I recently received a request from a member wanting to know where it makes sense put their focus when it comes to marketing of imaging services: consumers or physicians. The member also wanted to know which audience got most of the funding. This is actually two unique questions- I would argue that the dollars don't necessarily translate to the effort.
First off, I believe all progressive imaging programs should market to both physicians AND consumers. However, if I had to choose one as the larger opportunity, I would say referring physicians is where most of the effort should go. Here at the Advisory Board, we've researched marketing strategy for multiple service lines (I actually headed up the study on marketing of cardiovascular service line last year). Over and over, the conventional wisdom historically has been that more often physicians choose where to send patients and rarely do patients self-refer. I would say this still largely true for imaging. However, this is definitely changing. We've heard a lot of feedback from the membership that patients are becoming more price-sensitive and choosing where to go based on price and other factors. Exactly how much isn't clear, however, 91% of you reported to us in our 2010 Volume Trends Survey that patients in your market are becoming more price-sensitive. Furthermore, a recent study by McKinsey revealed that often it is actually a joint patient-physician decision so I would never recommend counting the patient decision out.
When it comes to funding physician vs. consumer marketing, the answer is a little less clear. This is because the consumer market is a larger target audience and thus marketing usually involves expensive mass media- TV commercials or print ads. While the return on these efforts is not as high, the value to brand exposure and image is high. On the flip side, physician marketing involves liaisons which command a considerable salary- about $50K to $70K per year. If you include this, the funding may come out about equal. If you don't, then consumer marketing is the clear funding winner.
In our Imaging Marketing survey (distributed to imaging directors as part of research process for Imaging Marketing Strategy), we found that the average percentage devoted to consumer marketing (vs. physician marketing) was 46% (n=51). It should be noted that the n was particularly low for this question because most respondents (n=85) answered "don't know." I actually thought this percentage seemed low, and that more of funds would go to consumer marketing. In the survey we submitted to cardiovascular service line leaders (in conjunction with the cardiovascular marketing study), 67% of respondents said that consumer marketing made up 80% or more of the budget. It should be noted in that in this survey, we asked respondents to NOT include the cost of staff salaries in their answer. Unfortunately, we did not add this condition in the wording of the question for imaging survey- so I can't know for sure if respondents included that in answers. Taking all of this together, my conclusion is that after staff salaries, about 60-80% of funds should go to consumer marketing, with the rest to physician marketing.
Given the increase price-sensitivity of patients and the declining volumes in imaging right now, physician referral strategy and improving the patient experience are high priorities for hospitals right now. Therefore, they are high priorities for the Partnership in 2011. Please let us know if you would like to be sure you are included in the research process next year. We welcome member feedback and information on these topics.
CMS announced a new project today that is aimed at examining the efficacy of decision support programs in guiding appropriate ordering of imaging exams. Starting January 1, 2011, the project has $10 million dollars in funding and will initially focus on the 11 high- cost and utilization imaging exams listed below.
- CT abdomen, brain, lumbar spine, pelvis, sinus, and thorax exams
- MRI lumbar spine, brain, knee, and shoulder exams
- SPECT myocardial perfusion imaging exams
Inappropriate imaging can result in increased costs, unnecessary radiation exposure and reduced quality and safety of patient care. Decision support programs, currently in limited use in some outpatient settings are designed to assist physicians in deciding if and what type of imaging is appropriate to order based on patient presentation. In this project, CMS hopes to solicit the participation of 2500 to 3500 physicians to implement decision support tools and have resulting utilization data reported to CMS.
More details and request for proposals can be found here.
Modern Healthcare recently released their list of the top ten stories of 2010, as ranked by their readers. Approximately 700 healthcare executives completed the online poll describing what they believed were the most important stories of the first half of 2010. While the passage of the Patient Protection and Affordable Care Act garnered over half (56%) of votes, many other topics, primarily related to changes to healthcare delivery models and regulatory changes, displayed significant interest.
