After completing his radiology residency and neuroradiology fellowship at Emory University, Ivan DeQuesada, MD, left Atlanta in 2016 and headed southwest to join one of the nation’s largest private radiology practices, Radiology Associates of North Texas, in Fort Worth, Texas. It was not a choice he made lightly.
By Arl Van Moore Jr, MD, FACR
I’m sometimes asked by academic radiologists, residents, and even private practice colleagues why I believe that a vibrant specialty needs a healthy, independent private practice model. I’ve had quite a while to think about this in various leadership roles, so in the interest of brevity, I’ll focus on three of the reasons that have the greatest implications for personal fulfillment.
The hotly anticipated white paper from the ACR Corporatization Task Force (CTF), recently published online by Journal of the American College of Radiology, reports on the current status of corporatization in radiology and its potential to impact patients, radiology, and radiologists.
In an all-too-familiar scenario, the patient entered the ED with pain and urinary problems, the emergency physician ordered a CT, and the radiologist issued a report identifying kidney stones, and, incidentally, a rounded area of high density in the bladder that warranted follow-up.
A recent communication issued by CMS in July provided some all-important billing guidance for radiology practices and others that intend to use the Appropriate Use Criteria (AUC) program test year for exactly that—to test the mechanics of implementing AUC in 2020, before penalties begin in 2021.
While most would agree that radiology practices are undergoing consolidation, many questions remain regarding its extent and its effects, resulting in hype, hyperbole, and not a small amount of uneasiness throughout the specialty. In an attempt to bring some order to the subject, Randal Roat, FRBMA, Strategic Radiology COO, reviewed the landscape, tallied up the available numbers, and attempted to assess whether consolidation had delivered on its objectives in “Radiology and Independence in a Consolidating World,” a talk presented at the RBMA Paradigm meeting on April 15 in Colorado Springs.
Radiology practices across the country can no longer bet that CMS will delay the mandate to consult appropriate use criteria (AUC) scheduled to commence in 2020—but that did not stop the American Medical Association (AMA) from passing a resolution at its annual meeting in Chicago requesting yet another delay in implementation. According to Strategic Radiology chair and CEO Arl Van Moore Jr, MD, FACR, the resolution is likely a shout into the wind, as turning back the clock yet again would require new legislation to reconcile the differences in PAMA (enacted 2014) and MACRA (enacted 2015). Dr Moore is chair of the ACR delegation to the AMA.
North Carolina’s oldest radiology practice dates back to the First World War and in one respect, says Mecklenburg Radiology Associates (MRA) president James C. Johnson, MD, the practice remains single-minded in a business strategy that has served it well. “From its early beginnings, the practice has employed an approach of being aligned with our health system partners,” Johnson says. “We think it is important to be as engaged as possible with our health system partners.”
If you heard corks popping, that was the Strategic Radiology (SR) revenue cycle and data analytics team cheering completion of Phase 2 of the reconfigured revenue cycle database. The team celebrated the transition from charge data to transactional data with a webinar to show members around the enhanced reporting capabilities of SR’s new RadIQ™ business intelligence (BI) tools.
The latest segment in the Radiology Leadership Institute (RLI) podcast series will be a treat for Strategic Radiology members as the interview subject is our CEO and Chair, Arl Van Moore Jr, MD, FACR. In this episode—the eighth in a compelling series of interviews with prominent leaders in radiology by RLI board member Geoffrey Rubin, MD, FACR—Moore shares a bit about his early years, leadership path, current tenure with SR, and passion for independent radiology. Below are highlights of the 1.5-hour interview.
Few practices these days can claim a pedigree that reaches back to the Great Generation, but Strategic Radiology’s newest practice, 44-member Asheville Radiology Associates, is one of them. Located in North Carolina’s western Blue Ridge Mountains in Asheville, county seat of Buncombe County, the practice was founded by three radiologists in 1944.
Taking the podium mid-stream during a series of talks on AI at the annual meeting of the California Radiological Society in February, Greg Mogel, MD, was mock-apologetic about interjecting a dose of cold reality into radiology’s topic du jour. Yet the timeliness of his talk on implementing order-entry radiology clinical decision support could not have been better. With CDS on the docket for a test year in 2020, the day of reckoning is near, barring any further delays. Furthermore—as you will read—he sees a very real and pressing role for AI in future iterations of CDS.
Ever wonder how many radiology practices there are, what their size is, and how much consolidation has occurred in recent years? All of those questions are addressed in a fruitful effort by Rosenkrantz et al published online in the Journal of the American College of Radiology.
