AMA, Congress Sign Pact for Quality of Care Measures
With the Bush Administration pushing for accountability in medical care, the American Medical Association signed a pact with Congress in December to develop more than 100 standard measures of performance. These measures—to be developed by the end of this year, with implementation in 2007—will cover about 34 clinical areas, and physicians will voluntarily report results to the federal government. The agreement says doctors “should receive” compensation for their time collecting and reporting the data, according to a February article in The New York Times.
The AARP-supported pact will create measures focusing on diagnostic tests and treatments known to improve the patient’s quality of life, the Times reported.
“It’s a little bit easier for other medical specialties, other than radiology, because it’s easier to track outcomes,” observed Shelley Nan Weiner, MD, medical director of CareCore National. “When you’re looking at performance, you need to look at objective data, not subjective data. In radiology it’s much harder to get objective measures because, in fact, radiology reports are considered interpretations.”
The American College of Radiology (ACR), Reston, Va, reports that the AMA will eventually look into imaging as one of the specialties that has to come up with measures of performance. And while the ACR is in favor of having a standard in place, spokesman Shawn Farley says it is still early in the process. The AMA has designated lead organizations to help develop the measures, and the ACR is one of the organizations that will help develop standard measures of performance for imaging services.
“We, however, are in favor of quality measures in imaging, as we have been talking about for the last year and a half or so,” Farley says. “We are obviously happy to work with them in doing this.”
In developing these measures, John W. Breckenridge, MD, chair of radiology at Abington Memorial Hospital, Abington, Pa, says the measures have to be easy to implement, and when using peer review, for example, must have somebody who can review studies objectively.
Quality measures some radiology groups already implement include peer review, the recording of complications, and complaint gathering. Peer review of prior reports is practiced by radiologists at Abington Memorial Hospital.
“The thing that we’ve been doing in our department for a long time that works, and that the ACR is now doing, is [peer review] at the point where the radiologist is interpreting a study and that radiologist has access to a prior study,” Breckenridge says. “The reason this is a lot easier is that in the course of one’s normal work, one looks at prior studies so it does not require the extra effort of somebody putting films up on a Rolloscope and having two people view it. It’s a much easier, less labor-intensive way of doing it.”
Weiner says the standards developed should be a little different for radiology than other specialties because to look at every modality on an annual basis would be too overwhelming in time and money. She suggests accreditation by the ACR as a standard measure of quality.
Both Weiner and Breckenridge agree that once Congress passed the Mammography Quality Standards Act (MQSA) and accreditation became required, the quality of mammography care greatly increased. Under MQSA, the government required radiologists to meet certain standards, such as callback and biopsy rate, a medical audit of the practice, reporting false-positives and false-negatives, and tracking what happened with their cases.
“This is an objective measure of what’s happening for a radiology practice,” Weiner says. “It is, however, very time consuming, very labor intensive, and costly to do in a radiology practice.”
Nonradiologist Reports Not Up to Par
 Figure 1. Comparison Between Radiologist- and Nonradiologist-generated Reports. (Click the image for a larger version.) |
A study authored by Shelley Nan Weiner, MD, FACR, medical director of CareCore National LLC, Wappingers Falls, NY, found that reports by radiologists provided consistently better quality information than reports by nonradiologists. For this study, published in the American Journal of Managed Care, one imaging report was randomly selected from 50 self-referring physicians for both chest and bone radiographs from two metropolitan New York health plans, totaling 200 reports. Another 50 radiologist-produced reports were randomly selected from the organization’s quality management department. After reviewing the reports, 53 were disqualified. Radiologists outshined nonradiologists in demographic areas, such as including the interpreting physician’s name (96% vs 65%), and the interpreting physician’s signature (92% vs 17%). Radiologist-produced reports were also superior in providing clinical information, such as including the description of the findings (100% vs 41%), and impressions or conclusions (94% vs 47%). The study concludes that imaging service providers “should be required to produce legible x-ray reports that are easily identified.” It also suggests that a report’s essential elements be defined by the health plan, preferably using the American College of Radiology’s guideline for communication, and that “all imaging service providers be held to this national standard.” With permission: Weiner SN. Radiology by nonradiologists: is report documentation adequate? Am J Manag Care. 2005;11:781-785.
