Are you hiring techs? You may be the only one. Many members have reported a measurable increase in the number of technologist job applications they are receiving, although few departments seem to be hiring. An Imaging Economics article says that the current vacancy rate for technologists is 2.1% (which measures the number of vacant positions versus the total number of FTE positions). Apparently this is the lowest rate in at least seven years.
Many imaging departments were forced to make staffing shifts in the wake of the 2008 financial collapse. In addition, while some hospitals were able to hold the line on staffing and avoid letting any techs go, freestanding imaging centers are cutting staff at the same time. Members in markets with several imaging centers are reporting an increase in applicants from former employees of these providers--applicants that hospital imaging departments had difficulty attracting in the past. Departments also report no longer being required to offer substantial signing bonuses and other stipends to potential candidates. With outpatient imaging market consolidation in the future and the national unemployment rate still high, we assume this trend will continue in the near term.
In a study published in the September issue of the American Journal of Roentgenology, researchers at Massachusetts General Hospital (MGH) found that radiologists turned around imaging reports significantly faster following hospital implementation of a pay-for-performance program that rewarded speedy reporting. Specifically, the mean time from scan complete to signed report went from 42.7 hours to 31.6 hours in the 3 month period after implementation. The specific target of the program was reduction in the time it took staff radiologists to provide final signatures on initial reports prepared by residents. In the initial stage of the program, radiologists whose review time averaged less than 24 hours during the evaluation period were offered $2,500 every six months. MGH achieved this goal- radiologist review went from 22.7 hours to 12.6 hours. Interestingly, turnaround time remained low even after MGH abandoned the program- mean total turnaround times were 16.3 hours in the 3 month period after program termination. The researchers also mention that monetary incentives were likely not the only factor that lead to improved radiologist report turnaround. Simply providing transparency of performance, as in pay-for-reporting programs, also encourages improvement.
This latest report follows a general trend of hospital's raising service standards for radiologists, an area we discussed in our national meeting speech, "Re-envisioning the Imaging Enterprise" and a recent webconference, "Trends in Hospital-Radiologist Contracting."
Physicians order too many unnecessary imaging tests that fail to discover the cause of patients' complaints, increase patients' exposure to excess radiation and raise medical costs, according to a paper published on Tuesday in the journal Radiology.
The paper is based on the "best ideas" from a two-day summit with representatives from more than 60 groups involved in medical imaging. William Hendee, the paper's author and a radiologist at the Medical College of Wisconsin, said that most imaging procedures enhance the accuracy of medical diagnoses or guide treatment decisions, making the tests "fully justified." However, he wrote that "some imaging procedures are not justified, because they are unnecessary for the patient's care." Two reasons for unnecessary tests include physicians' attempts to protect against potential future lawsuits and physicians who refer patients to imaging facilities they own, Hendee said.
A recent article in Diagnostic Imaging touches on the volume trends that we have written about in prior blog posts and addressed in our research this year. Our volume survey from earlier this year showed that in the first quarter of 2010, the median hospital respondent was down six points in 2010 versus the same time in 2009 in terms of outpatient MRI and CT. For other modalities such as mammography and nuclear medicine, the decline was even more pronounced.
This article cites a couple of other sources that might help readers compare their own performance against larger trends. First, the article quotes a VP from Arlington Medical Resources who says that hospital CT and MR volume has remained flat but that non-hospital imaging center volumes are declining. For hospitals, this is roughly consistent with our survey, which should that on average, hospitals saw zero percent growth in outpatient MR in the first quarter of 2010 compared to 2009, although CT growth was -2% during that same time (not flat as implied by the quote).
However, while hospital volume in aggregate may be flat, there is obviously a lot of variation in volume performance at the individual facility level. The article also cites a poll of 206 hospitals, conducted by an organization called MarkeTech Group. Their survey showed that 32 percent of hospitals have seen CT volumes decrease by by as much as ten percent "in the past six months" (not sure exactly when the survey was conducted), while 27 percent have experienced flat volumes. Another 20 percent have seen increases by as much as ten percent. This variation in growth is similar to the results from our survey, although our data show more hospitals more down than up in volumes in 2010 for every modality, with the exception of outpatient MRI where only half of respondents reported negative growth. Also in our survey, fewer respondents reported "no change" in volume.
