Washington D.C. March, October 22, 2022

 

Imaging's Torrid Growth Rate Is Slowing

 Is the era of rapid growth in medical imaging procedure volume over? The volume of advanced imaging services delivered to Medicare beneficiaries decreased in 2009 -- the first decrease in 11 years, according to a study released Wednesday.
Washington, DC-based research and consulting firm the Moran Company found that the volume of advanced imaging services billed within the Medicare system decreased by 0.1% in 2009 compared with 2008, while overall imaging services declined by 7.1% for the same year-to-year comparison.

"It's pretty clear the era of very rapid growth in advanced medical imaging seems to have come to an end at this point in time," said Don Moran, president of the Moran Company. "All the data point to a leveling. It's unclear whether we will see further declines, but the prior growth of these modalities and the advantages they offer to clinicians seems to be peaking."
The study, released today by the Access to Medical Imaging Coalition (AMIC), reviewed Medicare claims data from 1999 through 2009, examining both spending and volume of advanced imaging services, such as CT, MRI, nuclear medicine, and PET, as well as overall imaging services, including mammography.

Declining Volume

The analysis also found that the total volume of mammography screenings decreased by 0.3% in 2009, compared with a 2.8% compound annual growth rate in the past decade. In addition, the total volume of dual-energy x-ray absorptiometry (DEXA) exams fell by 2.2%, while spending on this technique decreased by 16% from 2008 to 2009.
The new findings are comparable to a 2008 analysis of Medicare claims data that showed a 19.2% reduction in Medicare spending on advanced imaging from 2006 to 2007. It also revealed a significantly reduced procedure volume growth rate of only 1.9%, which was less than the overall rate of physician-payment growth.
In addition, a study presented by David C. Levin, MD, and colleagues at the 2010 RSNA meeting found that imaging procedure volume grew at a compound annual growth rate (CAGR) of 1.4% between 2005 and 2008, well down from the 4.1% CAGR experienced between 1998 and 2005.
Imaging industry observers have attributed the slowing growth rate to reimbursement cuts for medical imaging such as those enacted by the Deficit Reduction Act of 2005. The healthcare reform legislation passed in 2010 includes additional reimbursement reductions.
The study shows that "medical imaging has been decimated by these cuts," said Tim Trysla, executive director of AMIC. "The impact of these cuts, even by the government's own estimates, has 'de facto' caused access problems for patients and providers. We are very concerned about choking off the access to these lifesaving technologies."
John Patti, MD, a radiologist at Massachusetts General Hospital in Boston and chair of the American College of Radiology Board of Chancellors, said he and fellow radiologists are concerned with imaging's declining growth rate, because the Medicare population is increasing and the incidence and prevalence of disease remain the same.

Early Diagnosis

"One of the tremendous benefits of advanced imaging over the years is that it has obviated the need for more costly and evasive diagnostic evaluation," Patti said. "This reversal of trend suggests that Medicare patients may not be receiving those appropriate exams and thus the benefit of early diagnosis."
In addition, he said the decrease may have "negative downstream effects on the health of our aging citizens and on the cost of providing the more complex care that may be necessary to treat disease if it is discovered in advanced stages."
One potential victim of the decline is outpatient imaging center owners and operators. Because of reimbursement cuts for outpatient imaging, some physicians have sold or given their imaging activities to hospitals, which are reimbursed at a higher rate under the Hospital Outpatient Prospective Payment System (HOPPS). That scenario, in turn, could lead to less access to advanced imaging services.
In other study data, Medicare spending for advanced imaging services increased by less than half the spending growth for physician services overall. With a 1.2% increase in spending for advanced imaging, compared with 2.6% for services overall, imaging was one of the slowest-growing segments of the physician fee schedule in 2009.


Some Optimism
Despite the volume downturn in 2009, Trysla believes that advanced medical imaging will continue to contribute to patient care. "Medicine will not turn its back on advanced technology, especially with the benefits of early detection of disease, such as Parkinson's disease and cancer," he said. "I think you will see growth through new applications in technology, and medicine will continue to evolve from exploratory surgery toward early and more exact detection."
ACR's Patti also speculated that the dip in growth in 2009 would be temporary. "I don't think there are any physicians who are taking direct care of patients who don't understand the value of advanced imaging," he added. "And, I don't think there are any physicians who are willingly withholding [advanced imaging] from patients."


by : Wayne Forrest

Lessons From Norman Rockwell

by Brandon Betancourt



This past summer I got a chance to visit Washington DC. While I was there, I saw a Norman Rockwell exhibition at the Smithsonian American Art Museum. As it turned out, the exhibition was the private collection of George Lucas and Steven Spielberg. The exhibition highlighted Rockwell’s masterful storytelling.
I didn’t know much about Norman Rockwell before that day. I knew he was a famous American painter and I had seen a few of his replicas in restaurants. But after seeing the exhibition, I got a deep, deep appreciation of Rockwell and especially, how he was able to communicate an entire story with a single frame.


The old days
My 75 year old grandfather was with me that day and told me how, back in the day, he couldn’t wait to get the Post Magazine to see Rockwell’s cover and to read it cover to cover. He also shared with me how Rockwell’s pictures told stories about growing up, how they instilled patriotism and depicted American family values.




