CMS Proposal to Hit Hospital-based Physicians Hardest, Says ACR

In providing comment on the proposed modifications of the 2004 Physician Fee Schedule by the Centers for Medicare and Medicaid Services, the American College of Radiology (ACR) vigorously objected to the method of determining the Medicare Economic Index (MEI). The ACR is concerned that the new methodology shifts relative value units (RVUs) from the professional services component of the Physician Fee Schedule to the technical side in a misguided attempt to increase the malpractice RVUs.

Among the byzantine calculations used to determine physician Medicare reimbursement is the MEI, a tool that measures inflation in physician practice costs and wage levels and a key component in updating physician payment rates. Under CMS’ proposed modifications, the data sources, cost categories, and price proxies used in the MEI would be changed. The ACR is in favor of a “much needed” increase in the weight given to malpractice insurance costs; however, it objects to the increased value taking place on the technical side rather than the professional side of the fee schedule. “Evidence shows that physicians have been most affected (as opposed to hospitals) by the increase in professional liability rates, a cost that they incur,” the ACR states in comments addressed to Thomas A. Sculley, CMS Administrator. “The ACR has not seen evidence to show that facilities billing the technical component have also incurred similar rising costs in malpractice.”

The proposal will be particularly onerous to radiologists and radiation oncologists who are hospital-based and do not participate in the technical component.

The ACR also wrote that “it is critical that the agency maintain stability of the RVUs, particularly physician work RVUs and refined practice expense RVUs. Adjusting the components of the resource based relative value system (RBRVS) not only affects the basis of the RBRVS system (relatively), but impacts research methodology, sets precedence for private payor reimbursement systems and affects methodology established and applied by the AMA, Relative Value Update Committee (RUC).”

Representing the freestanding imaging center segment of the market, the National Coalition for Quality Diagnostic Imaging Services (NCQDIS) expressed approval of the proposed changes to determining the MEI, with respect to rebasing the MEI to year 2000, revising the cost categories, and changing a number of proxies currently used to ensure the index reflects the most recent price information available. However, it urged CMS to continue refining the MEI methodology by eliminating the costs of Medicare-covered outpatient drugs and biologicals in establishing expenditure targets, instituting more accurate accounting for changes in the volume of services provided to Medicare patients due to policy decisions beyond providers’ control, and more accurately assessing the costs and savings associated with new technologies.

Additionally, NCQDIS urged CMS to add to its plans for incentives for high-quality care with additional payment for diagnostic imaging services offered by facilities accredited by the ACR and other organizations. “We believe that providing financial incentives for facilities to become accredited will result in a substantial increase in the number of accredited facilities, which will in turn improve the quality of diagnostic imaging services overall,” NCQDIS president Cherrill Farnsworth wrote in the organization’s comments to CMS.

Both the ACR and NCQDIS lauded CMS’ extension of the deadline for supplemental practice expense survey data to March 2004 for determining practice expense RVUs for the 2005 fee schedule.


A new study conducted by German researchers shows that a combination treatment is successful in shrinking and killing liver tumors.

The study, published in the November edition of Radiology, was conducted by a research team led by Thomas J. Vogl, MD, chairman of the Department of Diagnostic and Interventional Radiology at University Hospital, Frankfurt, Germany. The researchers experimented with an outpatient procedure known as transarterial chemoembolization (TACE), which uses occlusion, reduction of the blood supply, and chemotherapy to help decrease the tumor’s size. Following that procedure, an interventional radiologist inserts laser fibers into the tumor, in a procedure called laser-induced thermotherapy (LITT).

The researchers treated 162 patients with liver tumors between March 1999 and December 2001, using the TACE procedure. The biggest tumor was 80 mm in diameter pretreatment. If the tumor’s diameter decreased to less than 50 mm, that patient was treated with MR image-guided LITT. The results showed that 51% of the patients (82) responded successfully to TACE, with a mean tumor size reduction of 35%. They were then treated with LITT. No reduction in tumor size was achieved in 47 of the patients, and in an additional 33 patients, the disease had progressed, leading to more TACE treatments.

