Stay on Top of the Process!

by Chris Gaerig

Leonard Lucey

By now, all radiologists should be aware of the importance of January 1, 2012, the day on which health care reform changes from the Centers for Medicare and Medicaid Services (CMS) mandate that for imaging centers to continue receiving reimbursement, they must be accredited by one of three organizations: the Intersocietal Accreditation Commission (IAC), The Joint Commission, or the American College of Radiology (ACR). What many radiologists might still have questions about, though, is what the actual accreditation and renewal processes—the latter of which will become a near-constant process for the accrediting bodies—consist of.

Featured in the May 2011 issue of Axis Imaging News is an article (“Timing Makes Accreditation a Top Priority“) that outlines the accreditation processes from The Joint Commission and IAC. However, the ACR accreditation process differs dramatically from The Joint Commission’s and has minor differences from the IAC.

Even more pressing than choosing your accrediting body is the need to be accredited by January 1. Because of the importance of the date, the ACR has reminded imaging facilities for over a year now that they must become accredited.

“We’ve been telling facilities for the last 18 months to make sure that they’re going to be accredited on time,” said Leonard Lucey, JD, ACR senior director, diagnostic modality accreditation. “They needed to apply by June 30 of this year. Facilities that are now coming in, if they just started their application in July, we probably can get them through in 90 to 100 days. If there is an issue or we have a problem, it could take longer, but they’re still probably going to be OK. It’s those facilities that come in for the first time in October or November that are going to have difficulty. We’ll do everything we can, but there’s only so much you can do.”

The reason for such lead time is that the accrediting process is detailed and extensive, and may require changes to an existing facility. Lucey notes the various tasks that need to be completed before accreditation can take place, including filling out an application, collecting and reviewing diagnostic images, and filling out various other paperwork pertaining to your facility, personnel, and equipment. And despite the fact that, without significant holdups, the accreditation process takes approximately 90 days, there is a significant amount of work that needs to be done.

“You fill out an online application, execute a survey agreement—that’s an agreement between the facility and the ACR as to what’s expected on both sides—and have approximately 45 days to submit a lot of your paperwork,” said Lucey. “Then, we send you a testing package. We look at clinical images—this is imaging accreditation, so we want to make sure that the facility is capable of producing diagnostic-quality images—and we also look at phantom images, which are a calibrating tool that looks at the equipment that produces the images. Those are the main two components. We also make sure that you have a quality assurance and quality control program, that you do periodic testing of your equipment, and that you participate in peer review.”

Unlike The Joint Commission, which accredits an entire facility, the ACR and IAC each accredit individual modalities, which means that in order to continue receiving reimbursement in CT, nuclear medicine, PET, or MRI, a facility must be accredited in those specific modalities by either the ACR or IAC. Lucey believes that this focus on modalities, in addition to the ACR’s review of diagnostic and phantom images—done by specialists in the respective fields—sets the ACR’s accreditation apart.

“If you’re a patient and you’re going to go to a facility for a CT scan, sure, you want the facility to be clean and patient friendly, but what you want more than anything else is to make sure that the equipment that they’re using is proper, has been adequately tested, and can produce an image of diagnostic quality that a physician can actually interpret,” said Lucey.

Aside from the aforementioned paperwork and preparation materials, the ACR accreditation process includes random, unannounced site visits, and the CMS requires a number of minor regulatory requirements of all facilities including, for example, the need to have a written patient complaint policy.

After the accreditation period, which Lucey believes can be done relatively painlessly, the facility remains accredited for 3 years, at which time, the facility or modality needs to renew its accreditation. But he insists the renewal process is typically much easier for facilities.

“We send out e-mails and notices 8 months before a facility’s accreditation expires to let them know that they’re getting close to their renewal period,” said Lucey. “Then we send them the information that they need to go online and complete the process and send us the data that they need to review. It’s all online, and what’s nice is that since it is online, if any time during the cycle, you want to go in and update your account, you can make changes like update equipment or your personnel file. You can stay on top of it.”

SCENARIA Proves Best Scenario for Busy Practice

by Chris Gaerig

Joseph P. Finizio, MD

When evaluating and purchasing a new piece of imaging equipment, there are a number of factors that facilities investigate before making their decision. Dose reduction, physical footprint, and ease of use are just a few of the important features of any imaging system. But for Joseph P. Finizio, MD, CEO and medical director, Radiology Imaging Associates, Prince Frederick, Md, who recently purchased the new Hitachi SCENARIA 64-slice CT scanner, it was Hitachi’s corporate structure, reliability, and former successes that helped push the product over the edge.

“We looked at all of the vendors,” said Finizio. “I go to RSNA in Chicago and kick the tires. I listen to all of the marketing spiels. What excites me about this is the nature of the company. I think the company has done a very good job right down to their application folks and engineers. ?Reliability is a key functionality.”

This is not to say that Finizio and his practice were not also wowed by the machine’s technical specifications or capabilities. Despite Hitachi’s business model being the tipping point, Finizio’s favorite aspect of the new SCENARIA machine is its dose reduction capabilities.

“We get radiation every day,” said Finizio. “This machine is the first machine that has fourth-generation, intrinsic capabilities to lower the dose to minimum amounts of radiation as compared to prior products. CT is a very valuable tool, and it could save your life. But now, we have the option with the new product to lower the dose and deliver great image quality.”

The system features a number of technologies that lower the dose delivered to patients. The Intelli EC (3D) Automatic Exposure Control enables the scanner to automatically modulate mA to lower individual patient dose levels depending on patient anatomy and size. The SCENARIA is also equipped with Intelli IP, which allows the scanner to achieve high image quality with significant dose reduction using adaptive iterative reconstruction processes in projection and image space.

Hitachi Medical Systems America offers providers the SCENARIA 64-slice CT scanner.

“We can lower the dose right now with pretty much any machine, but you can’t read the images,” said Finizio. “If a heavy smoker comes in and you do a CT of the chest, you say, ‘We have to do a low dose.’ But then you find out that you can’t see the lung cancer or the little nodule that may turn out to be lung cancer. The hat trick that has occurred is that Hitachi has delivered a product that allows you to manipulate the dials to a point that we can clearly say that we can reduce dose by 50%—or as high as 70%—which is also very important in the pediatric population.”

But dose reduction is not all the SCENARIA has to offer. The CT scanner simultaneously acquires 64 slices in a 0.35-second scan time, enabling shorter breath-holds and reduced patient motion artifacts without compromising image quality. In addition, the SCENARIA’s high-density view rate provides 2,880 data samples per detector element per second, which offers improved data density on the periphery of the field of view.

One feature that Finizio was especially impressed and intrigued by is the SCENARIA’s lateral shifting table, which allows physicians to easily position patients. The table allows for up to a 80 mm left/right lateral shift from centerline. This feature greatly increases patient comfort, which was another aspect of the Hitachi scanner that drew Finizio’s interest.

“The bore is much wider,” said Finizio. “Most range from 60 to 65 centimeters, but this is a 75-centimeter bore, which is quite capacious. It is very good for the larger patient. Some people are even claustrophobic with CT, so this adds to their comfort.”

Perhaps just as important as all of these specifications, however, is how the new machine will benefit both the facility and its local community, a relationship that Finizio is very passionate about.

“I strongly feel that medicine is local,” said Finizio. “Medicine will always remain local. Patients talk to me and I talk to their doctors; I know their doctors. They have access to me.

“There isn’t anything that we can’t do with this machine. I’m really excited for the community. It will add another dimension to the community and will truly address radiation.”