Advancing the Business of Radiology
The leading professional organization for radiology business management professionals in any radiology setting.
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Welcome, Leaders!

As a practice leader, you have come to the right place for radiology business professionals who are dedicated to supporting and enhancing their vocation, investing in their career and pursuing higher goals. You have the respect of your physicians to help guide, develop and maintain a practice/department and you strive to advance the profession and improve the business of healthcare.

RBMA is the place to turn for inspiration, resources and practical tools you can’t find anywhere else.

Leaders
“The RBMA provides critical information through expertise and dedication to the field of radiology business. Being a member of RBMA as an administrator has provided me with the most up to date information and networking opportunities to assist me in performing at the highest level.”

More Resources For Practice Leaders:

Resources For Leaders

Register now for DataMAXX for reliable and immediate data to make the right operational decisions, optimize resources, continuously improve performance and develop a strategy for the future

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Welcome, Radiology Business Managers!

As a manager you have come to the right place for information and resources that will assist you in coding properly and obtaining the best possible reimbursement for your practice.

RBMA connects radiology business managers with resources and practical tools to help you succeed.

Manager
“I have been in the radiology business for 34 years and have seen many changes. One of the best changes is how the RBMA has grown and provides us with the necessary tools that we need in order to help us continue on this rocky road.”

More Resources For Managers:

Conference Audio Recording

Articles

Resources For Managers

DataMAXX

RBMA U

Enroll in RBMA U’s Radiology Business 101 – an overview program covering the basics of radiology business as defined under the RBMA Common Body of Knowledge.

DataMAXX

DataMAXX

RBMA’s innovative new practice analytic solution that takes benchmarking to new levels through the combination of your practice’s information and state-of-the art technology and data query protocols.

 

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Welcome, Coders!

As a coder, you have come to the right place for for information and resources that will assist you in coding properly and obtaining the best possible reimbursement for your practice.

RBMA connects coders with resources and practical tools to help you succeed.

“RBMA membership offerings, either the list serve or conference attendance, has provided up to date trends in coding, payor policy and practice management issues. The topics discussed through the list serve either coding or practice management has helped my practice be proactive.”

More Resources For Practice Coders:

Resources For Coders

Ladies

Prepare for tomorrow. Order your ICD-10-CM Toolkit today.
The IDC-10-CM Toolkit designed by Coding Strategies (CSI) and Radiology Business Management Association (RBMA) gives the busy radiology administrator all of the tools needed to prepare the practice for the implementation of ICD-10.

Libman Education
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Welcome, Marketers!

As a marketer, you have come to the right place for information on the state of imaging today and how to effectively market your radiology practice by incorporating tools and strategies including social media and today’s technological innovations.

RBMA is the place to turn for inspiration, resources and practical tools you can’t find anywhere else.

“The RBMA Marketing Conference is a great way to network with colleagues from around the country to gain different ideas and perspectives without the threat of direct competition.”

More Resources For Practice Marketers:

Order your Marketing Toolkit today.

A toolkit designed specifically for radiology marketing, includes samples forms and ideas.

Click here to preview Table of Contents.

Resources For Marketers

5 Steps to Effective Social Media Measurement
If you’re going to invest time in social media, you need to measure performance, but it can be difficult to identify relevant metrics.

How to Generate Compelling Content Ideas for Your Online Customer or Member Community [Infographic]
Are you looking for content to fulfill your new content marketing strategy, but don’t know where to start? Try these 10 great content ideas – plus a bonus idea – to jump start or breathe new life into your efforts.

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Welcome, Vendors!

As a vendor offering radiology products and services you have come to the right place to find your target audience. RBMA attracts decision-makers with buying power.

RBMA members rely on vendors to keep them informed of new technologies, developments, and products for their practices.

“RBMA provides the foundation for connecting with the right people. We appreciate the opportunity to visit with our existing clients as well as meet new prospective clients.”

More Resources For Practice Vendors:

Resources For Vendors

Start planning your 2017 marketing program with RBMA today! Consider a Global Level Sponsorship. Contact daphne.gawronhski@rbma.org for details.

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GOP_Plans_for_Federal_Health_Spending_Would_Impact_RBMA_Members

(Leadership) Permanent link

The American Health Care Act (AHCA) and the president’s 2017 budget, together signal that conservatives want the Federal government to reduce its role in social welfare spending, bring down the deficit, lower taxes and take an overall smaller role in both domestic governance and international influence. Discretionary spending on arts, the sciences and the environment is also sharply cut.

