Imaging After the Recession

Elyas Bakhtiari, for HealthLeaders Magazine , February 4, 2010
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But hospitals are going to be forced to keep up with capital purchases and develop more aggressive budgets for 2010, says Allen. "As the economy rebounds and the value of [hospitals'] investments goes back up and things seem to be more stabilized, that might offer some benefits that might make 2010 better than 2009 and 2011 better than 2010."

However, normalizing after a recession in some ways presents as many challenges as adjusting going into one. Hospitals and physicians have to know the right time to ramp up investments and think strategically about new purchases.

Hospital imaging departments face constant pressure to stay ahead of the technology curve, and before the recession, that pushed many departments to overspend on a piece of equipment just to stay ahead of—or keep up with—a competitor.

Economic circumstances, however, forced leaders to approach imaging investments the way they should have all along—by thinking strategically and focusing on the technologies that are best for the patient and align with the organization's high-priority service lines. Although budgets are bound to loosen up, it wouldn't hurt hospitals to retain the fiscal lessons learned during the downturn.

Uncertainty about the effects of healthcare reform also has some physicians and hospitals hesitant about developing long-term plans. Aside from potential reimbursement cuts, the process itself has been fairly disruptive. "People who invest lots of money don't like uncertainty," says Allen.

Success Key No. 4: Get specialists to the table
As the imaging market changes and shifts, one recent constant has been the challenge of turf wars. Specialists—not just radiologists, but vascular surgeons, neurologists, and other physicians—increasingly overlap in the types of diagnostic and interventional procedures they can perform. And where there's overlap, there's potential revenue loss, which can lead to some fairly intense battle.

The turf tug-of-war works in both directions. Interventional radiologists have run up against both vascular surgeons and cardiologists when it comes to performing angioplasty or peripheral angioplasty, and the development of computed tomography angiography allowed radiologists to start performing cardiac imaging without the involvement of a cardiologist. But surgeons and specialists have also chipped away at radiologists' bread and butter, by installing imaging equipment in their own offices.

Methodist Hospital ran into some roadblocks when cardiologists managing the hospital's heart center wanted to hire their own radiologists not just for interventional procedures, but also to read MRIs. Although the radiology department was amenable to the cardiovascular center reading heart-related scans, when they wanted to use their own physicians for all MRI readings, tensions started to build.

Instead of forcing a solution, hospital administration convinced the various physicians to meet face-to-face over several months to work out a fix. The heart center had its own CT and MRI scanners, and agreed to partner with the radiology department and put three or four radiologists in the center to collaborate on reads, says Rose. The revenue will be shared between the two.

Patient experience was one of the reasons for the compromise. The physicians didn't want to put patients through two exams and double the billing paperwork because of a turf dispute. But the breakthrough happened in large part by simply getting physicians to the table, says Rose.

"People have to come to the table and work it out and say, 'We can work it out. Let's grow the pie bigger,'" says Rose.

Elyas Bakhtiari is senior editor for physicians and service lines for HealthLeaders Media. He may be contacted at

Going Mobile

Imaging may become much more mobile as smartphones and other handheld devices begin offering software that displays high-resolution scans.

At last fall's meeting of the Radiological Society of North America, for instance, Asim F. Choudhri, MD, a physician in the division of neuroradiology at Johns Hopkins University in Baltimore presented results from a study that found radiologists were able to correctly diagnose appendicitis using an iPhone 3G equipped with OsiriX Mobile medical image viewing software.

Fifteen of the 25 patients were correctly identified as having acute appendicitis on 74 of 75 (99%) interpretations, with one false negative. There were no false positive readings.

"The iPhone interpretations of the CT scans were as accurate as the interpretations viewed on dedicated picture-archiving and communication system workstations," Choudhri was quoted as saying in an RSNA release.

At only $20, the application is cheaper than most imaging software. However, physicians and hospitals will likely be reluctant to use mobile software until they feel confident that it is comparable to traditional alternatives when it comes to security and quality.

But there may be another application for the program: Patients with smartphones can also download the software, potentially allowing them to carry around a library of their personal medical images. Then the next time the patient is about to receive a duplicate scan because of poor information exchange between a hospital and a physician, he or she can pull out a phone and provide a recent imaging history.

Elyas Bakhtiari

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