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2007: The year of the Deficit Reduction Act

Radiology Administrator's Compliance and Reimbursement Insider, January 1, 2008

Administrators reflect on the year that was and look ahead to 2008

The year 2007 for radiologists and imaging specialists will perhaps be remembered as the year the Deficit Reduction Act went into effect. Signed into law in February 2006 and beginning January 1, 2007, President Bush’s Act cut $2.8 million from Medicare reimbursement previously designated for imaging over five years. The American College of Radiology (ACR) estimated the cuts will actually amount to $6 billion during those five years.

So how did radiology and imaging departments cope? Theresa Wade, MPHA, ACMPE, administrator at the Elizabeth Wende Breast Clinic in Rochester, NY, and David A. Dowe, MD, medical director of the Coronary CTA program at Atlantic Medical Imaging in Galloway, NJ, reflect on 2007 and look ahead to 2008:

Staff needs to be kept happy

RACRI: What was your best achievement in 2007?

Wade: Working toward being totally digital, which will mean we can start to eliminate some of the paper processes we now have in place. We also tied employee increases this year directly to their evaluations, which was received fairly well by the staff.

RACRI: What was one thing you wish you could do over and why?

Wade: I need to trust my staff more and let them problem solve without my interference. Empowerment makes for a happier employee and also a more valuable employee.

RACRI: What are your goals for 2008?

Wade: To be 100% digital and to continue to work on a totally electronic emergency medical record [system], which will continue to define our work flow. We also need to figure out a good merit system that rewards and motivates employees instead of the bonus system we have had in place for the past few years. I also would like to review the insurance contracts to make sure we are receiving enough for what we do and terminate any contracts that are below our profit margin.

Cost cutting in light of DRA

RACRI: What was your best achievement in 2007?

Dowe: Restructuring our corporate debt and cost cutting in response to the Deficit Reduction Act [DRA] Part I. [DRA-2 is buried inside the SCHIP or CHAMP bills that Bush has been vetoing this year. Nobody is sure what it will look like in the end.] By doing this, we were able to preserve benefits for all of our employees and physicians at pre-DRA levels.

RACRI: What was one thing you wish you could do over and why?

Dowe: I wish I could do cost cutting and restructuring of debt in years prior to the DRA. What I have learned is that in good times and in bad, you should run your business as lean as possible. We, like many businesses in times of plenty, forget to look at every dollar and just march from day to day without thinking about it.

RACRI: What are your goals for 2008?

Dowe: To continue to respond to the challenging reimbursement environment in which we live. My other goal is to continue to fight for across-the-board national reimbursement for coronary CTA and cardiac CT. There is no doubt that coronary CTA will replace stress tests as the initial exam a patient receives if [his or her] physician is considering coronary artery disease. Coronary CTA already has replaced many elective diagnostic coronary catheterizations. This trend will continue and is unstoppable.

Insider sources

Theresa Wade, MPHA, ACMPE, administrator at the Elizabeth Wende Breast Clinic, 170 Sawgrass Drive, Rochester, NY 14620, 585/758-7002; www.ewbc.com, tess@ewbc.com.

David A. Dowe, MD, medical director of the Coronary CTA program at -Atlantic Medical Imaging, 44 East Jimmie Leeds Road, Galloway, NJ 08205, 609/677-XRAY (9729); ddowe60@hotmail.com, www.atlanticmedicalimaging.com.

Tips for a smooth renovation in your radiology department

If there were ever a change to a radiology department, Angela Krause, CRT, has seen it.

Krause, now the diagnostic operations manager for the Radiological Associates of Sacramento and the Roseville (CA) Imaging Center, oversaw in November the installation of a third MRI scanner. The facility removed radiology and Fluoro equipment. The center demolished the old Fluoro room and an open shell space to create the space for MRI 3.

Last year, Krause’s team replaced two radiology rooms with two digital radiology units at Roseville Imaging. She now manages multiple outpatient centers and was part of another project in 2006 at Folsom (CA) Imaging.

“We expanded its center to another building next door and built the suite from the ground up, as well as made some modifications to the existing center,” Krause said. These included changes to the reading room/tech areas, and the addition of a subwait room for patients on deck.

Below is a Q&A RACRI conducted with Krause about how radiology departments can handle renovations.

RACRI: How did your radiology department cope with the renovation?

Krause: Renovation is always a challenge. We try to keep staff [members] informed about what will be happening so they’re aware and on board with the changes. We ask for their input in the planning process, so they’re usually excited about the completed project. We ask for their patience during the process as well. We post flyers for patients to let them know we’re under construction to improve our center. We ask our staff to be extra nice and apologize to the patients for our current mess. We put candy in a hard hat to hand out as a token of apology for the disruption, wait times, and inconvenience, etc. We provide treats for staff [members] to keep them going as well.

RACRI: What would you do differently?

Krause: We learn something every time we undergo a renovation project. We try to not repeat previous mistakes, but no matter how much you plan and coordinate, there are always issues that come up that no one thought of. The hard part is not knowing what you don’t know. We’ve learned to have weekly meetings with all involved parties to make sure everyone is on the same page.

RACRI: What was the worst part?

Krause: The environment is the most challenging part. We try to work with our contractors to do the heavy work after hours.

However, our business is open seven days a week, all day, and frequently into the evenings. Despite efforts to minimize it, we always have to deal with equipment noise, dust in the air, odors, tracked-in dirt, etc.

RACRI: What kind of tips do you have for folks undergoing the same process?

Krause: It’s important for the operations team [members] to work closely with the contractor. They must understand the scope of the project and have clear timelines to know when certain parts of the project will begin and end. They must also be prepared for those timelines to shift—usually backwards.

They must have a plan for operating the department during the construction and be prepared to implement contingencies or changes to the plan based on unknown factors. They must know who the key workers are with mobile phone numbers in case they need to contact them day or night. They must be prepared to apologize often and to ebb and flow as challenges arise.

RACRI: What are the benefits of the renovation in your department?

Krause: We have a better department in the end. It’s painful to get there, but anything worthwhile usually is.

Insider source

Angela Krause, CRT, diagnostic operations manager, Radiological Associates of Sacramento, Roseville Imaging Center, 1640 East Roseville Parkway, Suite 100, Roseville, CA 95661, 916/746-2108 direct line, 916/784-2277 Roseville Imaging, 916/932-1103 direct fax, 916/508-4897 mobile phone; krausea@radiological.com.

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