It is uncertain whether the GOP will be able to muster the votes necessary to pass the AHCA as a start in the repeal and replacement of the Affordable Care Act. In addition, the president’s budget will need to be adjusted considerably in Congress if it is to have any chance of passing because its many spending cuts simply impact too many constituents. However, the overall intention to roll back spending on almost all government programs outside of defense will certainly be a prominent part of federal bills and budgets going forward.

Among the medical specialties, radiology is arguably among the most experienced in what across-the-board federal spending cuts can mean. It survived the arbitrary reimbursement cuts triggered by the Deficit Reduction Act of 2005 and sequestration. It also holds the dubious record of having endured one of the longest strings of continuous cuts (more than a dozen) in Medicare payments.

RBMA members are experienced in rolling up their sleeves and finding new practice efficiencies to help offset a significantly tighter reimbursement environment. However, now that practices already run very lean, it will certainly be a considerable challenge to try to find further savings.

The American College of Radiology, the RBMA and other organized radiology groups are watching developments closely. Experience shows that cuts tend to fall the most heavily on those who do not have a voice in Washington.

In addition to direct reimbursement cuts, some of the ways RBMA member practices could be impacted may include:

  • An increase in bad debt from caring for uninsured patients. The Congressional Budget Office estimates that under the AHCA, 24 million Americans would lose health coverage.
  • A decrease in overall patient volume, especially for preventive screenings that patients may believe are no longer covered.
  • Less funding for research grants.
  • Greater difficulty in attracting top radiologists to positions, especially as foreign medical students and researchers look for better opportunities in other countries.

RBMA members have access to the weekly RBMA Washington Insider electronic newsletter, which covers both what is happening with the AHCA and with other significant health bills and regulatory changes that can get lost among the headlines covering the bigger issues. Members also get e-Alerts when there is breaking health policy news. In addition, the ACR’s Advocacy in Action eNews is updated weekly and is available free to the public at acr.org/Advocacy/eNews.

Finally, Ted Burnes, executive director of RADPAC, the radiology political action committee, will be at the RBMA PaRADigm conference April 23 to 26 in Chicago to give an update on health policy developments. Visit rbma.org/paradigm to learn more. 


Coders Turn to Peers for Guidance in Billing Unusual Treatments and Services

(Coding) Permanent link

The world of medical research is one of innovation, imagination and infinite possibilities. The world of medical coding isn’t. Coding exists to bring structure and order to the art and science of medicine. To clearly define situations by what they are and are not so that they can be reimbursed fairly and efficiently. 

Occasionally, these two worlds collide. When an ordering physician faced with an unusual medical problem decides on an unorthodox (but research-informed) combination of tests or treatments, this can present quite a challenge for the coder. It is at times such as these that communities of coders, like the RBMA’s Coding Forum, really prove their value.

The RBMA Coding Forum has seen questions ranging across a broad gamut, including how to code and bill imaging done on conjoined twins. Recently, a member asked if it is possible to bill for a radiology department’s part in fecal transplant procedures.

Although once rare, fecal microbiota transplants (FMT), as they are officially known, are now done at hospitals across the nation. Research findings support that FMT is effective in the treatment of C. difficile infection, and it is now being studied as a possible treatment for many other conditions, including diabetes, ulcerative colitis and even autism. 

Still, the treatment is new and not officially approved by the U.S. Food and Drug Administration. The FDA allows its use under its investigational new drug guidelines and a 2013 special guidance for the treatment of C. difficile in patients who have tried the standard therapies without result.

There is also no one standard way to perform a FMT, with multiple ways of administering the fecal microbiota from the donor in use. One of those ways is through a nasogastric tube, which is how the Coding Forum member’s hospital radiology department became involved.

FMT patients would check into the Endoscopy Department and then be sent to the Radiology Department for placement of the NG tube with fluoroscopic guidance. But there is no official protocol for how to code such situations, and even the American Gastroenterological Association is at a bit of a loss. It recommends 44799, the code for unspecified procedure lower intestine, for situations where donor microbiota is administered by either oro-nasogastric tube or enema. Of course, payers sometimes will not accept unspecified codes. In addition, Medicare does not pay a separate fee for installing microbiota by NG tube, according to the American Gastroenterological Association.  

