Maximizing Opportunities for Patient Care: MRI of Reston

Reston Radiology Consultants (Ashburn, Virginia) is a hospital-based imaging practice in business for over twenty years that includes several outpatient centers, including MRI of Reston, where four systems carry an imaging load that reaches a combined average of 24,000 studies annually. This suggests a fair amount of volume seen at that lone location; however, having too many patients is “usually not a bad thing,” according to Jeffrey Atkin, MBA, COO of Reston Radiology Consultants. In Grapevine, Texas, on August 16, 2011, at the annual meeting of AHRA: The Association for Medical Imaging Management, Atkin presented “Patient-centered Business Models in Diagnostic Imaging,” reporting that in 2010, MRI of Reston decided to alleviate the pressure of performing so many procedures per year. The obvious solution was to add a higher-throughput MRI system, and Atkin and his team immediately targeted the imaging center’s 0.7T open MRI system for replacement. The imaging center, which is located in a certificate-of-need (CON) jurisdiction, applied for state approval of a 3T MRI system, which would have allowed the faster throughput that it was seeking. Unfortunately, the state said no. “CON states are an interesting breed,” Atkin notes. “It’s a mixed blessing. It allows us to prevent the level of competition that could come in and put a new imaging center on every corner, but on the other hand, we can’t just go out and open a new magnet. Rather than fight it or reapply, we decided to try plan B.” An Open Alternative Atkin and his team then considered alternative MRI architectures, including high-field wide-bore systems. “We looked at the possibility of a wide-bore MRI because we knew we could actually get a 30-minute slot for that,” he says, “but let’s face it: Patients know a wide-bore system is not the same as an open scanner.” For that reason, he notes, “You can’t go from a true open scanner to a wide-bore scanner and expect it to work.” Seeking an MRI system that could accommodate the high number of difficult patients routinely seen at MRI of Reston (among them, claustrophobic patients), the imaging center began exploring the next generation of open MRI scanners, which offer higher field strengths and faster throughput than the original wave of 0.7T systems. “We’ve always been on the cutting edge,” Atkin says. “We were the first to have MRI in the area, we were the first to have 3T. We were the first to have an open unit.” The imaging center soon discovered the high-field boreless 1.2T Oasis system from Hitachi Medical Systems America (Twinsburg, Ohio), which would enable it to “hit the quality target and deliver higher levels of patient satisfaction,” Atkins says. “What’s neat about it is the amount of open space. It gives the appearance of windows. Patients can see daylight—left, right, and up. It’s providing a new level of comfort while preserving the traditional high-field MRI capabilities.” Better Throughput MRI of Reston implemented the Oasis system last year and immediately saw the benefit of faster scan times: The average time spent with the 0.7T unit was 45 minutes per patient, while the Oasis enabled Reston to lower that number to 30 minutes. “We’re going from just under 20 patients a day to over 30 now—an increase of an average of eight patients a day, which is close to $1 million in true revenue that we didn’t see before,” Atkin estimates, noting that, at that rate, the Oasis will pay for itself within two years of its installation. The breakeven point could come even sooner if other cost savings are considered. For example, Atkin notes that overtime is a cost not often considered by imaging centers. “We can now use the open scanner for patients we’d normally put on the 1.5T,” he says. “We can get the day done on time and eliminate overtime. I worry about FTEs as much as hospitals do. Time is money, and we want to eliminate overtime whenever possible.” In addition, anxious patients are now easier to manage, Atkin reports; as a result, MRI of Reston is able to serve patients who were too claustrophobic before to cope with the confines of a standard-size scanner. Then, there are obese patients; those who could not be scanned because of table limitations are readily accommodated today because the Oasis can handle patient weights in excess of 600 pounds, and the system’s coils and scan protocols are optimized for this underserved population. “It’s easy to use, patients are happy, and they’re in and out,” Atkin says. The Oasis also allows MRI of Reston to attract more athletic patients. In the past, athletes were problematic for the center because their shoulders were typically broad enough to preclude comfort in wide-bore, closed scanners. This is not so with the Oasis, Atkin says. He adds that the center’s goal is to share with its market its ability to ensure comfort, regardless of the patient’s needs, medical conditions, or body type. “We’re not just trying to attract the heavy or claustrophobic patients. If you can have a choice in whether you’ll be in an open scanner, what are you going to choose?” he asks. 1.5T Quality Atkin contends that MRI image quality depends as much on how well a patient fits within the chamber as it does on magnet field strength, which explains why the Oasis 1.2T boreless system produces such a good image. “The image quality really, truly is comparable to the 1.5T,” he conveys. “Referring physicians have difficulty telling the difference between the two.” Indeed, an MRI of Reston marketer who calls on referring physicians has been showing them comparison samples of wide-bore closed MRI and Oasis boreless images, and a few disbelieving physicians have jokingly accused the marketer of substituting 1.5T images for Oasis images. “We treat it like a 1.5T, and now, so do our referring physicians and radiologists. They are seeing the difference, which is increasing confidence in our service,” Atkin says. Confidence is also up because system uptime, Atkin says, “has been spectacular; 99% uptime is an understatement.” He notes that Hitachi customer support includes 24/7 electronic monitoring of equipment status, counter-to-counter parts support, and after-hours and checklist-driven preventive maintenance. In summary, Atkin says, new-generation, high-field open MRI systems like Hitachi’s boreless Oasis increase the opportunity to serve patients while reducing operating costs, they augment patient and physician satisfaction, and (most important) they offer high image quality for the best diagnostic confidence. “This is a scanner we will image any patient on, and we’re happy with the results,” he says. “Our referring physicians are happy with the results.”Rich Smith is a contributing writer for ImagingBiz.com.