Governance, Mission, Growth

MGMA Report Catalogs Success Factors of Better-Performing Groups
ONI Medical Introduces 1T Extremity MRI
Computer Program Predicts Chance of Breast Cancer Recurrence

MGMA Report Catalogs Success Factors of Better-Performing Groups

Performance and Practices of Successful Medical Groups: 2006 Report Based on 2005 Data has been issued by the Medical Group Management Association (MGMA), Englewood, Colo; it analyzes 508 “better-performing” practices in search of guidelines for better financial performance. Considered a benchmarking standard among medical groups for the past 8 years, the report was generated using data from more than 1,200 respondents to the MGMA 2006 Cost Survey and a supplemental questionnaire that assessed practices and procedures of better performers.

Detailed within are the processes employed by practices that excelled in four performance management categories: profitability and cost management; productivity, capacity, and staffing; accounts receivable and collections; and patient satisfaction. The report also offers 12 case studies, which demonstrate how groups have tackled such issues as accommodating health savings accounts, recruiting physicians, creating effective leadership structures, and implementing new technology.

Better-performing groups are more likely to employ larger support staffs, the report notes, and enjoy lower overhead than their peers despite higher personnel costs. Better performers tend to have invested in information technology (IT) already, and IT costs per full-time-equivalent physician were 13% higher for better-performing groups, suggesting that major capital investments in IT yield profits. The report also observes that better-performing groups are more productive than their counterparts, performing about 3,000 more procedures per year, and succeed in getting paid more quickly.

A financial case study profiles the accounts receivable practices of California Cancer Care (CCC), Greenbrae, Calif, one of the largest medical oncology practices in the San Francisco Bay area. At CCC, accounts receivable is maintained at a positive level through such practices as verifying patient benefits prior to each office visit, advising patients of their financial responsibilities, and making use of online fee schedules provided by many payors. Two financial counselors cross-train on all payors, enabling the counselors to answer patient questions knowledgeably.

The report also includes “Best Practice” sections, such as “Managed Care Contracting: A Systematic Approach” and “EMR/EHR Practice Readiness Assessment.” In the latter, users are asked to assess their practices’ readiness based on criteria like current workflow solutions, average number of laboratory orders daily, and average amount of time it takes to pull a chart.

For the first time, the 2006 report lists better-performing groups by state; North Carolina leads the country with 41, while Washington, DC, New Hampshire, Oklahoma, Rhode Island, Vermont, and West Virginia are each home to just one. The report is $290 for MGMA members, $340 for MGMA affiliates, and $505 for nonmembers at

ONI Medical Introduces 1T Extremity MRI

ONI Medical Systems Inc, Wilmington, Mass, offers an open MRI for extremity imaging—with a magnet strength of 1T. Axis Imaging News spoke with Peter Roemer, PhD, ONI’s vice president and chief technology officer, about the device’s potential.

IE:  In light of the DRA and re-duced reimbursement for outpatient MRI, what value can an extremity magnet bring?

Roemer: ONI is part of the solution. The DRA is all about reducing health care costs while maintaining image quality. The reduced reimbursement for nonhospital services will require imaging centers and private practice offices to seek lower-cost solutions without the compromise of quality. Some will go out of business if they don’t make an adjustment. Hospital-based radiology practices likely will see an increase in volume, and our product represents an opportunity to offload patients from these whole-body systems, eliminating the need for another whole-body purchase. Keep in mind that more than 20% of all MRIs currently prescribed today can be performed in our system at one third of the cost while maintaining image quality. I can’t imagine a health care scenario where this is not a win for all.

IE:  How much volume would a center need in extremity studies to reach ROI in 3 years?

Roemer: The ROI is less than 3 patients per day based on a 5-year lease. This would include a full-coverage maintenance contract and leasehold improvements necessary to site the system.

IE:  How do siting and suite layout come into play?

Roemer: The system can be sited in as little as 165 to 250 square feet, depending on layout. This includes space for the operator, patient area, and equipment.