Further Cuts Loom if Private Payors Follow Medicare’s Lead in Contiguous Body Part Payment Reductions
In an effort to mitigate the impact of the Deficit Reduction Act of 2005 (DRA), the American College of Radiology, Reston, Va, has stepped up its continuing education and grassroots campaign to lobby Congress to make changes it deems necessary for the survival of imaging. Included in those changes are lobbying to have the 50% reduction for contiguous body parts removed for 2007.
A larger problem, however, will be if private payors follow Medicare’s lead in technical component payment reductions, says Pam Kassing, senior director of economics and health policy for the ACR. There are several private payors that either do not pay for the second examination or pay 50%. Currently, Humana pays nothing for the technical and professional components of the second examination; Tufts pays 50% for the technical component; and United Healthcare plans to implement a 47.5% reduction to the technical component for the second examination in June.
In March, the ACR teamed up with the Radiology Business Management Association (RBMA), Irvine, Calif, for an e-Seminar titled, “ACR Update on the Deficit Reduction Act and the Medicare Physician Fee Schedule for 2006-07: Their Effects on the Future of Imaging” to educate radiology professionals about the ongoing efforts to have the DRA changed.
The DRA was passed by Congress and signed into law in February. Originally, the bill did not contain cuts to imaging. The cuts to the technical component were added at the last minute, after a conference report was written without the input of any imaging organization. This policy did not have any Congressional hearings, and stakeholders had no participation in the direction of the policy. The bill was then filed at 2 am on a Sunday, and voted on at 6 am the same day, explained Josh Cooper, senior director of government relations for the ACR.
The ACR characterized the bill as bad policy for several reasons. First, rural imaging facilities will be disproportionately impacted because of a lower volume of patients. Patients will then have to choose between traveling longer distances for imaging services, or just not having the necessary imaging services done. Second, there could be repercussions for mammography services. Because mammography is already a low profit procedure, services may be reduced or not offered at all in an office setting so the physician can concentrate on more profitable imaging services leading to less timely access, which is critical in the detection of breast cancer. Finally, no distinction has been made between diagnostic imaging and imaging for treatment planning. It is still up in the air if these cuts will affect treatment planning.
Cooper says the ACR’s efforts to have these cuts rolled back are in full swing. Currently, legislative efforts are being aimed at reevaluating the Radiology Advocacy Political Action Committee (RADPAC) contribution strategy; Congressional members are being revisited to discuss the shortsightedness of the cuts to imaging, and efforts are being made on behalf of a Congressional hearing and review of the policy; the ACR is also reaching out to align with other associations, including the AMA and manufacturers; an increase in grassroots activities is underway to keep awareness and education of the issue alive; and the ultimate goal of the ACR is to have the legislation repealed, or at the very least have its impact mitigated. The ACR is lobbying to have the scheduled 50% contiguous reduction eliminated in 2007, and made a specific request to CMS in January 2006.
Kassing says there are a few areas of uncertainty with respect to the impact of the DRA: interventional, radiation oncology, and PET and PET/CT. She says the Health and Human Services Secretary will be interpreting the rule in 2007.
ACRIN Launches RFA Trial
The American College of Radiology Imaging Network is still seeking participants for the ACRIN protocol 6673 clinical trial, which uses radiofrequency ablation to treat hepatocellular carcinoma. The primary goal of the trial, “Multi-center Feasibility Study of Percutaneous Radiofrequency Ablation of Hepatocellular Carcinoma in Cirrhotic Patients,” is to estimate the proportion of patients undergoing RFA treatment sessions whose hepatic tumors can be controlled. A CT scan will determine tumor control at 18 months following initiation of the therapy. The protocol design allows for repeat RFA treatment of tumor recurrences, which can be performed up to 15 months after initial treatment with the intent of controlling all hepatic tumors.