A New York Times editorial on Monday provides an update on the medical isotope bill languishing in Congress, and calls for an end to procedural roadblocks in the Senate.
The American Medical Isotopes Production Act has two sound objectives. It seeks to create domestic capability for making a radioisotope, molybdenum 99, whose decay products are used tens of thousands of times daily in the United States to diagnose cancer, heart disease and other ailments.
The legislation has been endorsed by medical organizations that use radioisotopes and by national-security groups that worry about controlling the spread of bomb-grade materials. It was approved by the House by a thumping 400-to-17 vote in November and unanimously approved, with some amendments, by the Senate Energy and Natural Resources Committee in December. Then Mr. Bond, taking advantage of Senate rules, placed a "hold," preventing floor debate and a final vote.
If the medical groups that need a reliable supply of isotopes believe the bill will meet their requirements, it seems foolhardy to allow Mr. Bond to impose his contrary judgment. The Senate needs to approve this bill before it expires with the end of the session.
A member recently asked us what our recommendations would be forecasting Medicare hospital-based imaging reimbursement out five years (they were completing a pro forma on a new imaging center). Should they anticipate major increases or decreases moving forward?
My advice for projecting hospital-based reimbursement by modality is to assume flat or slightly negative payment updates for radiology. Across the next few years, CMS will be issuing payment updates for the Hospital Outpatient Prospective Payment System in line with the market basket update reductions stipulated by the health reform law (Patient Protection and Affordable Care Act or PPACA). PPACA calls for CMS to reduce the market basket update for HOPPS across the next several years. For CY2011, the market basket update reduction is 0.25%. Hospitals would have received a payment update of 2.4% in 2011 compared to 2010, but now with PPACA, the 2011 update is 2.15%. So rather than resulting in a decrease to payment, the health reform bill resulted in a reduction of an increase. Similar "reductions" will be made in subsequent years. Even with smaller market basket updates, the planned decreases from PPACA across the next few years are not that sizeable.
Read more »
I recently came across some interesting data about medical homes and imaging utilization. In this story about practices designated as medical homes by Blue Cross Blue Shield of Michigan (consisting of 1800 physicians in 500 practices), those physicians had a lower utilization of imaging for adults:
Preliminary data suggests designated practices are better managing patient care to improve quality and reduce costs. Medical home practices have a 2 percent lower rate of adult radiology usage than other practices, and a 2.6 percent lower rate of adult inpatient admissions.
Under the medical home model, physician practices are designated patients' "medical home" to coordinate the continuum of care. The practices are redesigned to be more functional and workflow-friendly, and new processes are developed to focus on quality, safety and alternative reimbursement methods. The care model also calls for extensive use of health information technologies, including electronic health records, e-prescribing, clinical decision support, secure messaging and Web portal software.
At first glance, a two percent reduction in imaging utilization isn't that impressive. It could suggest that there isn't a big cost savings opportunity with primary care physicians and imaging utilization. RBMs have reported that primary care physicians often have the highest ratio of appropriate to inappropriate advanced imaging orders; however, PCPs typically don't order a lot of advanced imaging anyway. The imaging they do order is probably more routine (x-ray, ultrasound and echocardiography), potentially more appropriate and less costly. Of course, this is just one example of a medical home program, so it will be important to weigh the experiences of other payers and providers.
At this year's national meeting, we dedicated a portion of our discussion on securing imaging margins to reducing imaging supply costs. One idea we presented is the use of non-GPO arrangements in cases where working directly with vendors may offer better pricing. We've received a number of follow-up questions from members on this practice, so I wanted to provide some further comments.
The real potential to reduce costs by dropping your GPO lies in the negotiable rebates achieved by the "Discount Safe Harbor". Absent GPO affiliation, a health system can redirect the rebates, normally given to GPOs, directly to the participating institutions. In the cases we have researched involving larger health systems, these rebates can add up to as much as $7-9 million annually. Additionally, working outside the GPO requires institutions to strengthen their relationships with vendors to achieve ideal pricing. By customizing each contract to meet the needs of each vendor interaction, vendors are often more confident that the terms of the contract will be upheld. This can often lead to pricing that is well below the highest tiered pricing within the GPO.
Read more »