IE:  What would you say to the critics who talk about field strength and image quality issues?

Roemer: Our system is 1T field strength, which is considered high-field; therefore, the image quality is comparable to other high-field whole-body systems. Patient comfort and positioning of the anatomy are equally important factors in providing consistently good image quality. For the upper extremity, we typically provide superior image quality because the joint is easily positioned in the sweet spot of the magnet while maintaining superior patient comfort in a nonthreatening environment.

IE:  Technologically speaking, what advances enabled you to achieve this level of image quality?

Roemer: There are a number of factors. First is the field strength of 1T, which was made possible by using the latest cryo-cooler technology to keep a compact superconducting magnet cool, along with proprietary vibration isolation design resulting in good magnet field stability. Equally important is the availability of six different removable radiofrequency coils. The RF coils range from 80 mm to 180 mm in diameter, and a corresponding range in signal-to-noise of a factor of 6. By properly choosing the coil to fit the anatomy, signal-to-noise is optimized for each patient. Finally, the specialized electronics used to run the system operate at much lower power than a whole-body system, resulting in better fidelity of the system.

The way I usually explain the benefits is by analogy. Think about the quality of sound that results from a small inexpensive handheld music player and earphones. Now, try to get the same quality over a larger room. The power required is greater, the equipment is more expensive, and the quality is typically worse. The ONI MRI system is more like that small music player with earphones, and a whole-body system is more like the room-filled sound system.

Computer Program Predicts Chance of Breast Cancer Recurrence

Physicians from Tufts-New England Medical Center, Boston, have developed a computer tool that predicts the risk of breast cancer returning in the same breast over a 10-year horizon based on seven factors: patient age, the size of the tumor, the grade of the tumor, whether there was lymphatic or vascular invasion in the specimen, whether the patient received chemotherapy, whether the patient received tamoxifen or other hormone therapy, and margin size.

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“The tool is based on data we’ve gathered from publications on breast cancer, like randomized trials and institutional studies,” explains Mona Sanghani, MD, an oncologist at Tufts-New England and the lead author of the study, which was presented at the 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO), held November 5–9, 2006, in Philadelphia. “We’re working now on clinical validation. It would be used by the patient’s physicians—her oncologist and surgeon—to predict the chance of the cancer coming back, as well as to predict the benefit that radiation therapy could have for that particular patient.”

For most patients with early-stage breast cancer, the standard of care incorporates breast-conserving surgery followed by 6 to 8 weeks of radiation therapy; however, recent research suggests that not all patients stand to benefit from radiation therapy, Sanghani notes.

“Patients who are elderly with low-grade tumors, are taking tamoxifen, and have negative margins [of resection] represent a really low-risk group,” she says. “And a lot of people are starting to advocate no radiation therapy for them, because trials are showing that they have a really low risk of recurrence. So, there are definitely situations where it might help gauge whether someone should get radiation.”

On the whole, Sanghani expects that the predictive tool will reinforce the necessity of radiation therapy. “Risk of recurrence is really driven by prognostic factors,” she notes, “so part of the program’s utility would be looking at what’s causing the high risk of recurrence. If it were a positive margin, the answer probably would be to go for another surgery. But if they have a high risk of recurrence and negative margins, they should have radiation therapy.”

But what will the tool tell an oncologist that he or she would not already have been able to figure out from statistics and epidemiology? “What we’ve been doing all these years, and what we’re still doing, is using our intuition and the knowledge we have about risk factors,” Sanghani explains. “But I think one goal here is to quantify risk so that people aren’t just working based on their intuition. Everyone has their own biases. If you took any particular case and asked a handful of oncologists, they all would give you different numbers. They might be in the same ballpark, but they still would be different. This is a way to standardize it and make it more objective.”

Sanghani’s team is still in the process of validating the program, but she expects it to be ready for use in a Web-based format by the end of 2007.