Health Imaging & IT - January 2008 - (Page 24)

In Review RSNA 2007 IN-Depth @ RSNA360.HealthImaging.com Ü Practice extenders Paul Ellenbogen MD, chair of the American College of Radiology (ACR) Commission on Human Resources said he foresees the radiologist assistant (RA) and radiology practitioner assistant (RPA) converging into one position—the RA. “We do not anticipate RAs to be a replacement for individual diagnostic practitioners, but merely an extender,” he said. John Patti, MD, observed: “There is a need to meet the demand and workload driving us in one direction but fear is driving us in the other—fear that they will replace us.” Ellenbogen said that the Inter-societal Commission on the RA has been formed to address issues related to the practice of radiologist extenders and to create a definition of their scope of practice. Ü P4P When it comes to the 2007 Physicians Quality Reporting Initiative (PQRI) and pay for performance (P4P), “radiologists must play,” said Paul Larson, MD. “We need more data for radiology,” he said. “Why not get paid for collecting it?” Mark Bernardy, MD, said consumers will shop around for their medical care, forcing not just physicians, but radiologists, to offer more value and quality than before. Susan Nedza, MD, of the Special Program Office of Value-Based Purchasing at the Centers for Medicare and Medicaid Services (CMS), said it needs input from radiologists to create effective measure sets, which will only be as good as the feedback CMS receives. Partners Healthcare in Boston opted to move to a P4P model, said Thomas Lee, CEO. Physicians who achieve targets are rewarded with a greater net increase, while those who do not will receive their guaranteed increase, but will see a lower net. The current reimbursement system doesn’t reward quality or punish poor performance, said Bruce Reiner, MD, of the VA Maryland Health Care System. He recommended the standardization and integration of reference databases, tracking quality assurance (QA) performance from the patients’ point of view, tying malpractice rates to individual QA rates, and tying reimbursement to the practice of evidence-based medicine. Ü Reimbursement “If you’re not at the table, then you’re on the menu,” warned Chris Ullrich, MD, chair of the ACR managed care committee and managed care network during a course on reimbursement issues. Richard Duszak, MD, chair of the ACR committee on coding and nomenclature, said that radiologists can facilitate the payment process by encouraging radiology certification among coders. The budget-neutral adjustment in the current CMS environment reduces the physician work component of Medicare payments, and radiology remains in the cross hairs for future cuts, said Bibb Allen, MD, vice chair of the ACR Commission on Economics. Ü Lung cancer screening Caroline Chiles, MD, from Wake Forest University Baptist Medical Center in Winston-Salem, N.C., acknowledged that lung cancer screening is not always effective because “screening tends to detect slowly growing cancer rather than rapidly growing cancers.” Chiles highlighted two on-going randomized controlled clinical trials that she thinks will eventually shed light on how helpful imaging is in the detection of lung cancer. The U.S.-based National Lung Screening Trial (NLST) and the Belgium-based NELSON Trial are long-term trials on lung cancer screening in high-risk subjects. David Yankelevitz, MD, from New York-Presbyterian Medical Center and Weill Cornell Medical College in New York City, spoke about the need to standardize the terminology of the clinical trial. Both Chiles and Yankelevitz reminded the audience that no radiological method or trial is currently considered the gold-standard in lung cancer detection. Ü Cardiac imaging: CT and MR Ricardo Cury, MD, from Massachusetts General Hospital in Boston, heralded the benefits of CT for cardiac imaging, while J. Paul Finn, MD, from the University of California at Los Angeles, supported the use of MR for cardiac imaging. Cury believes that CT can be used for comprehensive cardiac acquisition, including the coronary arteries, left ventricular function, coronary valves, and for perfusion and viability. Finn said that cardiac MR is a “very versatile and flexible modality to approach cardiac imaging.” He stressed the clear advantage of cardiac MR is the evaluation of viability and myocardial perfusion. Ü Gadolinium and NSF Radiologists need to be aware that mounting evidence suggests the use gadolinium-based contrast agents may lead to nephrogenic systemic fibrosis (NSF) in patients with chronic kidney disease. “We have been relatively confident all along that increasing the administered dose of a gadolinium-based MR contrast agent (GBMCA) for patients with severe or end-stage chronic kidney disease increases the likelihood of a patient developing NSF,” said Emanuel Kanal, MD, from the University of Pittsburgh Medical Center. “New data from several more recent articles in the peer-reviewed literature now strongly suggest that cumulative doses of administered GBMCA [over an as yet undefined time period, possibly even a lifetime] seems to play a role in determining not only the likelihood of developing NSF, but also the severity of the clinical case of NSF that will be developed/experienced,” he said. 24 Health Imaging & IT | January 2008 HealthImaging.com http://RSNA360.HealthImaging.com http://HealthImaging.com

Table of Contents Feed for the Digital Edition of Health Imaging & IT - January 2008

Health Imaging & IT Table of Contents On the Web The Enterprise: Is More Better? News Update A Look Inside Next-Generation Multidetector CT Convention Spotlight: RSNA in Review RIS/PACS in the Imaging Center Sweden: A Study in Mammography Excellence The Votes are in: Yea for Speech in U.S. Capital & Beyond Subspecialty Reading Services: Quality Reads, Peace of Mind, 24/7 Enterprise Lung CAD Eases Workflow Advertisers Index Company Index Coming Soon Stat Sheet

Health Imaging & IT - January 2008

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