Governance, Mission, Growth

Tracking Time and Money
ACR Updates Appropriateness Criteria
Growing Pains: Balancing Technology and Volume
Outsourced Billing Optimizes Costs

Tracking Time and Money

Web-Hosted Program Helps Manage Employee Labor and Wage Data
A Web-hosted program from Atten-dance on Demand Inc, Farmington Hills, Mich, was recently implemented at Midtown Imaging LLC, Palm Beach Gardens, Fla, via partner company Labor Strategy, Greensboro, NC. The solution tracks employee time and attendance over secure networks on a monthly subscription basis, allowing Midtown to manage labor information from 175 staff members across five locations.

“The on-demand service is especially beneficial as it helps us track overtime and labor costs between separate cost centers and locations,” noted Athene Dunn, HR generalist at Midtown. “Accessing up-to-the-minute employee scheduling and payroll costs can be done from any PC with a web browser, which helps us monitor our 7-day operation.”

Attendance on Demand’s system is customizable, allowing you to access employee scheduling, payroll costs, and more.

Scott Augustin of Labor Strategy explains that one of the system’s prime benefits is how customizable it is. “You can adapt the application to different focuses,” he said. “You can limit it to what you need to know. At Midtown, they really liked having the ability to say, ‘I want these managers to be in charge of this data,’ and then just give them that. You can also customize the names of the different areas so they’ll make sense to people.”

For an imaging center staff member, the day begins by “punching in” to Attendance on Demand electronically. “You just go to the web site, typically it’s an icon on the PC, they double-click and enter a user ID and password, and that screen is configured off their unique ID,” Augustin said. “They punch in, they punch out. A button creates a time stamp, and they’re done.”

But that’s not all an employee can do. They can also manage their time off, check their hours, or punch in and out after the fact.

Meanwhile, administrators can manage the entire coverage and scheduling process from a centralized location—no mean feat when you’re dealing with hundreds of employees spread out over multiple locations.

“In real time, administrators can see who’s at any location,” Augustin explained. “They can also see whether they took lunch, whether they need overtime. The pay system automates that. For example, reallocation of overtime is a problem in health care, where you often have shortages. Techs are in high demand. If a tech has to move to a different location, if my employees have to go somewhere else, they should get overtime. I can program the system so anytime they punch in at a different location, they get overtime automatically.”

Implementation of the system takes 3 to 6 months, depending on the complexity of the business, and includes two kinds of training sessions—one for daily process and one for system administration. “There’s also complete support,” Augustin noted, “so if you need to reconfigure the system 6 months down the line, you can.” Monthly subscriptions run from around $2.50 to $4 per employee.

“The strength of the application is really its ability to adjust to the clients’ needs,” Augustin noted. “It can be as simple, or as complex, as the customer needs it to be.”

—Cat Vasko

ACR Updates Appropriateness Criteria

Times change. And so does what is considered appropriate and inappropriate changes—as much in health care as in culture. Subsequently, organizations, particularly those in health care, must strive to update their guidelines as often as necessary. “If you look at criteria topics from even just 1 or 2 years ago, they don’t always represent the current state of knowledge or the best approach,” said Michael Bettmann, MD, professor and vice chair of radiology at Wake Forest University School of Medicine in Winston-Salem, NC, and chair of the Appropriateness Criteria Committee of the American College of Radiology (ACR of Reston, Va).

To keep up with the times, the ACR has released updates to 25 criteria topics and begun its annual review of the more than 160 topics covered. The information is intended for use by referring physicians seeking guidance in their choice of imaging modality. “We want to help physicians decide which modality is the most likely to be helpful,” said Bettmann.

For instance, if a physician is seeing a patient for acute flank pain with suspected stone disease, a nonenhanced CT ranks as the most potentially helpful with a rating of eight. An abdomen x-ray is listed as the least appropriate, with a rating of one, but comments note it is the most useful in patients with known stone disease. In addition, the criteria also list Relative Radiation Level (RRL) information based on reviews of current literature and expert experience (CT abdomen and pelvis without contrast rates “high”; abdomen x-ray “low”).

The criteria cover all disciplines, including cardiovascular imaging, gastrointestinal imaging, interventional radiology, musculoskeletal imaging, neurology, radiation oncology, thoracic imaging, urology, pediatrics, and women’s imaging. Updates have been made in most sections, with the greatest number in urologic imaging: 15, according to Bettmann. “This area had been dormant for a while,” said Bettmann. More releases are expected in January.

More than 200 physician representatives are involved in development of the evidence-based criteria. The ACR Task Force on Appropriateness Criteria uses broad-based consensus techniques and input from other specialties, including attributes for developing acceptable medical practice guidelines used by the Agency for Healthcare Research and Quality (AHRQ). These are validity, reliability/reproducibility, clinical applicability, clinical flexibility, clarity, a multidisciplinary approach, scheduled review, and documentation.

The team reviews the material that individual physicians do not have the time to read. “Individuals can’t cover everything on their own and criteria provide a rational approach to the settings that are covered,” said Bettmann.