“This was initiated because we could not perform the laser therapy on tumors that were too large,” wrote Vogl in the study. “We see a lot of patients with liver tumors larger than 5 cm and in the past we had to refuse them. We needed a way to reduce the tumor to a size where we could perform the laser treatment.”

The median survival of patients responding to the combined treatment was 26.2 months, while the rate was only 12.8 months for those patients treated with TACE alone.

While Vogl and his team have thus far used the treatment only for liver tumors, he believes that it could have applications for lung, bone, and lymph node tumors.


The New York physician and entrepreneur who protested this year’s Nobel Prize for medicine, awarded to American scientist Paul Lauterbur, PhD, and British doctor Peter Mansfield for their work on MRI, has stepped up his media campaign even furtherrecently taking out a second full-page advertisement in the New York Times appealing to the two winners to let him share the $1.3 million award.

Raymond Damadian, president and founder of a Melville, NY-based company that manufactures MRI technology, owns a patent on MRI machines. He contends that in 1970, he discovered differences between cancerous tissue and normal tissue could be seen using nuclear magnetic resonance (NMR), a precursor to MRI. Lauterbur and Mansfield developed technology that permitted advances to be made from original MR technology, enabling clearer images to detect damaged tissue.

In early October, Damadian took out ads in the Times and The Washington Post, claiming that Lauterbur and Mansfield made technological improvements based on his work. He also accused the Nobel committee of “rewriting history,” saying that there was a place for three award recipients, and that the panel had purposely excluded him.

Sir Peter Mansfield is a doctor and professor at the University of Nottingham, England. Lauterbur, a professor at the University of Illinois, Urbana, is currently studying NMR spectroscopy and the motions of small molecules diffusing within the interstitial aqueous solution of single protein crystals and their interactions with active sites and molecular surfaces in general. He also has begun a program for studying possible prebiotic interactions of small molecules with polymers.

Both Lauterbur and Mansfield are due to pick up their prize in Swden on December 10.


Medicine’s favorite whipping girlmammographyhas just received another lash. This time it has come in the form of an October 2003 article in The Journal of the American Medical Association (JAMA), “Comparison of Screening Mammography in the United States and the United Kingdom” by Rebecca Smith-Bindman, MD, et al. The article found that the recall rates for American patients were twice as high as for British ones, but netting a nearly identical detection rate with just under six patients per 1,000 in the United States and just over six per 1,000 in the United Kingdom being diagnosed with cancer.

American mammographers have taken exception to the study, pointing to significant differences between the socialist system in the island nation and the capitalist system in the United States. In the United Kingdom, women are screened only every 3 yearsand may exhibit larger, more obvious cancers. In the United States, women in the study group age range50 and olderare recommended to receive a screening mammogram every year. Many of the cancers detected by the more frequent screening are smaller and more likely survivable, a better measure of the effectiveness of a screening program, according to a statement by the Society of Breast Imaging.

The study implied that the lower recall rate in the United Kingdom might be tied to the fact that British mammographers are required to read 5,000 mammograms per year, while in the United States the requirement is only a few hundred. The authors of the JAMA article also suggest that US liability issues may also drive mammographers to be overly cautious, causing them to increase their recall rate. According to Ellen B. Mendelson, MD, FACR, professor of radiology and chief, breast imaging section, Northwestern University Medical School/Northwestern Memorial Hospital, Lynn Sage Comprehensive Breast Center, Chicago, the authors have made an out of context argument that does not acknowledge the fundamental differences between US and British medicine. “The liability issues are really not as prominent in England and the rest of the UK as they are in this country, where there hasn’t been an effort made to put a cap on judgments&to help reduce the fear of being sued,” she says. “The requirement to read 5,000 mammograms, that’s fine, if that’s all you’re doing. Maybe in the future of this country there will be a centralization of screening services where they will be done only by people with huge experience as exemplified by this 5,000 mammogram per year requirement [in the UK]. To compare what they require of their physicians with the way health care is delivered in this country&at this point is not relevant.” She adds that in most US practices, radiologists are reading 10,000 to 15,000 radiologic studies of all types per year.

