Of all the outsourcing decisions that radiology practices must make, none might take as long as deciding whether to outsource medical billing and coding. This is due, in part, to the fact that billing is the company’s cash register, so to speak, and is therefore more likely to be scrutinized —even agonized over—than are other services.

The federal meaningful-use program has been particularly challenging for imaging, both in its inception and in its execution. Initially, it seemed as though radiology would be exempt from the system of incentives and penalties devised to increase electronic health record (EHR) adoption; a rule change reversed that, making 90% of practicing radiologists eligible providers. For specialists, however, the menu set of requirements can be puzzling, at best, and prohibitive to participation, at worst.

The theme of 2012’s annual RSNA meeting in Chicago, Illinois, was Patients First, reflecting a question on the minds of many in the imaging community: How can a specialty with very little patient interaction built into its workflow improve its service to patients? As an emerging practice model, patient-centered radiology has a nice ring to it, but as Greg Thomson, CPA, executive vice president with Medical Management Professionals (MMP), notes, “This represents a major cultural leap for radiology. Radiologists have long had multiple customers—including referring physicians and hospitals—along with patients, and because they often do not interact with patients, their focus has been on the referring physicians, not the patients. It is a mindset shift for the specialty.”

The diagnostic-imaging industry continues to face significant reimbursement headwinds as a result of recent Medicare reimbursement cuts. Industry-specific cuts recently enacted include the Multiple Procedure Payment Reduction (MPPR), which was introduced in the 2012 Medicare Physician Fee Schedule (MPFS) and expanded in the 2013 MPFS, and the increased equipment-utilization rate (used to calculate Medicare reimbursement) contained in the American Taxpayer Relief Act (ATRA), passed in January 2013.

One of the most emotionally loaded conversations in imaging is that concerning efficiency and productivity. In recent years, these considerations have become increasingly vital to groups’ survival, according to Chad Calendine, MD, CMO of Optimal Radiology Partners and President of Premier Radiology (Nashville, Tennessee). “As peoples’ incomes began to decrease with decreasing reimbursement, they became more focused on how to regain that lost income, and the way to do that is through additional efficiencies and productivity,” he says. “It’s an emotional issue because it strikes to the heart of whether you are a good radiologist and a good partner. Are you pulling your weight?”

Managing emergency-department volume is a perennial challenge for hospitals, and at St. Mary’s Regional Medical Center (SMRMC) in Reno, Nevada, emergency-department volume is only expected to grow, according to Helen Lidholm, CEO. “We’re assessing what our emergency-department volume is going to look like, based on what we know about our community and how our local patient population will be affected by the Patient Protection and Affordable Care Act,” she says. “Every community is different, but we’re anticipating higher volume in the emergency department.”

In February 2013, the ACR® Harvey L. Neiman Health Policy Institute (HPI) released a brief¹ proposing a classification system for repeat medical-imaging studies. Richard Duszak, MD, CEO of HPI, says, “We wanted to propose a way to study the incidence, utilization, and appropriateness of repeat imaging for research and policy purposes. While that was our primary audience, and they would be researching this retrospectively, there is a lot of opportunity to do this in a prospective, real-time fashion for quality-improvement purposes.”

Mercy San Juan Medical Center is a 370-bed acute-care hospital in Carmichael, California, that is part of the not-for-profit Dignity Health System. It has experienced significant growth since it opened its doors in 1967—particularly following the 2009 introduction of a new patient tower that added 110 beds.