The influence of storytelling
The exhibition and my grandfather’s account reminded me of how powerful storytelling is. Rockwell did it with pictures and to some extend he moved a nation. But could we use storytelling to do other things such as inspire patients, communicate with customers or stir up emotions in people? I think so. Companies do it all the time. And the ones that have stories that resonate with the public are generally some of the most recognizable companies in our society.






Toyota, Hummer, Harley Davidson, American Express & Target
A perfect example of companies telling stories are car manufactures. When a person buys a Prius, they are telling a story to others about themselves. They are telling others, (and themselves) they are environmentally conscious and are doing their part to contribute towards the “green” cause. The opposite end of the spectrum is Hummer vehicles. The person that drives a Hummer is not concerned about the environment. We know at least that much.
On a Prius, one might find a sticker that reads, “my kid is an honor roll student at George Washington Elementary School,” whereas on the Hummer, you may find a similar sticker but it reads “my son can kick your honor roll kid’s ass.” Each car tells a different story.
Harley Davidson motorcycles tell a story of freedom, ruggedness and loudness. American Express tells a story of class, success and refinement. Which is the complete opposite of “Capital One’s” story. Wal-mart’s story is low prices. But despite being in the same business, Target has a completely different story. Target’s story is “design democratization.”






What is the story?
The story is essentially how we think and feel when we see a product or a service and what we tell others (and ourselves) about us when we use the product or service. Clear as mud, right?






What does all this have to do with our medical practices?
Glad you asked. Just like Starbucks creates a warm, hip, comfortable experience to support their story (different from the Dunkin’ Donuts experience), we too can use some of these storytelling elements I learned from the Norman Rockwell exhibition to help us define the narrative we tell our customers and patients.






Lessons From Rockwell
1. Define the story. We have to characterize what our narrative is going to be. For example, Subaru has had multiple advertising campaigns to support their story. Recently, they’ve used: “Love. It’s what makes a Subaru, a Subaru.” That slogan reinforces their story that people who own a Subaru, LOVE Subaru. It also talks about the Love that goes in to making a Subaru. It is not just an ordinary car. More recently, they’ve focused a lot on “safety.” That’s a story as well.
In our medical practices’ we too can define our story. We can have a customer service story or our story can be about being compassionate, loving and caring. We can tell the story about how we embrace holistic medicine or even be known as an obesity and nutrition clinic. A while back I met a dentist that wanted to have a high-tech dentist office. That was his story.
Answer this: What do you want others to think when they hear your practice’s name?


2. Paint the picture. Rockwell used a canvas to tell his story; Spieldberg and Lucas use movies; Apple Inc uses design to tell their story of sophistication, simplicity and innovation.
In a medical practice, we too can paint our picture and tell our story by how we decorate our offices, how we design our advertising, how we answer the phone and how we treat patients.
Painting the picture is simply the vehicle we choose to tell our stories. It can be done in many different ways. It doesn’t matter how we choose to tell our story. Heck, it could even be a simple as creating a blog for your practice. But always have the story at the center.


3. Cast to support your story. One fascinating tidbit about Rockwell was that he casted the people in his paintings much like a filmmaker cast an actor for a role in a movie. Once he found the right person or group of people, he used them as stand-ins while drawing the picture. He knew that the characters he choose would support his vision for the story he wanted to tell. This was brilliant in my opinion.
Let’s say your story is customer service … do you hire people that can support that story or do you have Ms. Grumpy McGee as the front office clerk?
At their retail stores, Apple “cast” geniuses (if you’ve been to an Apple store, you know what I’m talking about) and Starbucks don’t just have servers, they have “baristas.” Both of which help reinforce each company’s story.


4. Pay attention to detail. Norman Rockwell did not leave anything to chance. Everything in his painting was there for a reason. Every single little detail, every prop, even the supporting characters helped tell the story. In fact, for some, the details were what really emphasized the story. In other words, often it was a little detail that made the story complete.
As Walt Disney once said, “There is no magic in magic, it’s all in the details.”


In a medical practice, there are details that can enhance our story or detract from it. It could be the cleanliness of the waiting room chair or the old magazines or the pictures hanging on the wall. It could be how we answer the telephone to how the doctor is dressed to the manicure of the nurse.
We often underestimate details because, well, they are details. But I’m sure many of you can agree that sometimes, one little detail is the difference between a good story and a bad story. Don’t leave the details to chance.
Well, what do you think about this correlation between Norman Rockwell and a medical office? At first, there might not be much of an association when you first think about it. But I think there are many lessons.

Study: Self-referral for advanced imaging is common

The Center for Studying Health System Change (HSC) of Washington, DC, said its study is unique in focusing broadly on ownership of advanced imaging equipment rather than on specific healthcare services. The data indicate that policymakers may want to reconsider the in-office exemption to the Stark anti-self-referral law, which enables nonradiologist physicians to own and operate imaging equipment in their offices.


