Orthopaedic Practice: 4 Ways to Increase Revenue

In-house imaging provides orthopaedic practices with ancillary revenue stream

“Where you win or lose the game in a medical practice is on the revenue side of the balance sheet.”

Orthopaedic practices, like all medical practices, are feeling the pinch of increased costs, reimbursement pressure, and time-consuming administrative procedures. But on the positive side, there are many opportunities to increase revenue to make your orthopedic practice not only more Chart shows revenue increasingprofitable, but more efficient, for and more satisfying for your patients.

The AAOS created a useful 45-page guide, Enhancing Your Practices Revenue: Pearls and Pitfalls (A Primer for Orthopaedic Surgeons (1). It gives excellent recommendations for adding services, staff, and equipment that are likely to generate incremental revenue in an orthopedic practice.

These suggestions include Non-Physician Extenders (NPEs) such as Physician Assistants (PAs), Nurse Practitioners (NPs), and Athletic Trainers (AT/ATCs), who can “increase physician productivity, patient satisfaction, quality of care, and physician revenue.” Another idea for ancillary revenue generation for orthopedic practices is to add non-surgical physicians who can provide coverage when the surgeon is in the OR. Urgent care centers are another opportunity to make use of your physical set-up and location to build revenue after hours or on weekends.

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RSNA 2015: Important Presentations and Studies from Day 4

RSNA 2015Today’s summary of studies and presentations from RSNA 2015 highlight breast density notification laws, head CT and MRI, MRI technique for osteoarthritis in college football players, organ dose management, and how CT and 3D printing helping in a surgery to separate conjoined girls.

Breast Density Notification Laws Don’t Affect Reporting Over Long-Term – RSNA Daily Bulletin

According to research presented by Manisha Bahl, M.D., M.P.H, a breast imaging fellow at Duke University Medical Center, breast density notification laws have had an immediate but not long-term impact on the reporting of dense breasts on mammography. Dr. Bahl said two possible explanations could account for the study results. Radiologists may have wished to simply avoid the new requirements for reporting, or they downgraded assessments out of fear that facilities would be overwhelmed by an increase in women seeking supplemental screening.

Studies Investigate Significance of Follow-up Head CT, MRI – RSNA Daily Bulletin

A research team at University of California, San Francisco (UCSF) Medical Center sought to evaluate the common practice of ordering CTs at six-hour intervals for mild traumatic brain injury patients with small, deep brain hemorrhages that can’t be decompressed surgically. Only three out of 90 patients studied had any increase in bleeding evident on follow-up CT, and all three had impaired clotting ability, due to either medications or underlying blood conditions. For the other patients, the hemorrhages either were stable or decreased in size on a follow-up scan.

MRI Technique Shows Link to Osteoarthritis in College Football Players – RSNA Daily Bulletin

Wenbo Wei, Ph.D., of Ohio State University presented on how using delayed Gadolinium-enhanced MRI of Cartilage (dGEMRIC) on knee cartilage shows that playing collegiate football for a longer period of time may lead to microstructural damage that is an indicator of osteoarthritis (OA). The findings of the study demonstrate that dGEMRIC is capable of assessing glycosaminoglycan (GAG) loss within each individual articular cartilage region as well as the gradual changes related to the cumulative years of playing collegiate football, said presenter Wenbo Wei, Ph.D., of Ohio State University.

CT, 3D Printing Help Team Separate Conjoined Girls – AuntMinnie

In a 26-hour operation, a multidisciplinary team used CT scans and a 3D-printed model of the organs of conjoined twins to help perform a successful separation. The presentation was given by Dr. Rajesh Krishnamurthy, chief of radiology research and cardiac imaging at Texas Children’s Hospital. The children, Knatalye and Adeline Mata of Lubbock, TX, were born on April 11, 2014. The surgery was attempted 10 months later. To prepare for the separation surgery, Krishnamurthy and colleagues performed volumetric CT imaging with a 320-detector-row scanner, administering intravenous contrast separately to each twin to enhance views of vital structures and plan how to separate the girls.

