My MRI precertification sailed swiftly through my insurance company’s gatekeepers. The surgeon at the Wound Healing Center who debrided the festering puncture wound in my foot ordered the MRI because he was concerned about the possibility of bone infection. This is a serious concern for anyone, but a doubly serious one for diabetics like me.

I scoured the imaging order and everything I’ve learned from coding experts over year suggested that the paperwork was in good order, which was confirmed by the speedy precertification. The ducks lined up neatly and I’m off to the MRI center at Paoli Hospital this afternoon.

While working through the details of this little healthcare and imaging episode, I thought about my case in the bigger picture of the current healthcare reform and imaging utilization debates. From what I’ve learned from about 20 years in medical reporting, my brain tells me that my MRI order clearly falls in the realm of appropriate imaging. The prompt MRI precertification approval confirms that.

Then another thought crept into my head. What if the MRI hadn’t been ordered or authorized?

If the surgeon hadn’t ordered it, I would have presumed he didn’t think it necessary but I would have raised the question. If the insurer had denied the doctor’s request, I’d have badgered the heck out of someone. (I certainly trust doctors more than insurance companies.)  Yet, like many Americans, concerns about overutilization, appropriateness, and cost tend to disappear when the utilization and cost are in my personal best interest. That’s certainly one big driver of healthcare costs in this country … and something for me to ponder in the tube this afternoon.

This article was just plain interesting. No, the images weren’t displayed wrong on the PACS—apparently about 1 in 10,000 people’s internal organs are in the wrong place, as described in this article on situs invertus posted MedPage Today.

If you read the letter James Thrall, MD, sent the White House and the five Senate and House committees involved with healthcare reform, you’ll see something everyone in radiology can get behind. Malpractice tort reform needs to be part of healthcare reform (or follow shortly thereafter if politics dictate).

Incredibly, the White House says it “hasn’t heard from physicians” on the issue. Change that.

A new review questions using MRI for planning breast cancer surgery, suggesting that it influences many more women to undergo mastectomy without any improvement in outcomes or the need for follow-up surgery.

“Routine use of preoperative MRI in women with established, early stage breast cancer should be discouraged until (and if) high levels of evidence demonstrate that preoperative MRI either improves surgical care, reduces the number of required surgeries, or (more importantly) that it reduces at least local recurrence, if not distant metastases and death due to breast cancer,” the authors wrote.

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Speaking to an audience at AHRA’s annual meeting Wednesday, consultant Bob Maier provided a clear warning for hospital radiology departments: You are going to lose a significant part of your business if you don’t find a more cost effective way to provide imaging services.

Maier, CEO of Regents Health Resources, spoke about succeeding in medical imaging in the coming decade. Part of his presentation included data from a radiology benefits management (RBM) firm detailing 20 MRI providers in both the hospital and outpatient imaging center environment. The facilities’ charges for an MRI exam ranged between $332 and $1,399 (some were global fees some were hospital technical components). The average cost was $660. All 20 of the facilities had quality ratings of at least 94 out of 100. The highest and lowest priced provider had identical quality scores of 97, negating any meaningful quality argument. Given roughly equivalent quality measures, it only makes sense that the RBM will steer patients to lower cost facilities. Read the rest of this entry »

Eduard Michel, MD, PhD, is chief medical officer and co-founder of telerad provider Virtual Radiologic Corporation (VRC). Besides providing quality interpretation, VRC’s success depends on radiologist efficiency. The company has developed its own systems and procedures for improving workflow efficiency. Michel discussed eight pitfalls to workflow efficiency in a digital radiology environment Tuesday at the AHRA annual meeting. Smaller groups and facilities might not have the resources and expertise at their immediate disposal to implement all of Michel’s suggestions, but his pitfalls list still represents eight areas to investigate for organizations seeking to improve their workflow. Here’s Michel’s list of pitfalls to reading efficiency: Read the rest of this entry »