TMIST—the first randomized controlled trial (RCT) to identify patients for whom breast tomosynthesis bests digital mammography (DM) in reducing the development of advanced breast cancer—is now underway and accruing patients.
In a historic first for the coalition, Strategic Radiology was awarded a $282,000 grant from the Coverys Community Healthcare Foundation (CCHF) to research methods to ensure that patients are aware of incidental findings identified in imaging exams acquired in the ED, a setting fraught with communication challenges.
As president of a 55-radiologist practice that covers 24 hospitals and operates two busy outpatient imaging centers, W. Kent Hansen, MD, has a full plate that just got fuller—he answered the call affirmatively to serve as newly elected member-at-large on Strategic Radiology’s Executive Committee (EC).
Radiology Associates of Appleton, a 24-physician practice based in Appleton, Wis., joined the Strategic Radiology coalition of independent practices in November 2018, bringing with it the strong commitment to excellence and service to communities in Wisconsin’s Fox River Valley since 1968.
Shortly before its 2018 annual meeting, the Radiological Society of North America (RSNA) announced that Sina Tavakoli, MD, had been awarded the inaugural Strategic Radiology-RSNA Research Seed Grant. Dr. Tavakoli will use the $40,000 grant to investigate the role of quantitative 18F-fluoroglutamine PET in non-invasive metabolic imaging of macrophages in atherosclerosis. His attempt to characterize the immunometabolic features of atherosclerotic lesions could eventually lead to the more accurate identification of vulnerable plaques.
Strategic Radiology practices performed well in the first year of the CMS Quality Payment Program—100% of the SR practices that submitted data (representing 19 TINS) received a positive update, and 95% achieved the exceptional bonus. That compares well with the broader universe of participating practices, of which 93% achieved positive updates, 71% achieved the exceptional bonus, 2% achieved a neutral adjustment, and 5% received a negative update.
Andrea G. Rockall, MRCP, FRCR, had never heard of machine learning when she arrived at Imperial College of London in 2012. A working radiologist and researcher with interests in genitourinary cancer, image-based trials, and functional imaging and response assessment, she was asked to develop several machine learning trials.
Naugatuck Valley Radiological Associates (NVRA), one of Strategic Radiology’s newest affiliate practices, has excelled at meeting the needs of the Waterbury, CT, community for 30 years. It has forged a tight relationship with St. Mary’s Hospital, founded in 1909 by the Sisters of Chamber and now a Level II trauma center. NVRA operates four outpatient imaging centers in the community—including two joint ventures with the hospital.
A commanding presence in radiology for many years, Arl Van Moore Jr, MD, FACR, FSIR, Strategic Radiology (SR) CEO, reached into his former Navy life—training and serving as an officer in the nuclear submarine service—to share leadership lessons from the military during SR’s Executive Education event in Fort Worth in September.
Kurt Schoppe, MD, talks about reimbursement the way others dissect a novel or an episode of a favorite TV show: players, motives, plot points, unintended consequences. The ACR advisor to AMA’s RVU Update Committee (RUC) held attendees rapt at Strategic Radiology’s Executive Education event in Fort Worth in September as he delivered the first of three short talks that linked payment policy with relationship building and strategies to deal with the reimbursement uncertainty ahead.
As the hype behind artificial intelligence (AI) is replaced with a recognition of the barriers to adoption, radiologists increasingly are intrigued with AI’s potential to expedite, augment, and generally improve their ability to interpret medical images. To that end—and presumably to pre-empt a Wild West scenario—the ACR has created an AI framework for developers that would ensure that the tools created are reliable, useful, diverse, and pose no threat to patients.
United Imaging Consultants (UIC), based in the Kansas City suburb of Mission, Kan., grew out of a four-way merger in 2000 and the recognition that busier nights and the rise of subspecialization in radiology required scaling up in size. The practice has followed a steady path to delivering greater value to its hospital partners ever since.
Sharon Fremer, Strategic Radiology’s new vice president, revenue cycle optimization, is on a heat-seeking mission for results. Fresh from her first session with business analytics director Dave Polmanteer, she is preparing to bring 30 years of experience in revenue cycle to bear on improving member practice finances.
By Wayne K. Baldwin
In a prior life, I was General Counsel and Chief Development Officer for Comprehensive Medical Imaging, a consolidator of outpatient imaging centers across the country. It is interesting to me that consolidation has again become in vogue.
Ever wonder or worry about the toll reading room interruptions could have on the accuracy and/or efficiency of your personal practice? A group of researchers that included Booth Aldred, MD, from SR member practice Austin Radiological Association, looked into those question and published their results in a recent issue of the Journal of Medical Imaging. Their research could improve reading room protocols in the future.
