Advancing the Business of Radiology
The leading professional organization for radiology business management professionals in any radiology setting.
X

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

X

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.

 

X

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
X

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.

X

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 2014 marketing program with RBMA today! Consider a Global Level Sponsorship. Contact daphne.gawronhski@rbma.org for details.

megaphone

Enhance your RBMA presence, increase brand awareness, and solidify your position in the industry through a variety of sponsorship programs

Let's Talk

RBMA Fall Educational Conference Day 3: Learning Through Sharing

(Fall Educational Conference) Permanent link

The third day of the RBMA Fall Educational Conference in New Orleans started out someplace most attendees had never been before. On the Dark Web.

General Session speaker Brian Hill of Computer Forensic Services in Minnetonka, Minn., took attendees on a tour of recent high-profile cybercrime events and visited sites on the Dark Web, a collection of websites that are public but hide the IP addresses of the servers that run them. These included sites that traffic in personal health information and stolen credit card information, as well as illegal pornography and even murder. Hill’s caution was that there is a very efficient and sophisticated market for hacked information, and it is not if your information is going to be accessed and stolen but when.

More than a few RBMA members probably changed their passwords after Hill’s presentation or headed over to the mid-morning session on cyber insurance. However, any paranoia about sharing information seemed to dissipate as they networked in the exhibit hall and traded stories and best practices in the multiple roundtable discussions and formal presentations that followed.

The discussion in the ICD-10 roundtable led by Shannon Marshal, a Solutions Manager at Merge Healthcare, was especially lively. Many who took part in the roundtable discussion were worried about what might happen next week when the ICD-10 leniency period negotiated between the Centers for Medicare and Medicaid Service and the American Medical Association expires. Restrictions on the use of unspecified codes are expected to tighten up, and while payors may still accept unspecified codes, these claims could get flagged for post-payment reviews and denials.

“Don’t think because you don’t see denials on October 1, that everything is Kosher,” one attendee cautioned.

Another attendee worries that radiology billers and coders had not gotten the message from CMS that the leniency period was to give them more time to prepare and not to simply rest easy and stop worrying about ICD-10 coding for another 12 months.

“We’ve not taken advantage of the past year to learn how to code at the highest levels of specificity and now we are coming up on the deadline again,” she explained. “My fear is that we have squandered this year.”

The Executive Idea Swap session was also productive. Attendees shared ideas about how to make shareholder meetings more effective, what to do about difficult physicians, how to reduce conflicts among radiology group shareholders, where to get reliable cost benchmarking data, and how to properly recognize radiologists for non-RVU producing activity, like administrative tasks, board membership and consulting on findings.

Other  sessions on the last day of the conference addressed the ACR’s Dose Index Registry, revenue cycle management, staffing analytics, data mining and much more. It all demonstrated the RBMA’s mission of education and motto: Progress through sharing!

 

 


RBMA Fall Educational Conference Day 2: MACRA Economics

(Fall Educational Conference) Permanent link

More than one RBMA Fall Educational Conference speaker was heard to wish for a crystal ball on Monday. The final rules of the Medicare Access and CHIP Reauthorization Act (MACRA) are due out sometime in October and there are still lots of unknowns. How will the government decide whether a radiologist is a patient-facing clinician or not? Will the budget-neutral Medicare Incentive Payment System (MIPS) be able to award any incentives if the Centers for Medicare and Medicaid Services (CMS) sticks to plans for a slow and lenient start to the program? (No penalties, no rewards in a budget neutral program, right?) Will the timeline for clinical decision support fall even further behind? And just what did acting CMS Secretary Andy Slavitt mean when he said that in the first year of MIPS, providers could report just “some measures”? Which measures?

 n the second Fall Educational Conference general session, Richard Duszak, M.D., FACR, FRBMA, and Dany Hughes, Ph.D., of the Harvey L. Neiman Health Policy Institute, illuminated one possible path forward through this maze of questions by explaining how to use quality metrics and data analytics tools, including some free options from the Neiman Health Policy Institute, to take back control in the move toward new payment models.

For those nervous about survival in a post-fee-for-service world of alternative payment models, accountable care organizations, bundled payments and capitation, Dr. Duszak had a calming quote from Mark Twain. “When it comes to fee-for-service, ‘the reports of my death are greatly exaggerated,” he quipped.

Fee-for-service will be very hard to get rid off, and radiology, like most complex specialties, will continue to be paid in a fee-for-service method for a long time to come, Dr. Duszak predicted. CMS wants to move away from paying by procedure or service into paying flat fees (bundles) for episodes of care, but it is hard to set up a bundle. This creates an opportunity for specialties, like radiology, to seize the wheel a bit and propose the types of bundles that are best suited for them. The same goes for selecting quality measures.