NCI Software Automates Organ Dose Measurement – AuntMinnie

Researchers from the National Cancer Institute (NCI) are finalizing a longstanding project to build a user-friendly software program that converts CT dose index volume (CTDIvol) scanner readouts into accurate organ dose estimates. The just-published National Cancer Institute CT (NCICT) project shows the calculation for converting normalized CTDIvol to organ doses for six patient ages and both genders recently approved by the International Commission on Radiation Protection (ICRP), with software to be released early next year.



IDoR: Paediatric Imaging a Bright Spot in Advancing Radiology

IDOR Image

In addition to special lectures and courses being held to mark the
International Day of Radiology, hospitals and radiology departments all across the world held open days and special events to make the public more aware of radiology.

Re-posted from Diagnostic Imaging (DI) Europe with permission.

Timed to coincide with the date (8th November) of the discovery of X-rays by Wilhelm Röntgen in 1895, the International day of radiology (IDoR) has now evolved into an annual event of “action and awareness” organized by the main radiological professional societies, such as RSNA, ACR and the ECR, as well as an umbrella radiology organizations on all continents. Thus, throughout the world all sorts of events were organized with the stated objective of “building greater awareness of the value that radiology contributes to safe patient care, and improving understanding of the vital role radiologists play in the healthcare continuum”.

There is no doubting the validity of such a laudable intention, but now in the fourth annual celebration of IDoR (the first was launched amid much pomp in 2012) the real question remains whether the IDoR is actually achieving its objective. Even more practically, just exactly how do you measure whether actions to “alert the world to the stunning medical, scientific and even artistic possibilities of medical imaging, the essential role of the radiologist as a part of the healthcare team in countless medical scenarios, and the high educational and professional standards required of all staff working in medical imaging” are actually succeeding?

It goes without saying (but is nevertheless worth while repeating) that radiology with all its various imaging modalities has become more than ever a central unavoidable facility in modern medicine. This makes it all the more depressing that, time after time, surveys of the general public show that they have indeed very little idea of exactly who a radiologist is (most patients confuse the radiographer with the radiologist) and even less on what the radiologist actually does.

Such misunderstanding on the part of the public is bad enough, but what is perhaps even worse is that the morale of many radiologists themselves is continuing to sag under the pressures of ever-increasing work-loads. Therein lies the paradox of the profession. The more the role of radiology becomes central in medicine, the more the workload increases and the more the radiologist is in danger of being perceived as an out-of-sight anonymous provider of images and reports.

The biggest impact on the typical radiologist’s workload has come from the dramatic increase in the number of cross-sectional imaging studies (i.e. CT or MRI) being carried out. By definition the three-dimensional nature of these modalities means that radiologists are spending more and more time in reading the images. A recent study highlights just how dramatic is the impact of such an increase in workload (McDonald RJ, Schwartz KM, Eckel LJ, Diehn FE, Hunt CH, Bartholmai BJ, Erickson BJ, Kallmes DF The Effects of Changes in Utilization and Technological Advancements of Cross-Sectional Imaging on Radiologist Workload. Acad Radiol. 2015 Sep;22(9):1191-8).

A group of researchers from the Mayo Clinic analyzed the statistics at their institution on the use of cross-sectional imaging over the last decade and found that the combined numbers of CT and MRI carried out over this period doubled but that, over the same period, the number of individual images being interpreted increased more than ten-fold. This translated into the average radiologist at the Mayo Clinic who was reading CT or MRI examinations being required to interpret one image every 3-4 seconds in an 8-hour workday to meet workload demands!

IDOR Image 2

The modern radiologist is facing ever-increasing workloads and is often perceived as an out-of-sight anonymous provider of images and reports.

However there may just be a glimmer of light at the end of the workload tunnel. In one particular sub-field, namely that of pediatric CT— and let’s not forget that the particular focus of this year’s IDoR is indeed pediatric radiology — there may be just a suggestion that the otherwise inexorable growth trend in the number of radiology examinations is being bucked. A recent study in one group of US pediatric hospitals (Parker MW, Shah SS, Hall M, Fieldston ES, Coley BD, Morse RB Computed Tomography and Shifts to Alternate Imaging Modalities in Hospitalized Children. Pediatrics. 2015 Aug 24. pii: peds.2015-0995) showed that, although there still was a steady increase in the total number of imaging studies carried out on children, for several pediatric diagnostic-related groups the number of CT examinations was actually declining.

