promoting Interoperability and Improvement Activities.
  • Facility-based clinicians have the option to use facility-based scoring if 75 percent or more of their covered professional services are performed in inpatient hospital (POS 21), on-campus outpatient hospital (POS code 22), or an emergency room (POS 23).
  • Payment adjustments will only apply to covered professional services and will exclude items such as Part B drugs.
  • The minimum thresholds for the Cost attribution methodologies (Total Per Capita Costs and Medicare Spend Per Beneficiary) have been reduced to 10 and 20 respectively.

Highlights of the proposed updates to Advanced Alternative Payment Models (AAPMs) under the Medicare Quality Payment Program for 2019 include: 

  • Increasing the percentage of a clinician’s payments that must come through an AAPM from 25 to 50 percent.
  • Increasing the percentage of Medicare beneficiaries a clinician treats through an AAPM from 20 to 35 percent.
  • Updating the AAPM Certified EHR Technology (CEHRT) threshold such that AAPMs must require 75 percent of participating eligible clinicians use CEHRT.
  • Extending the 8% revenue-based nominal amount standard for bearing risk under an AAPM through the performance year 2024 (formerly 2020).

The NPRM is available – click here – and comments must be received no later than 5 p.m. on September 10th, 2018.

P.S. A very successful joint FRS/FRBMA meeting was held in Orlando earlier this month with many timely and informative lectures. The following question was posed after “The Future of MIPS in 2019” lecture: “May radiologists be named participants in more than one ACO?” The answer is, yes, if they do not have e.g. NPs and/or PAs who carry Patient Attribution. Assuming they do not, then yes, CMS will take the higher of the two ACO scores for their MIPS score.

Barbara Rubel, MBA, FRBMA
President, FRBMA

July 2018

FRBMA President’s Message
This is my final E-Brief as President of the FRBMA. It has been a great two years with significant change in our field over that timeframe. It is comforting to know that you will have an even better President taking my place after the Orlando meeting, Barbara Ruble. She brings not only a wealth of day-to-day knowledge that should be helpful to all of you, but Barbara is nationally recognized and in tune with our field across the country.

My final thoughts as President will reflect more of a summary from the past two years versus any new and thought-provoking ideas.

Where are we headed as a field? Candidly, I am not sure. We have seen large national companies come in and buy up large groups in Florida at a real premium. This has included central and southeast Florida, with discussions being held elsewhere too. However, as a percentage of radiology statewide, it is a very small percentage. Recently, it was announced that Envision, which operates the former Sheridan Radiology and other entities, was purchased by an equity firm out of New York. What will this change mean? RadPartners has purchased a couple of large groups and MedNax has done likewise. Will these entities sell to someone else within 3 to 5 years or will even more groups be purchased? I suspect that the private practice of radiology will survive and thrive in our State with some penetration by the national companies.

Will Artificial Intelligence change our way of life in Radiology? I tend to think the answer is yes, but not in a threatening way and probably not as soon as some people think. Being able to reduce human error in patient processing and avoiding testing errors or even duplicate tests will be a huge assistance for the patient and those delivering care. The right test at the right time can only be enhanced with some of the technological advances we have seen. Do I think it will replace radiologists and technologists? Not in the next five years, but after that it may help us avoid having a radiologist shortage.

What about the future of RBMA and as such the Florida Chapter of RBMA?
The biggest challenge will be the dwindling number of Practice executives participating in RBMA due to mergers and acquisitions, as well as positions being eliminated. Our State Chapter is doing extremely well and is the largest Chapter in the country. However, we will need younger executives to get involved in the Board and help replace those of us who are getting closer to the end of our careers. Nationally, the challenge will be to lower seminar costs while maintaining a high level of speakers at conferences. As money gets tighter, groups tend to stop supporting national initiatives. 

What about a looming physician shortage in radiology? I speak to groups all over the State and this is becoming a real problem. We have seen an ebb and flow as it relates to recruitment packages being offered. Now in many areas of the country we are back to offering partnership and recruitment incentives. I believe this may change fairly soon now that most of the medical school programs are reportedly filling all of their slots. However, if the physician retirement accounts stay at a high level, you will see many doctors retiring. As I mentioned earlier, maybe A.I. can take over some of the lesser tasks, freeing up doctors to read studies and see patients. This could help us avoid a crisis.

Employed Radiologists or Entrepreneurs? Will we see the entrepreneurial spirit that has prevailed in our field continue or will we see younger/new physicians wanting to be employed by a hospital, national company, or even just employed by a mega group. The verdict is still out on this one. Many younger physicians have seen the limitations that working for someone else brings. So, I like to think that the entrepreneurs will prevail.

I have enjoyed my two years as President of FRBMA and will transition into Past President which is the best position to hold. Thank you to the FRS Board and FRS Foundation. I appreciate the relationship we have with you and never take it for granted.

Jeff Younger, MHA, FACHE, FRBMA
President, FRBMA
Chief Executive Officer

March 2018

Letter from the Editor

A recent article in the current issue of the ACR Bulletin discusses imaging across international borders. More specifically, it discusses the partnership organizations in Trinidad & Tobago. The article discussed agreements on a standard for radiological informatics and the national PACS system and removing existing geographic barriers to access patient information and imaging. South Florida especially is a strategic area for imaging across borders since the strong connections with the Caribbean, South, and Central America overcomes many of the language barriers that are a frequent impediment to the extension of services from the United States to these regions. Several local radiology groups have been approached for interpretations of these from outside the country or foreign nationals who come to the United States and require medical imaging which is transmitted overseas.

At the other end of this spectrum, unfortunately I am required to dictate to India by two of my clients, and the worry is not only the transcription services, but the interpretation services will be performed outside the country. The radiologists in Florida are certainly challenged by radiologists from out of the state dividing the market for local interpretation in Florida. While we have the continued requirement of restricting international interpretations of studies by Medicare and others, it is worrisome that these barriers may drop or be altered or circumvented by low cost and unverifiable interpreters. The worry is that imaging interpreted out of the country is unregulated and the interpreter may or may not be qualified or even be a radiologist interpreting the imaging. This concern may be perceived rather than real; however, the economic pressure and advantages to provide such a service would put not only the practice of radiologists in jeopardy but the health and welfare of our patients. Burying our heads in the sand and thinking this would not or could not happen seems foolish considering the potential threat.

Douglas Hornsby, M.D.
Secretary, Florida Radiological Society

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

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

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

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

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:

Jeffrey Stone, MD, FACR
President, Florida Radiological Society

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

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

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

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

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

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 (

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

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:

Respectfully Submitted,
Laura W. Bancroft, MD President
Florida Radiological Society

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

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
(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 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:

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

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

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

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

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:

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 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

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

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 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

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

Jeffrey A. Stone, M.D.
Secretary, Florida Radiological Society

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.

Jesse Davila, M.D.
President, Florida Radiological Society

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:

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:

Jeffrey A. Stone, M.D.
Secretary, Florida Radiological Society

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 (

Jeffrey A. Stone, M.D.
Secretary, Florida Radiological Society

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

 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

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

 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

Laura Bancroft, M.D.
Secretary, Florida Radiological Society

 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 ( 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 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

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  

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

 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