~Chris Wolski

New Radiology Residencies Show Slight Uptick

Although a large number of medical specialties have slowly been losing residents or fellows over the last several years, radiology is among the fields that saw the number of physician trainees grow slightly in 2003, according to recent data compiled by the American Medical Association, the Association of American Medical Colleges (AAMC), and organizations affiliated with AAMC.

According to the data, which reflected residents who went through the National Resident Matching Program (NRMP), diagnostic radiology showed a 3.1% increase in first-year residency positions (PGY-1) filled, to a 97.8% total fill rate. All medical specialties with second-year residency (PGY-2) positions experienced fill rates in excess of 90%, with radiation oncology and diagnostic radiology increasing their rates over 2002. In addition, eight additional positions (6.4%) were filled in diagnostic radiology in 2003, compared with 2002 (133 vs 125), with eight more graduating seniors (7.4%) entering diagnostic radiology (116 vs 108) than the previous year. Diagnostic radiology had experienced three consecutive years of increased positions filled from 1998-2001, followed by a decrease in 2002, then an increase in 2003.

Although 17 fewer residency programs participated in this year’s match, the number of offered positions increased by 450, including an increase of over 300 available PGY-1 positions.

Industry News

General Electric Co has completed the acquisition of British diagnostic imaging agent company Amersham PLC. The two companies have reached agreement on the terms of an all-stock transaction whereby GE will acquire all the outstanding shares of Amersham. Terms of the deal are reportedly $9.5 billion. Upon completion of the acquisition, Sir William Castell will become vice chairman and member of the board of directors of General Electric and, as CEO of GE Healthcare Technologies, will have financial and leadership responsibility for the combined Amersham and GE Medical businesses. Joseph Hogan, senior vice president of General Electric, will continue to lead the GE Medical business. The GE Healthcare Technologies business will be based with Castell in the United Kingdom…Konica Medical Imaging, Wayne, NJ, has officially merged with Minolta Corp to become Konica Minolta Medical Imaging USA Inc. The new company’s headquarters will continue to be in Wayne… Varian Medical Systems Inc, Palo Alto, Calif, has announced an agreement to acquire Zmed Inc, Boston, a privately held supplier of radiation oncology software and accessories, for $35.5 million. In addition, Varian is partnering with the American Society of Radiologic Technologists (ASRT) Education and Research Foundation on a new scholarship program. Under the partnership, Varian will fund 11 scholarships of $5,000 each in the 2004-2005 academic year, 15 scholarships of $5,000 each in the 2005-2006 academic year, and 19 scholarships of $5,000 each in the 2006-2007 through 2008-2009 academic years…Fischer Imaging Corp, Denver, has announced that its SenoScan® TrueView™ digital mammography system has been approved by the FDA for integration with the Second Look® digital CAD system from CADx, Beavercreek, Ohio…CancerSource and the Academy of Molecular Imaging (AMI) have co-launched, a Web site that is designed to be a complete consumer resource center for information on PET as it relates to cancer, heart disease, and neurological disorders. The peer-reviewed site will contain a comprehensive listing of PET centers throughout the United States, as well as information on diseases…AccuImage Inc, San Francisco, has announced an agreement with SMAART Medical Systems Inc, Dallas. Under the terms of the agreement, SMAART will offer AccuImage software under its pay-to-use plan…UNI-DATA AG, a UPS Supply Chain Solutions company, Atlanta, will transport and install x-ray systems throughout Europe for Philips Medical. Under the terms of the agreement, six teams of specialists from UPS will install up to 240 x-ray units this year in hospitals and medical practices…HInnovation Inc, Wauwatosa, Wis, has received a patent from the US Patent and Trademark Office that protects the company’s server-based MPR/3D medical imaging processing and visualization system and design used by its iConnection™ software…Swissray International, Elizabeth, NJ, has signed a distribution contract enabling it to sell cassette-based digital x-ray systems from FUJIFILM Medical Systems USA Inc. Swissray has also signed an agreement enabling the company to sell CR systems from Konica Minolta Medical Imaging Inc…QRS Diagnostic, Minneapolis, has been ranked 25th among Minnesota’s fastest-growing technology companies, according to the Deloitte & Touche Technology Fast 50 program. The rankings are based on percentage growth in revenues from 1998 to 2002…Sectra, based in Sweden, has released a new Windows®-based PACS for large hospitals called Sectra PACS Enterprise Edition™…Advanced Research Technologies Inc (ART), Montreal, Canada, and GE Medical Systems have announced the sale of the preclinical optical molecular imager, SAMI, to Novartis Pharma AG. SAMI is exclusively distributed worldwide by GE Medical Systems…Eastman Kodak Co, Rochester, NY, has purchased CAD technology that aids in the early detection of disease from MiraMedica Inc, Los Gatos, Calif. The technology includes software that automatically highlights suspicious areas on patients, digital medical images, or digitized film images…HealthHelp, Houston, a radiology service management company, has debuted RadAware, its new patient education program. The program is based on guidelines and research from academic institutions, radiation physicists, and state and national governmental agencies…Richardson Electronics, LaFox, Ill, has been named one of the Chicago area’s fastest growing technology companies in the Deloitte & Touche Technology Fast 50 Program. The company’s increase in revenues of 46% from 1998 to 2002 resulted in a ranking of 38th overall. The program is a ranking of the 50 fastest growing technology companies in the area.