One explanation for this is that, finally, the incessant banging of the drum through many campaigns such as “Image Gently” about the dangers of ionizing radiation in children is finally bearing fruit. It is still too soon to see whether there is any similar trend in the number of adult CTs. However this mini-trend should not be interpreted as a sea-change in overall radiology trends. On the contrary, it should be remembered that in the study by Parker et al., overall, the number of imaging examinations still rose. Even if pediatric CT was declining, this wasn’t due to fewer overall exams being carried out; instead CT was being replaced by alternative imaging modalities.

In the light of all this it is not surprising that the morale of the profession can suffer. Of course technological innovations and developments provided by the industrial suppliers of equipment and software to the profession can help by providing ever more efficient and powerful systems, but there are limits to workflow improvements in the face of such growing workload requirements.

So maybe the focus of the International Day of Radiology should in future be directed less to convincing the general public of the importance of radiology and more to reminding radiologists themselves of the importance of their profession, a victim of its own success.

Alan Barclay, Diagnostic Imaging EuropeAlan Barclay, Ph.D., is the editor of Diagnostic Imaging (DI) Europe.


White Paper: 3D Weight-Bearing Imaging Using CBCT

This white paper addresses the benefits of a prototype cone beam computed tomography (CBCT) system dedicated to extremity imaging.

The CBCT system was co-developed by scientists at Carestream Health and Johns Hopkins University. The CBCT system was designed to image both upper and lower extremities, with the lower extremities also capable of being imaged in a weight-bearing configuration.

This unique capability can unveil and better characterize certain pathologies in the knee and ankle joints such as meniscal extrusion, altered tibiofemoral joint space morphology, flatfoot deformity, and distal tibiofibular syndesmosis insufficiency.

As explained in the white paper linked to below, the CBCT system’s images are “excellent” for bone and “good/adequate” for soft tissue visualization tasks. Additionally, the image quality was equivalent/superior to MDCT for bone visualization tasks.

For more details about the CBCT system images, you can read the white paper, “High-Resolution Three-Dimensional Weight-Bearing Imaging of Lower Extremity Using Dedicated Cone Beam Computed Tomography (CBCT).”

Carestream CBCT Weight Bearing Images

Carestream OnSight 3D Extremity System received FDA 510(k) clearance in September 2016.

Diagnostic Reading #47: Five Must-Read Articles From the Past Week

Carestream LogoA new week means a new Diagnostic Reading, This week we are looking at health record security, meaningful use, a CT use study, ICD-10, and patient engagement in hospitals.

Report: 45 % of Americans Have Had Records Compromised – Clinical Innovation + Technology

According to a white paper from iSheriff, a provider of cloud-based enterprise device security, almost 45 percent of Americans have had their sensitive health information compromised via a cyberattack. The New Healthcare Crisis: Cybercrime, Data Breaches and the Risks to Patient Records highlights the largest breaches and points out that the five-year total is more than 143 million compromised patient records which is more than one-third of the 319 million Americans.

U.S. Government Finalizes Meaningful Use Regulations – AuntMinnie

The announcement by the U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) and the U.S. Centers for Medicare and Medicaid Services (CMS) featured the final rule for stage 3 in addition to modifications to current stages of the MU program. The reporting period for providers to attest to meaningful use of IT in 2015 has been dropped from 365 days to 90 days. New participants in the MU program can take advantage of a 90-day reporting period in 2016 and 2017.

6 Glaring and Disruptive ICD-10 Glitches – Healthcare IT News

Linda Girgis, MD, Family Physician, South River, NJ, shares her experiencing using ICD-10 in its first week. The glitches she experienced are outline in her article and include: the CMS grace period, clearninghouses, referrals, eligibility checks, wait times and personnel.

Study: Skip CT in Most Blunt Emergency Trauma Cases – AuntMinnie

According to a study of more than 11,000 patients that was published October 6 in PLOS Medicine, doctors can safely forego CT imaging in more than one-third of emergency blunt trauma cases by using clinical criteria to assess patients rather than automatically sending them to imaging. The researchers hypothesized that two validated clinical tools could be used to avoid unnecessary radiation-bearing exams and also save money. They showed that nearly all injuries can be found using the two sets of clinical criteria, which they called “decision instruments,” comprising either six or seven elements. Both deliver at most a small fraction of the radiation dose of CT, the group reported.

