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.

Radiologist efficiency has increased by leaps and bounds in the digital era, but reimbursement trends have kept steady the pressure to improve productivity further. A handful of emerging tools for the practice potentially could make already-productive physicians even more efficient, according to Bill Pickart, CEO of Integrated Medical Partners (IMP); Pickart says, however, that these tools will represent a cultural shift that will need to be managed skillfully for maximum effectiveness.

Influenced by emerging technology and regulatory changes, the role of the radiology-group CIO has undergone a dramatic shift in recent years: Wayne Davidson, CIO of Quantum Imaging & Therapeutic Associates, Inc (Lewisberry, Pennsylvania), a 40-radiologist practice, says, “In recent years, the focus has really become efficiency because of background factors like declining reimbursement. That drives the business to try to do more with less, and that goal is laid on the shoulders of the IT department.

Quantum Imaging & Therapeutic Associates, Inc, a 40-radiologist practice in Lewisberry, Pennsylvania, faced a problem common to radiology groups in the post-DRA era: improving efficiency without decreasing the quality of its interpretations. Elizabeth Bergey, MD, CEO of the group, says, “Radiologist efficiency and efficacy are based, somewhat, on internal factors. Everybody has his or her own personal work ethic, and in any population, there will be some variation.