With the annual fall back-to-school ritual just a month away, September brings multiple, rich leadership education opportunities in radiology—the Radiology Leadership Institute (RLI) Leadership Summit in Wellesley, Mass, Strategic Radiology’s (SR) Executive Education Program, and SR’s bi-annual SR Quality Forum in Dallas-Fort Worth. “Radiology is facing many challenges right now,” said Arl Van Moore Jr, MD, FACR, chair and CEO, Strategic Radiology. “How do we preserve what we prize most about our profession—the ability to innovate, the willingness to seek better tools and techniques to improve the care for our patients and keep them first—yet improve the value our nation gets from our sector? New approaches will be necessary, and we need to initiate leadership education for the next generation of leaders earlier in their training.”
In July, the National Institutes of Health (NIH) Clinical Center released DeepLesion to the scientific community, a massive dataset that contains 32,735 lesions in 32,120 CT slices from 10,594 studies of 4,427 unique patients. Its stated purpose was to help the scientific community improve detection accuracy of lesions.
By John Outlaw, CHC, CHBME
When I started my career in health care compliance nearly 15 years ago, compliance programs were just beginning to take hold outside of hospital systems and were a largely foreign concept for physician practices. Back then, they were strictly voluntary, but today compliance programs are a mandatory condition of participation in Medicare as part of the Patient Protection and Affordable Care Act of 2010 (ACA). At the same time, we have experienced tremendous expansion of government oversight of the health care industry that has dramatically increased risk for physician practices.
Providers that have stood on the clinical decision support (CDS) sidelines as the implementation deadline approaches received a strong signal that CMS intends to stand firm on the requirement to implement appropriate use criteria (AUC) and CDS with the July 12 publication of the proposed 2019 Medicare Physician Fee Schedule (MPFS).
Strategic Radiology’s CIO Jim Whitfill, MD, was recently installed as chair of the board of directors for the Society for Imaging Informatics in Medicine (SIIM). Whitfill, a clinically trained internal medicine physician, entered radiology by way of an informatics fellowship undertaken in the late 1990s, after which he took a position as CIO with a large radiology practice in the Southwest.
The 19 physicians of X-Ray Consultants (XRC)—Strategic Radiology’s newest affiliate practice based in South Bend, Indiana—have had a ringside seat on the consolidation that is reshaping the hospital landscape. The group goes back to the 1940s, when one of its founders Wallace Buchanan, MD, served as president of the American College of Radiology. In the early ’60s the practice became known as Lockhart & Beach until its incorporation as X-Ray Consultants in 1979.
The Strategic Radiology (SR) June Meeting returned to the idyllic mountain setting of Park City, Utah, last month to take care of coalition business and update member practices and the board of managers on progress toward the strategic plan and objectives of the coalition. Long days in meeting rooms ended in networking opportunities over the dinner table—establishing the trust and collegiality necessary to build a functional team requires interpersonal interaction and face time with all team members.
A dozen marketing directors responsible for marketing individual Strategic Radiology practices gathered in Nashville in June for their annual meeting prior to the RBMA Spark marketing conference—as usual, the three hours allotted flew by too fast. It was a great start to a conference that brought a number of marketing directors to the podium to both share their knowledge and collect awards. Content takeaway? We're all a little bit millennial.
No honor is sweeter than recognition by one’s peers, and that is precisely what happened in late May when Robert Epstein, MD, FACR, and William Keyes, MD, FACR, became fellows of the American College of Radiology during the annual meeting. Fellowship is an honor received by a slim 10% of radiologists and granted based on a radiologist’s contributions to the College, organized radiology, teaching, and/or research. The list of past recipients includes many luminary names, including SR CEO and chair Arl Van Moore, MD, FACR.
When neuroradiologist Bradley J. Bohnert, MD, MBA, isn’t describing brain tumors, measuring carotid stenosis, or interpreting spinal MRI studies, he wrestles with practice staffing issues and other management functions as CEO of Radiology Ltd., a Strategic Radiology (SR) member practice in Tucson, Arizona. He also found the time to map nearly 1000 radiology CPT codes to their appropriate subspecialties as part of SR’s broader effort to aggregate and organize data for clinical benchmarking and business intelligence purposes. In its infancy, the subspecialty mapping project is the first step in an endeavor that Dr. Bohnert hopes will demonstrate the value of radiology subspecialization.