ONC: Patient Engagement Capabilities Increasing in Hospitals – Healthcare Informatics

According to ONC data, which includes data from the American Hospital Association (AHA) Information Technology (IT) Supplement to the AHA Annual Survey, this is a significant increase from 2013, where 1 out of 10 (10 percent) hospitals provided the capability. Further, most hospitals allowed patients to transmit (66 percent) and download (82 percent) health information; however nearly all hospitals (91 percent) allowed patients to view their health information electronically.

Diagnostic Reading #45: Five Must-Read Articles From the Past Week

Carestream LogoThis week’s Diagnostic Reading focuses on duplicate imaging on emergency patients, medjacking, the cost doctors are paying for technology, tomosynthesis implementation, and the importance of setting up a data security plan.

1. Study: Emergency Patients Get Duplicate X-ray, CT Exams – AuntMinne

Researchers from Emory University examined the cases of more than 3,600 patients who underwent both x-ray and CT studies on the same body part as part of their workup after admission to the emergency department (ED). The team found that many of these exams were unnecessary, with both x-ray and CT sometimes ordered simultaneously, or CT ordered before results from an initial x-ray study were received.

2. Medjacking: The Newest Healthcare Risk? – Healthcare IT News

A recent article in WorldNow proclaimed, “It may sound like a science fiction novel, but medical devices could someday be the target of hackers.” But the fact is that these devices are already being hacked, a trend that is alarming hospitals and other healthcare organizations. In fact, this kind of hacking is already widespread enough to have a new name: medjacking.

3. Docs are Paying More for Technology Than Ever Before – Healthcare IT News

According to a new MGMA report, medical practices across the U.S. are now spending a lot more on technology this year, up nearly 34 percent from four years ago. The annual report published by Medical Group Management Association shows that just from last year alone, physician-owned multi-specialty groups reported nearly a 12 percent increase in technology-related operating costs.

4. Imaging Department Reaps Benefits of Tomo After Careful Implementation – Radiology Business

The Baylor College of Medicine department of radiology recently implemented DBT at their breast imaging department. They wrote about the experience for the  Journal of the American College of Radiology, stressing the importance of taking things one step at a time. Ebuoma and colleagues wrote that the first step was getting staff fully prepared for the transition. From the person answering questions from behind the front desk to the radiologists interpreting the images, each staff member had to adapt to this new technology and how it would impact their day-to-day operations.

5. Data Security: The Importance of Planning, Training, and Having a Risk-Management Strategy – Healthcare Informatics

According to a recent report from the Breach Level Index, the healthcare industry had the highest number of data breaches in the first half of 2015 and also led the way in number of records breached by industry, with 84.4 million records. These findings represent a dramatic shift from the past few years when healthcare had relatively small numbers of records involved in data breaches, according to the report. The report findings are just one more reminder of the ongoing threats to healthcare information security and highlight the importance of building a strong information security program.

Diagnostic Reading #44: Five Must-Read Articles From the Past Week

Carestream LogoIt’s time for a new edition of Diagnostic Imaging. This week we’re looking at medical imaging and pregnant women, digital tomosynthesis and CT lung nodules, how business intelligence affects security, doctors using EHRs, and imaging informatics and archiving in Scotland.

Diagnostic Imaging May Be Safe for Pregnant Women – Diagnostic Imaging

According to a review article published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS),  some radiologic imaging can be safe for pregnant women who have sustained traumatic injuries. Researchers from the Thomas Jefferson University in Philadelphia, PA, and the Garden State OB/GYN Associates in Voorhees, NJ reviewed the diagnostic dilemma that confronts emergency room physicians when pregnant women present with traumatic injuries that require diagnostic imaging.

Digital Tomo Falls Short of CT Lung Nodules – AuntMinnie

A new study published September 8 in the Journal of Digital Imaging indicates that tomo may have a tough time finding a role in the chest that’s not already well-served by the other two modalities. Researchers from the Mayo Clinic in Rochester, MN, compared digital tomosynthesis with chest x-ray in a population of 82 individuals, while also comparing both technologies to CT as the gold standard. They found that tomo was much better than standard radiography in several areas, such as for detecting nodules larger than 4 mm — considered the threshold for clinical significance.