“Ask, where am I really going to kick butt and those are the things to ask for,” Dr. Duszak advised.

Other speakers continued the theme of how to find success in a MACRA economic system. For example, Andrew Colbert, a managing director at Ziegler, a specialty healthcare-focused investment bank, explained how the changing radiology landscape was spilling over into valuation considerations. Maria Calamaro of Healthcare Administrative Partners, presented on how MIPS, which most practices will be paid under, does not need to be a “four-letter word.” Ted Burnes of RADPAC and Pam Kassing of the ACR explained the many health policy efforts the ACR has been engaged in as MACRA is implemented.

“At the ACR, we are swamped,” Kassing remarked.

MACRA and MIPS even spill over into practice marketing as data reported through MIPS will show up as star ratings under individual physicians on CMS’s Physician Compare website. CMS also plans to make this data feely available in a database format for other online physician rating services like Angie’s List and Health Grades to use, Calamaro explained.

Considering all that is at stake, Calamaro encouraged attendees to prepare as much as they can now for the implementation of the MACRA regulations and be ready for fast action in the last couple of months of the year.

“Once the final rule comes out, be prepared to hit the ground running,” she advised.

Thanks to her and the other Fall Educational Conference speakers, the attendees were more prepared to do just that.

 

 

RBMA Fall Educational Conference Day 1: Looking Ahead While Navigating a Confusing Present

(Fall Educational Conference) Permanent link

With the final Medicare Access and Chip Reauthorization Act (MACRA) rules expected in October, RBMA members gathered in New Orleans at the last RBMA Fall Educational Conference to learn all they could about what challenges may lie ahead and how to face them. 

The tone for the day was set by Zubin Damania, M.D., better known by his alter ego ZDogg MD, a medical humor rapper and song satirist. His Facebook page has more than 300,000 followers and his YouTube videos have received more than a million views.

ZDogg was the keynote speaker, which at first blush might seem an odd choice, but his message about the need to survive a data and metrics obsessed Health 2.0 world in order to get to Health 3.0 — where technology will serve not dictate patient care — really resonated with the audience or radiology business owners and managers.

Dr. Damania, in addition to being an internet celebrity, is one of a small handful of primary care physicians in the country experimenting with Health 3.0 in a Health 2.0 world. Turntable Health, the clinic he founded in Las Vegas, strives to offer what he terms re-personalized medicine. It is high-touch health care like the old-school Health 1.0 medicine his father delivered, but it also uses advanced Health 2.0 technology, electronic medical records and new concepts like mindfulness and health coaching to connect with patients. Turntable can experiment in this way because it gets a flat fee per patient and succeeds when its patients stay healthy. But it is no “cake walk,” Dr. Damania said.

“Health 3.0 is where we are trying to get to and you guys [administrators], are a critical part of how we will get there,” he said.

The booming laugh of RBMA past president Keith Chew, FRBMA, rang above the crowd with each of ZDogg’s three live musical performance. But after the presentation, he too expressed frustration with the failings of Health 2.0. “The IT guys run the show and they don’t want to let anyone connect to their systems,” Chew said.

As a result practice administrators are stuck with the unenviable tasks of pushing their radiologists to spend time optimizing documentation for billing purposes and not patient care, as well as explaining why easily moving information and images across platforms often remains frustratingly out of reach when retail industries they interact with every day make interoperability seem so seamless and easy.

Following Dr. Damania’s presentation, RBMA members headed into the concurrent sessions, the most popular of which was “Preparing Radiology for Physician-Focused Payment Models” presented by Robert Bradner, JD, and Miranda Franco of the Washington, D.C., office of Holland & Knight. 

“The government wants to pay by episode of care,” Bradner explained to an overflow crowd. Bundled payments, like those created for joint replacement and cardiac care, will become more common and providers will need to share more risk with payors.

With time running out on the present administration, there is definite pressure to put regulations in place that advance this goal of shared risk, Bradner and Franco explained. However, as the government moves to release the final MACRA regulations, it is also getting push back that it is moving ahead too quickly and threatening the survival of all but the very largest and most sophisticated practices that are ready to move to capitated payment models.

Whether practices will get a reprieve and be able to report partially instead of a full year of data under MACRA, as Andy Slavitt, acting administrator at the Centers for Medicare and Medicaid, promised in a hearing a week ago, is still unknown. However, evidence of the fallout from the move toward more shared-risk payment models was already showing up in the RBMA Imaging Center Roundtable discussion later that afternoon. For example, many hospitals, which CMS is putting on the hook in bundled payment scenarios, are no longer signing professional service agreements with independent radiology groups and are sometimes strongly pressuring groups to sell to the hospital, roundtable discussion attendees reported.

“Integration is their favorite word,” one attendee remarked wryly.