Only one clinical-related topic reached "Top Ten" status: the growing concerns related to radiation overdoses in medical testing. While only the 9th most popular choice (2% of votes), the significance of the topic cannot be ignored, even for hospital senior executives. Stories of patients receiving numerous CT scans and outrageously high doses per scan have caused many hospitals to re-examine their CT protocols and make strides toward managing proper imaging utilization. While the radiology community is only beginning to explore how to manage radiation dose, the interest shown by non-radiologists has appeared swiftly. Modern Healthcare will release their top 10 list for the entire year in December and we will have to wait to see if radiation dose can still command a top spot.
The phrase "time is brain" resonates throughout our industry as clinicians know they have a limited number of hours to achieve a successful intervention for stroke patients. Typically, patients presenting to the emergency department with stroke-like symptoms are often given a non-contrast CT and also CT angiography to rule out hemorrhage or other lesions that may appear to cause ischemic events, and also to diagnose infarcts (tissue death caused by an obstruction). After initial stroke diagnosis, an MRI is commonly performed to assess the extent of ischemic damage. CT imaging for stroke patients has many distinct advantages for use in the ED, including wide availability, speed of image acquisition, and relatively low cost. However, CT has become the assumed standard rather than being clinically proven as such. New advances in MR imaging are causing some researchers to rethink how stroke patients should be treated upon presenting with symptoms.
Diffusion weighted imaging (DWI) uses the rate of water molecule movement to reflect image intensity and measure tissue changes in the brain. In a new study published in the July issue of Neurology, Schellinger, et al conducted a literature review to determine the relative benefit of DWI over traditional non-contrast CT in diagnosing acute ischemic stroke. In one study reviewed, 356 patients who presented to the ED with stroke-like symptoms were imaged with both non-contrast CT and DWI MRI. The images were read by both neuroradiologists and stroke neurologists to determine if a stroke had in fact occurred.
Basing much of their review off of this one seminal study, the researchers report that DWI has both increased sensitivity and accuracy when compared to noncontrast CT (77% vs. 16% and 86% vs. 55%). While these two modalities had similar specificity (95% vs. 96%), the authors postulated that the particularly low sensitivity for CT may be due to the higher than normal proportion of cases that were positive for stroke.
For the near term, it is unlikely that DWI will overtake CT as the recommended exam for stroke patients in the ED. Additional multi-center studies will likely be required before clinicians can definitively state that DWI is preferred to non-contrast CT. Furthermore, the expense and exam time of MRI are likely too high for many organizations to adopt this care pathway. To prepare, institutions should keep close watch on the developing clinical literature as well as explore the feasibility of performing DWI exams in the emergency department. It will also be imperative for organizations to stay abreast of the latest development in CT brain perfusion imaging - a cutting-edge application that is often being used to justify investment in premium CT scanners, although currently without much empirical evidence supporting its value.
We've had a chance to look at the Medicare Physician Fee Schedule proposed rule for 2011 in more depth, and I want to provide an update to the RVU and payment reductions anticipated for non-hospital imaging providers through 2013. CMS is continuing with the phase of RVU adjustments based on the Physician Practice Information Survey. Also, pursuant to the Patient Protection and Affordable Care Act, they are also finalizing the equipment utilization factor increase to 75% in 2011, which will also lower RVUs for CT and MRI technical components. Before this 2011 proposed rule came out, the ACR had conducted an impact study estimating that CT and MRI technical payments could drop as much as 45% by 2013.
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As reported in PR News Wire, a voluntary program available to members of Blue Cross Blue Shield in New Hampshire has recently added incentives to consumers for choosing low-cost option for outpatient imaging procedures.
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has now added the four existing imaging efficiency measures to the Hospital Compare website. Now consumers can go onto the CMS website and look up different hospitals' performance on mammography follow up and MRI for low back pain, in addition to readmission rates and mortality.
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The Centers for Medicare and Medicaid Services (CMS) just released the Proposed Changes to the Hospital Outpatient Prospective Payment System (HOPPS) and CY 2011 Payment Rates. And, while there don't appear to be many imaging specific changes, of note is the addition of four new imaging efficiency measures for 2012 and two others for subsequent years. I've listed these below.
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