Security Needs Business Intelligence – Healthcare IT News

A truly risk-based security framework needs more than mere protective measures. It requires awareness. This article features quotes from Ron Mehring, senior director and chief information security officer, Texas Health Resources, who oversees security architecture and operations at the sprawling 25-hospital system/ Mehring explains how large health systems need to escalate up from “baseline security requirements” to something much more robust.

More Than 80 Percent of Docs Use EHRs – Healthcare IT News

More than eight in 10 doctors across the country, or 83 percent, have adopted electronic healthcare record systems, according to a new report from the Office of the National Coordinator for Health IT. Counting only certified EHR adoption, however, that rate goes down to 74 percent. Also, 51 percent of doctors are using only basic EHR functionalities, according to ONC.

Imaging Informatics: Archiving Scotland – Radiology Today

Alan Fleming, program manager for National Health Services (NHS) Scotland, says the process of setting up Scotland’s archive required extensive input from both clinical and business stakeholders. One of the most important tasks was selecting a supplier for PACS, data center storage, and hosting [Disclosure: Carestream was selected to provide the PACS and national image archive]. NHS Scotland also had to specify the services that would be provided by the archive, and the final implementation plan required approval from senior government officials.

Diagnostic Reading #42: Five Must-Read Articles From the Past Week

Carestream LogoAnother week means another edition of Diagnostic Reading, This week’s topics focus on mammography screening volume, cyber attacks on healthcare organizations, CT use in children’s hospitals, accountable care organizations (ACOs), and patient-radiologist communication.

Higher Screening Mammo Volume Equals Better Outcomes – AuntMinnie

According to a study published in the Journal of Medical Screening, women who undergo mammography screening at breast centers with high volumes tend to have better outcomes, which is encouraging news for a modality often criticized for its tendency to overdiagnose.

4 in 5 Health Orgs Hit by Cyber Crooks – Healthcare IT News

According to KPMG’s 2015 Healthcare Cybersecurity Survey, more than 80 percent of healthcare chief information officers, chief technology officers and other security leaders say their organizations have been victimized by at least one cyber attack in the past two years. Barely more than half – 53 percent of providers, 66 percent of payers – say they feel adequately prepared for a cyber attack.

Children’s Hospitals Utilizing Less CT in Favor of Other Modalities – Health Imaging

According to a new study published in Pediatrics, CT utilization in children’s hospitals is declining, possibly due to potential side effects related to pediatric exposure to ionizing radiation. According to the authors, more and more research has revealed the possibility that exposing children to ionizing radiation may increase their risk of cancer, leading to efforts to minimize such exposure.

Premier’s Damore: With the Right Help, ACOs Are Moving in the Right Direction – Healthcare Informatics

Shortly after the federal Centers for Medicare & Medicaid Services (CMS) announced the latest results coming out of the two main accountable care organization (ACO) programs operating under the aegis of the Medicare program, the Medicare Shared Savings Program for accountable care (MSSP) and the Pioneer ACO Program, leaders at the Charlotte-based Premier, inc. were able to trumpet positive results coming out of Premier’s population health initiative.

Patients Don’t Want to Talk to Radiologists – Diagnostic Imaging

According to a new study published in the Journal of the American College of Radiology, answering some fundamental questions might be wise before the field of radiology “embarks on such a sea change” of more direct communication with patients Based on a total of 617 survey responses from patients, they found that the majority—63%—preferred receiving their imaging results from a referring provider, not a radiologist.

Diagnostic Reading #38: Five Must-Read Articles From the Past Week

Carestream LogoIt’s time for a new edition of Diagnostic Reading. This week’s articles focuses on unnecessary CT scans to evaluate TBIs, the benefits of digital breast tomosynthesis, encrypted data in the EHR, ICD-10, and patient management duties of Radiologist Assistants.

1) Sports-related Head Injuries Spur Avalanche of CT Scans – AuntMinnie

According to a new report in the American Journal of Emergency Medicine, emergency department admissions for sports-related head injuries have skyrocketed in recent years — and so have unnecessary CT scans to evaluate them. More than half received CT scans, but only 4% were serious enough to count as a traumatic brain injury (TBI).