Sites in Alabama, California, North Carolina, Pennsylvania, Rhode Island, South Carolina, and Texas are participating in ACRIN 6673. Currently, only 4 sites have been IRB approved for the trial and have completed the ACRIN trial requirements, says Project Manager Donna Hartfeil, RN, BSN. About 10-12 sites are still working through trial requirements. For more information on how to contact the sites or to participate in the study, visit www.acrin.org/6673_protocol.html .
AHRA to Host Summer, Fall CRA Examinations
The American Healthcare Radiology Administrators (AHRA), Sudbury, Mass, will be hosting two Certified Radiology Administrator (CRA) examinations.
The summer 2006 examination will be administered in a paper-and-pencil format at AHRA’s 34th Annual Meeting and Exposition on August 3 in Las Vegas. Applications for this test are due by June 19, 2006.
A computer-based examination will be held November 10 at approximately 110 CompUSA Testing Centers in 36 states. Applications for this test are due by September 26, 2006.
The examination consists of 185 questions and tests a candidate’s knowledge in 5 management areas: human resource management, asset resource management, communications and information management, fiscal management, and operations management. About 30% of the questions will be knowledge-based, 40% will test application skills, and 30% will be analysis. The test is scored on a pass/fail basis.
The cost of the test is $300, plus a $50 application fee to verify eligibility.
For more information on eligibility requirements or to download an application, visit www.ahraonline.org , or call (800) 334-2472.
Letter to the Editor
I feel it necessary to point out some omissions in Keith Dreyer’s and David Hirschorn’s otherwise well-researched article in which he concludes that “certain” consumer color LCD monitors are as good as grayscale medical LCD monitors for radiographic primary diagnostic displays.
- The consumer monitors were running at their maximum luminance while the grayscale monitors were calibrated much lower than their maximum. The difference between maximum and calibrated luminance relates directly to the lifetime of the backlights. The consumer monitor would exhibit measurable dimming within a month of use whereas the medical monitors have backlight stabilization circuitry, which would maintain luminance (and thus calibration for tens of thousands of hours).
- The consumer monitor will take more than half an hour to reach its stable luminance when first powered on or when coming out of power save mode, whereas the medical monitor will take less than a minute. During this time, the monitor will not be calibrated. One could leave the consumer monitor on 24/7 to stabilize it, but this would only decrease its life expectancy further.
- The consumer monitor will only display an 8-bit grayscale. Since the consumer monitor does not have an internal lookup table (LUT), calibration is done by modifying the LUT on the video card. Because of the granularity of this configuration, adjacent shades of gray may be set to the same luminance thereby losing data. A medical monitor will be able to display 10 or more bit grayscale and the internal LUT will support this palette, so DICOM calibration is more accurate and data is not lost.
- It is possible that the testing done by Dr Hirschorn is flawed due to observer bias. Technically, this is an error introduced into measurement when an observer overemphasizes a result they expect to find and fails to notice a result they do not expect. If the radiologists knew they were being tested, they may have spent more time looking for positive findings knowing they were there.
While the thesis of the article may become true in the future, there are still many measurable differences between consumer and medical displays. Although medical displays are more expensive than consumer monitors of similar size and resolution, the differences can result in higher diagnostic accuracy and greater throughput due to better resolution of the grayscale.