However, there is one possible solution for departments doing a large enough volume of NG tube placements for FMT that the cost of this unreimbursed care becomes a concern. In Medicare patients, gastroenterologists will sometimes require patients to sign an Advanced Beneficiary Notice form to alert them that part of their treatment will likely not be covered by Medicare and that they will need to be responsible for paying this cost. The ABN is usually sought because Medicare does not cover the costs of screening donor fecal specimens for FMT. However, it could be adjusted to also address other areas of unreimbursed care in an FMT, including the Radiology Department’s work.

Have you encountered an unusual coding situation that left you perplexed? Does your hospital department place NG tubes for FMT or perform other more unusual procedures? Your peers on the RBMA Coding Forum may be able to help. The RBMA’s forums are exclusive benefits for RBMA members. Learn more at rbma.org/RBMA_Forums/.

Prospects for Consolidation in Radiology Services

(Vendor) Permanent link

By Slava Girzhel, Managing Director, Healthcare Investment Banking group of KeyBanc Capital Markets Inc. 

Over the years, the traditional independent doctor’s office has changed dramatically. Key industry changes such as an increasingly complicated reimbursement environment focused on risk sharing and population health management, and continually increasing requirements for technology investment, have turned the business side of medicine into an administrative burden to many physician groups. That trend is driven by managed care, Medicare and a gradual shift from fee-for-service to the value-based reimbursement model.

With the average doctor spending 8.7 hours per week on administration according to a 2014 study, a younger generation of doctors has preferred to simply practice medicine and not be burdened with its business side. As a result, a growing number of privately practicing physicians have joined the ranks of hospital employees controlled by large health systems. The hospitals are able to generate as much value to a health system by contracting with the best groups without the necessary upfront or ongoing investment in the support infrastructure. Most hospital-based physician specialties such as radiology and emergency medicine fall in this category.

By partnering with a physician support or medical services organization (MSO) owned by either a private equity group or in case of some of the largest MSOs, a public company, doctors can take advantage upfront of the value of their practice. Health service organizations (HSOs) and MSOs operate through a management services agreement which authorizes the supporting organization to act as a non-clinical arm, while the physicians continue to provide all the clinical services. In other words, MSOs take the administrative capabilities and turn them into a highly valuable company – what previously represented just cost becomes an investable asset.

Typically, doctors will continue to receive the market rate for their clinical services. In addition, they may get other benefits such as profit sharing and other incentive compensation, often not available for hospital-employed physicians. Certain doctors can also participate in the equity upside with their ownership position – when the investor gets paid and receives a return on their investment, physician partners can receive incremental earnings in the form of distributions as an equity holder.

Overall, more than 50 percent of ER doctors and approximately 75 percent of hospital physicians and anesthesia doctors are still not part of the MSO model trend. While the level of consolidation is increasing each year, there are still extensive options for physicians to create or join existing physician support organizations or medical services organizations that could be owned in partnership with either private equity investors or already established public companies—thus unlocking the value of their practice while establishing an enduring enterprise.

 

This article is for general information purposes only and does not consider the specific investment objectives, financial situation, and particular needs of any individual person or entity.  KeyBanc Capital Markets is a trade name under which corporate and investment banking products and services of KeyCorp and its subsidiaries, KeyBanc Capital Markets Inc., Member NYSE/FINRA/SIPC, and KeyBank National Association are marketed.

Slava Girzhel is a Managing Director in the Healthcare Investment Banking group of KeyBanc Capital Markets Inc. Mr. Girzhel has over 15 years of investment banking experience working extensively with physician groups as well as other healthcare providers. Most recently, Mr. Girzhel advised Riverside Radiology on their partnership with Excellere Partners. Mr. Girzhel holds an MBA with distinction from the Weatherhead School of Management at Case Western Reserve University and a BS in Accounting from Case Western Reserve University. 

Lessons from a Quest Award Winner

(Marketing) Permanent link

On March 7, the Radiology Business Management Association, awarded its 12th annual Quest Marketing Awards, which honor excellence in radiology practice marketing. Part of the role of the Quest awards is to facilitate the sharing of ideas and innovative marketing concepts with fellow RBMA members. All the winners displayed at the annual Building Better Radiology Practice Marketing Programs conference, held this year in Fort Worth, Texas, and photos of their submissions are also posted on the RBMA website.

This year, the big winner was Jefferson Radiology, one of the largest radiology private practice groups in Connecticut and a past Quest Awards winner. The practice took home three of the nine awards given out this year, winning both awards for patient marketing (campaigns over $5,000 and campaign under $5,000), as well as the physician marketing award for campaigns over $5,000.