Officials from the American Society for Therapeutic Radiology and Oncology (ASTRO) have announced the results of the recent election for the open positions within the Board of Directors and Nominating Committee. The new 2004 officers are president-elect: Prabhakar Tripuraneni, MD, Scripps Clinic, La Jolla, Calif; Treasurer: Leonard L. Gunderson, MD, Mayo Clinic, Scottsdale, Ariz; Healthcare Economics Council Chair: Michael Steinberg, MD, Santa Monica Cancer Treatment Center, Santa Monica, Calif…DMS Imaging, a member of the DMS Health Group, Fargo, ND, has named Mark Casner president and COO. In this role, Casner will be responsible for the overall executive management of DMS Imaging. His duties will include development and implementation of systems, strategies, budgets, priorities, and operational activities. Prior to joining the DMS Health Group, Casner was employed by Radiologix Inc…Konica Medical Imaging, Wayne, NJ, has announced the appointment of Bill Ward as vice president of marketing and sales. Ward, a 25-year veteran in medical imaging, will support Konica’s marketing and sales efforts as it enters a new phase of expansion through its merger with Minolta, which took effect on October 1, 2003. At Konica Minolta Medical Imaging USA, Ward will be responsible for field sales, corporate accounts, as well as the company’s marketing and new business development function…Barco, Duluth, Ga, has announced that Alan Orth has joined the company as business development manager for its medical modality business. In this position, he will focus on the development of Barco’s dedicated modality solutions business in North America. Prior to joining Barco, Orth was vice president of sales and marketing at DeJarnette Research and product manager at Siemens Medical Systems…Breast cancer survivor Kim Pierce, executive director of the Academy of Molecular Imaging (AMI), Los Angeles, has been appointed to serve as a member of the California Breast Cancer Research Program (CBCRP) advisory board. The program, administered by the University of California, Office of the President, is responsible for administering funding for breast cancer research in California. Pierce will serve a 3-year term…Language and Computing, Philadelphia, has appointed Whit Creech to the position of COO. Whit joins the company after a long career with Xerox Corp…Alliance Medical Corp, Phoenix, a reprocessor of single-use medical devices (SUDs), has appointed two new members to the company’s board of directors: John B. Grotting, former chairman, president, and CEO of Bridge Medical Inc; and Matthew P. Marshall, former senior vice president, HBOC division of McKesson Corp.