Herb Berkwits
Product Manager, Medical Displays
Quest International
www.questinc.com
Industry News
Philips Medical Systems, Andover, Mass, announces that it has acquired Witt Biomedical Corp, Melbourne, Fla… InSight Health Corp, Lake Forest, Calif, completed its acquisition of East Bay Medical Imaging LLC, San Ramon, Calif, on March 1, 2006… West Physics Consulting, Atlanta, has entered into an exclusive arrangement with InSight Health Corp, Lake Forest, Calif, to provide all ACR MRI physics testing and consulting services for InSight’s network of fixed site facilities… InSiteOne, Wallingford, Conn, and X-Ray Marketing Associates Inc, Romeoville, Ill, have signed an authorized dealer agreement enabling X-Ray Marketing Associates to assist their clients in meeting their long-term image storage and archiving requirements on a fee-per-study basis without the need for facility management and long-term capital hardware investments… Premier Purchasing Partners LP, San Diego, has extended its film and imager contracts with FUJIFILM Medical Systems USA, Stamford Conn, through August 31, 2008…. Medicsight Inc, London, will initiate eight Japan clinical studies jointly sponsored with the Japan National Cancer Center. The company’s ColonCAD, integrated as part of the Viatronix V3D-Colon workstation, will be used in the SIGGAR1 clinical trial to interpret CT colonography studies…For the third consecutive year, the Philips iSite PACS by Philips Medical Systems, Andover, Mass, was named “Best in KLAS PACS” in the 2005 Top 20 Year-End Best in KLAS Awards report…Siemens Medical Solutions, Piscataway, NJ, announced the FDA has approved Iowa to accredit its Mammomat Novation DR full-field digital mammography units within the state…Diagnostic Ultrasound, Bothell, Wash, has acquired GlideScope® manufacturer Saturn Biomedical Systems, Burnaby, British Columbia, Canada…Affinity Diagnostic Imaging, Houston, was established in August 2005 as a full-service provider of mobile, interim rental, and fixed-site imaging…The IntegradWeb PACS by Dynamic Imaging, Allendale, NJ, was named the No. 1 overall PACS by KLAS in the “Specialty Niche: PACS (Ambulatory and Imaging Center)” category in the Top 20 Year-End Best in KLAS Awards report…NEC Display Solutions of America Inc, Itasca, Ill, will market and sell the Matrox AuroraVX™ Series display controller boards by Matrox Graphics Inc, Montreal…GE Healthcare, Waukesha, Wis, and PhotoCure ASA, Oslo, Norway, announce a licensing agreement granting GE Healthcare exclusive global rights outside the US and Nordic region to market and distribute PhotoCure’s Hexvix®, an optical molecular imaging agent intended for the diagnosis and monitoring of bladder cancer…Eastman Kodak Co, Rochester, NY, and Fischer Imaging Corp, Denver, have signed an agreement making Kodak the authorized worldwide service provider for Fischer’s breast cancer screening equipment…Witt Biomedical, Melbourne, Fla, and GEMMS, Indianapolis, have agreed to a marketing and technology partnership to benefit cardiovascular physicians and patients.
People
 Elias Zerhouni, MD |
Andrew C. von Eschenbach, MD, has been nominated by President George W. Bush to lead the FDA. He has been serving as acting FDA commissioner since September 2005… Elias Zerhouni, MD, director of the National Institutes of Health, Chevy Chase, Md, is launching a campaign to educate the public and Congress on the value of their investment in medical research. His team will be collecting facts and figures to present to the public to quash the negative feeling some have regarding medical research…GE Healthcare, Waukesha, Wis, has promoted Mark Vachon to president and CEO of its Diagnostic Imaging business, replacing Reinaldo Garcia, who has been named president and CEO of GE Healthcare–International…North American Imaging, Camarillo, Calif, has appointed Paul Dempster president and COO, replacing Peter Dempster, who takes on a new role as founder and president emeritus… Jeff Hagmeier has joined the board of directors of SightLine Health, Houston… Michael Greenberg, MD, has been named chairman of the board of Orthocrat, Houston…The Radiology Business Management Association, Irvine, Calif, has selected Michael R. Mabry as its new executive director…Sonora Medical Systems, Longmont, Colo, has promoted Donald Patterson to director of strategic accounts and global sourcing… Mohan Mysore has been appointed chief executive officer of Data Distributing LLC, Laguna Hills, Calif… Barbara Faulhaber has joined the Medical Group Management Association, Englewood, Colo, senior leadership team as vice president, communications and marketing…A. Redmond “Rusty” Doms, Jr, has been elected to the board of directors of Radlink Inc, Redondo Beach, Calif…The College of Healthcare Information Management Executives (CHIME), Ann Arbor, Mich, has awarded member Tim Stettheimer, VP and CIO at St Vincent’s Hospital, Birmingham, Ala, as the CHIME/HIMSS John E. Gall, Jr CIO of the Year during the annual HIMSS Conference and Exhibition in February…Liberty Pacific Medical Imaging, Encino, Calif, has appointed Anthony Draye to CIO.