2) DBT Boosts Mammo’s Specificity, Lowers Recall Rate – AuntMinnie

According to a new study published in Radiology, adding digital breast tomosynthesis (DBT) to conventional mammography boosted the specificity of breast screening and cut the recall of women with benign lesions by more than half. Researchers from the University of Cambridge in the U.K. found that adding DBT to mammography improved specificity by about 20% across subgroups of patients with different types of breast density, dominant radiologic features, and age.

3) Is it Time to Encrypt Data Even Inside the EHR? Maybe So – Healthcare Informatics

In an opening keynote address, Mac McMillan, CEO of CynergisTek, laid out in the clearest possible terms for his audience of IT executives the growing cybersecurity dangers threatening patient care organizations. Among the key areas of concern he had discussed were “increased reliance”; “insider abuse”; “questionable supply chains”; “device-facilitated threats”; “malware”; “mobility”: “identity theft and fraud”; “theft and losses”; “hacking and cyber-criminality”; “challenges emerging out of intensified compliance demands”; and a shortage of chief information security officers, or CISOs.

4) Brace for Impact: ICD-10 Will Keep Radiologists Busy – Radiology Business Journal

According to a recent study published in the Journal of the American College of Radiology, radiologists should expect a 6-fold increase in the number of codes they use, as they convert from ICD-9 codes to ICD-10. The transition from more than 14,000 codes to almost 70,000 will have an “enormous technological, operational and financial impact,” according to study’s authors.

5) Study: RAs Oversee Substantial Patient Management Duties – Axis Imaging News

Findings from the Radiologist Assistant Practice Survey 2015, conducted by the American Society of Radiologic Technologists, indicated that weekly responsibilities include reviewing patients’ medical records, verifying the appropriateness of exams, and advocating for patient radiation safety and protection.

Diagnostic Reading #34: Five Must-Read Articles from the Past Week

Carestream LogoTomorrow is a holiday in the U.S., so this week’s issue of Diagnostic Reading will be taking place a day early. This focus of this week’s articles include data interoperability, how dense breast tissue affects mammograms, CT radiation dose levels, cybersecurity, and new findings by the Society of Radiologists in Ultrasound.

1) Q&A: A New Diagnosis for Radiologists – Diagnostic Imaging

An article published in Radiology by the Society of Radiologists in Ultrasound recommending that elastography techniques can be used to distinguish patients with no or minimal liver fibrosis and differentiate them from patients with severe fibrosis or cirrhosis. There were two significant outcomes from this recommendation: patients no longer need invasive liver biopsies to diagnose liver fibrosis, and radiologists will play a huge role in diagnosing diffuse liver disease, a part they did not play before.

2) How Breast Density Can Affect Cancer Screenings – Imaging Technology News (ITN)

Susann Schetter, DO, co-medical director of Penn State Hershey Breast Center recently published comments in an edition of The Medical Minute, a weekly health news feature produced by Penn State Milton S. Hershey Medical Center, on how when it comes to breast cancer screening, the fibroglandular density of breasts affects how well a mammogram can detect cancerous tissues.

3) Cybersecurity is an Increased Business Priority for Healthcare Leaders, Survey Finds – Healthcare Informatics

“The Healthcare Information and Management Systems Society (HIMSS) surveyed nearly 300 healthcare leaders across the industry on the issue of securing patient data. Nearly every single one, 87 percent in all, said cybersecurity was increased business priority over the past year due to the increasing threats to PHI. Two-thirds of the respondents said their organization had experienced a significant security incident.”

4) CT Radiation Dose Levels in Clinical Trial Surprise Researchers – AuntMinnie

“A group of researchers studying the use of CT for kidney stones were surprised by the radiation dose levels they discovered in their multicenter clinical study. Not only were many doses too high, they also varied widely between centers, concludes a research letter published June 29 in JAMA Internal Medicine.”

5) Innovation Pulse: A Better Road to Data Interoperability? – Healthcare IT News

Tom Sullivan, executive editor, HIMSS Media, takes a look at how enabling one doctor to use one EHR to access patient information residing in a different hospital’s EHR from a different vendor may not be best way to give doctors the data they need. He looks at the ability to overlay technologies, one on top of the other, as it might bring us close enough to interoperability.