While the criteria are not used directly by radiologists, they do have an impact on patient care. “It means more effective and rational utilization of imaging for the patient and the radiologist,” says Bettmann. The right test will be used in the right setting, eliminating overutilization or underutilization of imaging.

The guidelines are also available as Anytime, Anywhere PDA applications. Visit to access the guidelines.

—Renee DiIulio

Growing Pains: Balancing Technology and Volume

A CT scanner in 1977. An MRI in 1984. Digital mammography in 2005. With each new piece of technology, Inland Imaging LLC brings into its facility, the Spokane, Wash-based medical imaging service provider has enjoyed an increase in patient volume.

But as the number of patients it can evaluate grows, Inland Imaging must also add to the number of radiologists who can make those assessments. Consequently, practices like Inland Imaging are left to ponder a major issue: While patients may benefit from the latest and greatest innovations on the market, what does the expeditious workflow do for doctors?

“For the radiologist, it’s more difficult at times because there’s more information for them to actually read,” said Thomas J. Riffe, RIS/PACS information specialist for Inland Imaging. “There’s more data in the images. They need to teach themselves how to reread what is now digital normal compared to what was film normal.”

For example, Inland Imaging recently made the decision to digitize its mammography films using MammoPro, an all-in-one touch screen-controlled digitizer manufactured by Array Corp USA. Featuring laser-based optics and mammography hanging protocols that comport with DX and DICOM Part 14 grayscale display standards, the product has the ability to store prior 18 x 24 and 24 x 30 mammogram films to PACS.

MammoPro is an all-in-one touch screen-controlled digitizer from Array Corp.

Because of digital technology, technologists and patients do not need to wait around for film to be developed in order to see whether the image is a good one. Rather, the wait time is instantaneous. Patients are done when they walk out of the room, and technologists can fit in a higher number of patients per day—that is, if the mammogram is a screener. If the test is a diagnostic one, users might encounter some challenges.

“Our technologists have the ability to do more per day, but we are limited to what our radiologists can read, while still providing quality care necessary for mammography,” Riffe said.

In addition to a surge in productivity, the dedicated mammography digitizer also accounted for a 10% increase in patient volume. As a solution to the demands of higher volume, Inland Imaging recently boosted its manpower. To date, through various mergers, the company has grown to 71 radiologists, five surgeons, and more than 6,000 staff members.

Ultimately, while Riffe noted that limitations do exist in terms of what radiologists can handle, he pointed out that in the end, practices must consider what is best for the patient.

With MammoPro, his group achieves the highest quality of digitized mammograms, with more depth and better contrast than what could be seen on film, Riffe said. Inland Imaging noticed a decrease in man-hours needed to digitize priors, which allowed for the ability to dedicate equipment for use in other modalities. Furthermore, he continued, radiologists can set the images side by side on a monitor screen, allowing for a direct comparison.

And most importantly, feedback has indicated that patients prefer the advanced technology over traditional methods. “They really like it,” Riffe said. “They are more comfortable with the digital imaging, and they say their experiences are more positive with it.”

—Elaine Sanchez

Outsourced Billing Optimizes Costs

Outdated technology and a decline in physician reimbursement have led many practices to control the cost of doing business, something to which Medical Center Radiologists can personally attest.

And like many fellow radiology groups, the Virginia-based business has sought the assistance of an outsourced medical billing provider who could help with optimizing those costs.

Specifically, the practice has hired Indianapolis-based Zotec Partners to provide full, outsourced billing, dealing with the cradle-to-grave process of the charge. The firm will also install its licensed Electronic Billing Center practice management/billing software suite, designed to help in eliminating billing inefficiencies.

“The utilization of Zotec Partners’ full billing services and technology will dramatically reduce our cost of collections,” said John Donnal, MD, president of Medical Center Radiologists. “Zotec Partners was best suited for our practice; they’re uniquely qualified to provide industry-specific knowledge and expertise.”

According to Mark Isenberg, Zotec vice president for business development, his company will create an electronic interface for the center, code from dictated reports, perform data capture, and submit directly to the practice’s carriers. Also, it will handle the posting of carrier payments, bill and collect from the patient, as well as follow up on denials and inappropriately paid claims.

After a business licenses Zotec’s software, the billing provider can tailor its solution to fit the client’s desired parameters of individual claims. Through what is referred to as “campaigns,” users define how a charge automatically progresses as it moves through the revenue cycle. In this way, Zotec’s product is customizable and easily integrated.

This comes in handy when the business, such as Medical Center Radiologists, is already up and running. Hospitals or practices that had managed their own billing departments may find it difficult to part with their old ways, and Zotec must deal with converting the business’ previous accounts.

“The challenge in taking over an existing billing operation is generally in dealing with the conversion of old accounts receivable and interacting electronically with the hospital,” Isenberg said. “[Zotec] has an experienced implementation and programming staff capable of quickly transitioning.”

More than 5,000 physician’s offices throughout the United States use Zotec’s software solution, according to the company.

Zotec CEO T. Scott Law said the deal will allow Medical Center Radiologists “to focus on their commitment to providing outstanding patient care and customer service, which is what keeps them in the forefront of the radiology field.”

—E. Sanchez