Jefferson Radiology and the team of Rod Neaveill, its senior director of Marketing and Business Development, do a great job of marrying creative and clever ideas with sound planning and careful tracking of results. Their winning entry for patient marketing campaigns over $5,000 targeted women turning 40 with a birthday card mailing that included information about Jefferson’s mammography services. The campaign led to a 7.8 percent overall increase in mammography services volume and cost less than $3,000 per month to directly target more than 600 new patients. After analysis of the campaign showed this very positive return on investment, it was expanded to include sending birthday card packets to women turning 41 and 42 as well.

Jefferson’s winning patient marketing campaign under $5,000 was also related to breast cancer screening. The event-related marketing campaign was a contest to win a pink Kate Spade tote bag at the Connecticut Women’s Expo held in September of last year at the Connecticut Convention Center in Hartford. Through the contest, Jefferson Radiology captured 1,700 new emails that it could use for email marketing after the event, and drew the attention of 28 percent of the total audience at the event.

Finally, Jefferson Radiology won in the physician marketing category with a good old-fashioned direct-outreach campaign that aimed to connect personally with more than 3,000 of the medical offices that referred to Jefferson Radiology’s 10 centers. Supported by leave-behind materials like Jefferson branded magnets, wall calendars and personalized notes, the sales team found that their efforts increased calls to the appropriate physician liaison while raising the average number of referrals from the targeted offices by 8 to 10 percent. The referring physicians were also more engaged as shown by a 35 percent increase in the number of completed physician surveys over the previous year.

Other 2017 Quest Award winners included Charlotte Radiology, Fort Jesse Imaging, Radiologic Associates of Fredericksburg, Wake Forest Baptist Health, and Advanced Radiology Consultants. To view all the winners, go to rbma.org/Quest_Awards. 

Protect Your Practice from Immigration Enforcement Penalties

(Management) Permanent link

A priority of the new administration is better enforcement of laws and regulations governing who is authorized to work in the United States. For all employers, including radiology practices, this presents a financial concern as employers are the ones who will pay penalties if they do not have adequate procedures in place to ensure new hires are either citizens or foreign nationals who are authorized to work in the United States.

In the January/February issue of the RBMA Bulletin, Carol Hamilton, practice administrator for West County Radiological Group and a member of the RBMA Board of Directors, discussed steps radiology practices should be taking now to ensure they are properly documenting that all their new hires are authorized to work in the United States.

The big mistake employers make is not taking Form I-9, one of the many government forms new hires must complete, seriously enough. Typically, Hamilton writes, the daunting two-page form with seven accompanying pages of instructions, is filled out by the employee and submitted with copies of documents. The practice then files it away never to look at it again.

What practices fail to realize is that the employer, not the employee, is responsible for making sure the form was filled out correctly and that it was submitted with originals of the required documentation. Copies are OK to keep on file, but the original documents must be checked before being returned to the employee during the hiring process.

Another common mistake is to not use software to track when documents such as temporary work permits expire. Under federal law, the practice is responsible for examining the documents and knowing when an employee is no longer qualified to work in the United States. Failing to update needed paperwork when a documented work permission expires could be costly.

The good news, Hamilton writes, is that a simple audit of the practice’s records and learning how to use E-Verify, the online government system that allows businesses to determine the eligibility of their employees to work in the United States, could save the practice thousands of dollars in fines. Taking this seriously is important because fines are assessed per employee violation. If you made the same documentation and storage mistake on every hire for several years, the practice could be paying a large penalty indeed.

To learn how to conduct a practice self audit and take other steps to bring  hiring practices into compliance with government immigration regulations, read Hamilton’s full article, “I-9 and E-Verify, and Why Your Practice is Probably Not in Compliance” in the January/February issue of the RBMA Bulletin, an exclusive benefit for RBMA members at rbma.org/RBMA_Bulletin_Preview.

Additional online resources include:

  

FDA Simplifies Training Requirements for DBT

(Vendor) Permanent link

For facilities that provide mammography, ensuring staff is trained in accordance with the requirements of the Mammography Quality Standards Act is an important concern. On Feb. 6, 2017, the U.S. Food and Drug Administration updated its information on training requirements for digital breast tomosynthesis (DBT) to no longer require that the training must come from the manufacturer of the device being used.