HSC researchers asked physicians whether they owned or leased medical equipment as part of its 2008 Health Physician Tracking Survey, a mail survey of U.S. physicians working at least 20 hours per week in direct patient care. The survey sample was limited to 2,750 physicians practicing in community-based, physician-owned settings. Physicians who practiced in hospital-based settings or who were employed by hospitals were excluded.
They reported ownership of medical equipment by the type of devices being used, as well as according to physician practice size and specialty. Among the survey's findings:
Among all physicians, one in six respondents (17.4%) reported that they owned or leased advanced imaging equipment.
For basic x-ray equipment, 22.7% of all physicians reported owning or leasing equipmentOwnership of advanced imaging equipment was highest among surgical specialists: 30.3% reported owning equipment. That compares to 15.7% of procedure-based medical specialists such as cardiologists, 13.5% of nonprocedure-based medical specialists such as neurologists, and 10.6% of adult primary care physicians.
Ownership varied by the size of the physician practice, from a high of 52.9% of groups larger than 51 physicians owning advanced imaging equipment, to a low of 6.7% for solo practitioners.
The report went on to note that Congress and the U.S. Centers for Medicare and Medicaid Services (CMS) have made physician ownership of advanced imaging less attractive by cutting Medicare reimbursement. Also, the healthcare reform law passed earlier in 2010 includes provisions that as of January 1, 2011, will require self-referring physicians to disclose their financial interests to patients and to provide them with a list of alternative service providers.
"Given the growing evidence that physician self-referral contributes to unnecessary and costly care, policymakers might reconsider the broadness of the in-office ancillary service exemption to the Stark law," the report states. "Ultimately, moving away from fee-for-service payment toward payment mechanisms that reimburse physicians for a broader unit of service, such as an episode of care, or putting physicians at least partially at risk for the cost of care will alter the financial incentives that now encourage physician self-referrals."


By : Brian Casey

Old-School Code of Trust Ruined

Here's an article by John Hughes,former editor of The Christian Science Monitor/Pedram

The WikiLeaks dump of US embassy cables last month was a reckless act. It is a far cry from the responsible reporting on foreign affairs with which I am familiar.When I was the State Department spokesman in the Reagan administration, Bernard Kalb, then diplomatic correspondent for NBC, called me about a tip that the bad guys in Beirut, Lebanon, had captured and were holding an American CIA officer.


“Bernie,” I said, “I’ll only talk off the record about that.”
“No way,” Bernie replied, “If it’s off the record I can’t use it.”
“Well, that’s the deal,” I said. “See what your network says.”

The network agreed to the deal. I told Bernie that the officer being held was the CIA station chief in Beirut. We didn’t know whether the captors knew of his CIA association. If Bernie went with the story, the officer would certainly be killed. Honorably, the network did not run the story. Sadly, the captors tortured the officer, discovered his identity, and killed him.
The importance of relationships:
That was a classic example of trust between a diplomatic correspondent and a government official. It is the kind of relationship observed regularly between State Department officials in Washington and US diplomatic correspondents.
Sometimes the journalist is checking out a questionable rumor. Sometimes the diplomat is offering background on a situation that for good reasons cannot then, or ever, be made public. For example: Dissidents given secret sanctuary in a US embassy; a foreign diplomat barred from travel because he is actually a high-ranking intelligence officer recruiting American nuclear scientists; US diplomats caught outside the US Embassy in Tehran when it was seized by extremists, but hidden safely for months by diplomats of other countries.
Exchanges and agreements between responsible journalists and senior diplomats go on each day with clear understanding about what can, or should, be published.

The consequences:

Many of the cables revealed by WikiLeaks are of little consequence. In many respects the dispatches to Washington of US diplomats abroad echo the work of foreign correspondents. They report on formal discussions with foreign leaders, then attempt interpretations of what the motives and intentions of foreign governments may really be.
The peccadillos and peculiarities of a foreign head of state may be useful to chronicle.

One cable referred to Russia’s prime minister, Vladimir Putin, and its president, Dmitry Medvedev, as Batman and Robin. Mr. Putin was not amused. But Russia is hardly likely to sever diplomatic relations. Another embassy cable lauded French President Nicolas Sarkozy as a sturdy friend of America, but also called him “mercurial.” Half a dozen French columnists might have written the same thing.
As one of Secretary of State Hillary Rodham Clinton’s foreign counterparts told her: “You should see what we say about you.”
Disclosure of US moves to remove a Pakistani stockpile of highly enriched uranium is much more significant. Working to keep such material from hostile hands may have been immensely important. Revealing it may jeopardize that effort.

Similarly, reports that Arab leaders privately urged the United States to take out Iran’s nuclear weapons capacity can hardly have resonated well in their capitals. During my stint in government I sat through many meetings in foreign capitals with heads of state who blasted rivals and other governments but who in public proclaimed lasting friendship with the same characters and entities.
Trusted diplomatic correspondents know how to garner information and inject their dispatches with depth and detail without embarrassing sources that must be protected.
WikiLeaks’s indiscriminate dumping of tens of thousands of purloined classified documents into the public domain for friend and foe to read is neither responsible journalism nor does it strike a blow for transparency. It is the work of a politically motivated activist intent on doing America harm.


John Hughes, a former editor of the Monitor, writes a biweekly column.