Over the years, Strategic Radiology's newest affiliate practice Tower Imaging Medical Group (TIMG) has earned a place in the firmament of Los Angeles-based radiology practices, with a complex practice genealogy that blends entrepreneurship with an academic flair. It serves two prestigious hospitals—Providence Saint John’s Health Center in Santa Monica and Henry Mayo Newhall Hospital in Valencia—and in joining the Strategic Radiology coalition, the highly subspecialized but relatively small 17-radiologist practice found a beachhead in the rapidly consolidating Los Angeles market.
Shortly after joining the Strategic Radiology coalition, the leadership of Orlando, Fla.-based Medical Center Radiology Group attended the coalition’s twice-yearly Quality Forum and made a note: Designate a patient safety lead for the practice and initiate a formal quality program. Back in Florida, MCRG leadership reached out to Diana Stillwell, a nuclear medicine technologist who had just completed her MHA after going back to school and was working for one of their hospitals at the time. When they asked her to lead the program, she hesitated: “I didn’t feel that I had the knowledge that I needed,” recalls Stillwell, director of quality improvement and risk management, MCRG. “But I knew that I was a resourceful person and thought it was a great opportunity, so I dove right in. I have been in the role for about two and a half years now.”
A self-described militant pragmatist, radiologist Kurt Schoppe, MD, the ACR’s RUC advisor, is not one to shy away from unpleasant economic truths about medicine. Schoppe, a body radiologist with Strategic Radiology member practice Radiology Associates of North Texas in Dallas/Fort Worth, shared some plain-speak on medical economics in a recent column called “Unpopular Opinions” in the Journal of the American College of Radiology.
Strategic Radiology’s newest affiliate member practice was founded in 1970 to serve the needs of North Memorial Medical Center in Robbinsdale, Minn. “Like most groups, it began with a couple of radiologists sitting in a dark room at a growing hospital,” shares Troy Roovers, the CEO of the 26-physician Minneapolis Radiology Associates (MRA).
Linda Wilgus, MBA, CPA, has spent more hours than she can count over the past 20 years reading physician fee schedules, state and federal laws, and other legal and regulatory documents impacting the business of radiology. On April 5 in San Diego, Wilgus was recognized for her work as a member and chair of the RBMA Federal Affairs Committee by its president Thomas Dickerson, EdD, when he awarded her with the association’s Global Achievement Award.
Since 1930, Inland Imaging, Spokane, Wash., has provided radiology services for Providence Sacred Heart Medical Center & Children’s Hospital, a 719-bed quaternary care hospital, and Providence Holy Family Hospital, a 197-bed community hospital, owned by Providence Health & Services. The radiologists and hospitals deepened their relationship in 1998, when they entered into an exclusive outpatient imaging center joint venture (JV) contract that committed them to a 50-50 ownership of all of their outpatient imaging services in a prescribed geography.
In a unanimous vote, the Strategic Radiology (SR) Board of Managers approved a business plan to implement three sweeping national initiatives that will greatly enhance collaborative activity and services for members, 22 privately owned and independent radiology practices. “We have a clear direction, we know where our compass is pointing, and we know what to do,” said Arl Van Moore, MD, FACR, CEO and chair of SR.
Quality operatives from Strategic Radiology member practices gathered at the March Quality Forum recently, held in Phoenix at the Wild Horse Pass Resort, to share best practices and provide input on future quality initiatives. Lisa Mead, Strategic Radiology PSO and Quality Director, kicked things off with a review of the regulations governing Patient Safety Organizations (PSOs) listed by the Agency for Healthcare Research and Quality for the new participants in the room.
When a leading patient satisfaction survey provider announced changes to its survey tool that reduced its value to radiology practices—particularly those that operated outpatient imaging centers—one member wondered if Strategic Radiology could develop a more relevant and useful tool. Working together, Lisa Mead, RN, MS, CPHQ, executive director, SR PSO Quality and Safety, initiated a Quality Workgroup to develop the questions, and Dave Polmanteer, director of analytics and business intelligence, developed a survey tool that could be customized for each practice.
By Arl Van Moore Jr, MD
Last year’s record-breaking deal-making activity among hospitals and health systems suggests that the market is entering a new era of collaboration as consolidation continues. Size and scale have always propelled merger and acquisition (M&A) activity, but the 2017 deals were different Strategy not finance drove the deal-making, according to a report from Kaufman Hall & Associates.
Nine interventional radiologists (IRs) contributed to an enlightening guide to the Twitter IR ecosystem recently published in the Journal of the American College of Radiology special issue on Social Media and Medicine. Among the authors was one of Strategic Radiology’s more active users of the platform, Diversified Radiology’s Peder Horner, MD, @IR_Doctor.