The FDA has approved DBT devices from four different manufacturers for sale in the United States. In order of manufacturer name, they are the Fujifilm ASPIRE Cristalle, the GE SenoClaire, the Hologic Selenia Dimensions and the Siemens Mammomat Inspiration. Each has its own approved indications for use and unique technologies. However, they are similar enough that the FDA believes it is appropriate to handle them as a single modality under the MQSA, just as it does for full-field digital mammography units.

What this means is that mammography providers no longer have to ensure that the eight hours of required training on the DBT device being used come from the manufacturer of that device. It can instead be provided by a third-party training course or by a “qualified peer” who has already met his or her training requirements.

One reason this change is important is that DBT is growing in popularity, especially in the U.S. market. According to Future Market Insights, an international research and consulting firm with headquarters in London, the DBT equipment market will expand at a compound annual growth rate (CAGR) of 13.9 percent over the next decade with the majority of that growth occurring in the United States.

Insurance coverage for DBT is also increasing. Five states are currently considering passing laws that would require insurers to cover DBT. They are Maryland, New Hampshire, New Jersey, New York and Texas.

For health care organizations providing DBT, knowing that a doctor or technologist trained on one DBT device can move to working with another brand of DBT equipment without additional training will certainly be a help. Although the FDA still encourages equipment operators to go through voluntary continuing education to learn the differences between devices from competing manufacturers, this is not a requirement.

To learn more about the updated FDA guidance on training requirements for operators of DBT equipment, see the FDA’s revised Frequently Asked Questions about DBT and MQSA Training Requirements. To connect with a DBT vendor, see the RBMA’s Call a Vendor online resource. 

Do Marketers Have a Role in Reducing Health Disparities

(Marketing) Permanent link

Differences between groups of Americans in access to quality health care and related better or worse health outcomes is an ongoing national problem. Since 2011, the Centers for Disease Control and Prevention (CDC) and its partners have been working to identify and address the factors that lead to health disparities among racial, ethnic, geographic, socioeconomic and other groups.

Poverty and lack of health care coverage are at the root of many health disparities, but culture is also a factor. And if anyone knows how to change culture and create new behaviors, it is marketers.

Health disparities in radiology are perhaps best seen in mammography. This important screening test has been closely studied and there is data going back decades on mammography utilization rates by ethnic background. CDC data show that in every year since 1987, white women 40 and older have gotten screened at the highest rate and non-white Hispanic women 40 and older have gotten screened at the lowest rate. Although this disparity in screening rates has narrowed over time, it still exists even as the gap in mammography screening rates between white and black women has largely disappeared.

Could marketers for mammography be doing more to reach out to Hispanic patients and help erase this disparity? Yes, say experts interviewed by the American Marketing Association in last year’s AMA Marketing Health Services: Spring/Summer 2016 report. Interviewees in the article “Is Marketing Perpetuating Latino Health Care Disparities?” make the following points on how health care marketers could reevaluate their campaigns and make changes to how they connect with potential new Latino patients.

  • Know your target audience. Although the majority of Hispanics living in the United States have cultural roots in Mexico, more than a third come from other Latin American nations. In a 2013 report from Pew Research Center, Pew identifies 14 different statistical profiles for Hispanics living in the United States. They also differ by whether they were born in the U.S. or immigrated (65 percent are U.S. born) and by generation (Millennial, Gen X or Boomer). There is a tendency to look at Latinos in aggregate and this is a mistake, said Jake Beniflah, executive director for the Center for Multicultural Science, in the AMA story.
  • Form relationships. A reason Hispanics sometimes underutilize U.S. healthcare services is that it is less relationship-based. Bridge the gap and build trust by showing up either in person or with advertising at Hispanic community functions and other events where you can become known to the local Hispanic community.
  • Embrace digital. While Spanish-language, printed materials are important, don’t stop there. Latinos are adopting mobile phones faster than any other demographic, according to a Nielsen study. “The internet has made a major advance as a trusted source of medical information for Hispanics,” said Beatriz Mallory vice president of SensisHealth, a multicultural health care marketing agency. 

Finally, while there is an undeniable ethical imperative to care about health disparities if one values equality in health care, there is also a business imperative for marketers. The Latino population is projected to reach 119 million (or nearly 29 percent of the U.S. population) by 2060. If Latino women 40 and older are not being screened for breast cancer at the same rate as other groups, that gap represents mammography business your facility could be missing out on. 

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