Have you ever wondered how much time the radiologists in your practice spend on nonclinical, unreimbursed activities? When you meet with clients to negotiate contracts, do you struggle to accurately quantify the hours your radiologists spend on tumor boards, hospital committees, patient safety activities, and other contributions?
By Clint McClurg
Before I began my career with Diversified Radiology in Denver, I really never gave much thought to what a radiologist was, and I certainly didn’t think it mattered. After all, if they got their doctor of medicine degrees, weren’t they the same as any other physician? My second day on the job gave me a clear indicator that I was very misinformed. In a small, dark room with a bank of large monitors, I witnessed something completely unexpected.
Twice a year, Strategic Radiology’s CEO Arl Van Moore, MD, FACR, packs a bag and travels to a destination somewhere in the United States to represent radiology in the House of Medicine—the American Medical Association’s House of Delegates (HOD). He has represented radiology as a member of the American College of Radiology’s delegation since 1996.
At the conclusion of 2017, contributions from Strategic Radiology (SR) member practices exceeded the halfway milestone toward funding their $800,000 gift to the RSNA Research and Education (R&E) Foundation. The commitment will fund annual Strategic Radiology Research Seed Grants for 20 years in support research conducted by young investigators and push the specialty into the future.
Located in the Silicon Valley, Stanford Radiology has an enviable vantage point from which to advance deep learning in radiology. Curtis Langlotz, MD, PhD, director of Stanford’s new Artificial Intelligence in Medicine & Imaging (AIMI) laboratory, was one of three academic radiologists to share their institution’s approach to AI during a standing-room-only How I Do It session at the November 2017 meeting of the Radiological Society of North America (RSNA),
During the 2017 RSNA meeting, Jennifer L. Kemp, MD, a body imager with Strategic Radiology member practice Diversified Radiology, Denver, CO, was awarded with the Minnie Award for Scientific Paper of the Year from Aunt Minnie editor-in-chief Brian Casey. Kemp received the award as lead author of a paper published in Radiology that described the findings of an RSNA survey exploring radiologists' opinions about patient-centered radiology.
In June, one of Strategic Radiology’s most visible symbols of the value of collaboration, the Patient Safety Organization (PSO), will celebrate its fifth anniversary. Since it was listed by the Secretary of the Department of Health and Human Services and the Agency for Healthcare Research & Quality (AHRQ) on June 19, 2013, SR’s PSO has stood as the first and only radiology-specific PSO in the United States.
If you hadn’t noticed, you may be surprised to see that Strategic Radiology has a brand new, mobile-responsive web site. Take a few minutes for a test drive. On the home page, you’ll see that there are four user experiences to meet the needs of our primary visitors: radiologists, hospital executives, payers and other partners, and patients. Each section is designed to provide information that helps visitors understand the value that Strategic Radiology practices contribute to health care.
On September 18, 2017, CMS made available the 2016 Annual Quality and Resource Use Reports (QRURs) to every group practice and solo practitioner in the nation. SR PSO Quality and Safety Director Lisa Mead took that one step further and provided those Strategic Radiology (SR) practices that submitted their data to SR’s Patient Safety Organization with an additional benchmarking document showing them how they compared with their SR peers.
In January 2018, physicians will receive a positive, negative, or neutral update in their Medicare reimbursement rates based on their final score based calculated from 2016 data for the Merit-based Incentive Payment System (MIPS).
Although CMS gave no indication in the proposed 2018 Medicare Physician Fee Schedule (MPFS) that cost would be included in the 2018 calculation—along with quality, improvement activities, and advancing care information categories—the 2018 MPFS Final Rule allotted 10% of the total score to where radiologists fall on the cost spectrum. What does that mean?
Interest—and concern—about artificial intelligence ran so high at the 2017 RSNA meeting that fully 20 minutes prior to the start of “Deep Learning in Radiology: How I Do It,” all seats were occupied and the room was ringed by a standing-room only crowd. Luciano M. Prevedello, MD, MPH, Curtis Langlotz, MD, PhD, and Bradley Erickson, MD, PhD, repaid their eager audience with a rare gift in these times of high AI anxiety—they demystified a powerful new tool.
In his president’s address at the annual RSNA meeting in Chicago, Richard L. Ehman, MD, posed the following rhetorical question: “Is it time to reinvent radiology?” The 103rd president of the RSNA left no doubt that he believes the time is now, and he urged, cajoled, and implored radiologists to roll up their sleeves and engage in the transformation of the specialty.
Hub is the monthly newsletter published for the membership of Strategic Radiology practices. It includes coalition and practice news as well as news and commentary of interest to radiology professionals.
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