Where this will all lead, no one yet knows. However, Dr. Damania predicted that the fight to get from Health 2.0 to Health 3.0 would be as great and as important as any in U.S. history. “This is the defining challenge of our era,” he said. 

 

Mix Up the Ideal Marketing Potion in the Social Media Lab

(Marketing) Permanent link

The Mad Men era of creative talents overseen by almost clairvoyant agency directors who made big marketing decisions based on gut and feel is fast receding in the rearview mirror. Today, marketing is becoming increasingly scientific and egalitarian. Indeed, with the low cost of a highly targeted social media ad, even the humblest one-person practice marketing department can crack the formula for success in reaching prospective patients in their market. 

In the technology issue of the RBMA Bulletin, experienced radiology practice marketer Kim Kelley, FRBA, breaks down how practice marketers can use social media to do the type of highly precise market testing that once would have required a specialized advertising research firm.

Prior to late 2014, social media ads showed up in followers’ newsfeeds organically. It was free, but there was little control over who saw a practice’s social media content. Today, social media giant Facebook uses an algorithm called EdgeRank that makes it nearly impossible as an advertiser to break into newsfeeds organically. However, the upside is that paid ads have gotten better and can now be targeted in a way organic reach could not.

In a few clicks, practice marketers can now identify who will see their ads by age, gender, geographic location, lifestyle interests and a myriad of other characteristics including the time of day the target audience is active on social media and the type of device used to view social media content. Two different ads can be shown to the same group or the same ad can be shown to two different groups for A-B testing. Analytics provide near real-time feedback and the ad purchaser controls exactly how much they want to pay and what they want to pay for, such as choosing between paying for impressions or clicks.

With so many options, it is essential to have your end objective clearly defined, Kelley counsels. If you do not know exactly what you are aiming for, it is impossible to know if you have hit your mark with your advertising.

Don’t be afraid to experiment. By testing different combinations of message, audience and budget in a scientific way, you can learn about your unique local market. Keep in mind that different groups of people will value various benefits of your service differently. The example Kelley cites is mammography. Women in their 30s and early 40s will look for different thing than women 50 or older, and since you can target your ad by age, you can show these two audience different ads.

More tips in what promises to be the start to an exciting series by Kelley are in the July-August issue of the RBMA Bulletin, an exclusive RBMA member benefit. To see what else is included in the Technology issue, click here

ICD-10 Coding Leniency Period Comes to an End

(Coding) Permanent link

On October 1, the one-year ICD-10 grace period negotiated by the American Medical Association and the Centers for Medicare and Medicaid Services (CMS) officially ends. CMS has announced that it had no plans to extend ICD-10 flexibilities beyond October 1 and that by now providers should already be coding to the highest level of specificity.

Unfortunately, a specific ICD-10 code is not always possible. In an example raised by an RBMA member on the coding forum, chest X-rays for pneumonia nearly always have an unspecified ICD-10 code like “J18.9 – Pneumonia Unspecified Organism” because at the time the radiologist is dictating the X-ray results, no one knows what may be causing the pneumonia. Will these claims be rejected or audited?

In a CMS frequently asked questions (FAQ) document, the agency clarifies its position. What Medicare contractors processing claims are supposed to look for is ICD-10 coding that is as specific as possible. However, that is not the same as only using specific codes. In many cases, it is impossible to know exactly what type of disease or condition is being treated until further testing is done. Pneumonia is a great example of this.

 “When sufficient clinical information is not known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code (for example a diagnosis of pneumonia has been determined but the specific type has not been determined),” the FAQ explains.

This is of course different from situations where the clinical information is known but it is not in the patient’s chart because a clinician treating the patient did not record the information or did not share the information with the imaging provider or radiology practice. There is lots of gray area here and radiology practices are understandably concerned about how Medicare Administrative Contractors will decide which information it is reasonable for a radiology practice claims coder to have access to and which isn’t.

Some resources from CMS that could prove useful as the leniency period comes to an end include:

On October 1, the one-year ICD-10 grace period negotiated by the American Medical Association and the Centers for Medicare and Medicaid Services (CMS) officially ends. CMS has announced that it had no plans to extend ICD-10 flexibilities beyond October 1 and that by now providers should already be coding to the highest level of specificity.

Unfortunately, a specific ICD-10 code is not always possible. In an example raised by an RBMA member on the coding forum, chest X-rays for pneumonia nearly always have an unspecified ICD-10 code like “J18.9 – Pneumonia Unspecified Organism” because at the time the radiologist is dictating the X-ray results, no one knows what may be causing the pneumonia. Will these claims be rejected or audited?

In a CMS frequently asked questions (FAQ) document, the agency clarifies its position. What Medicare contractors processing claims are supposed to look for is ICD-10 coding that is as specific as possible. However, that is not the same as only using specific codes. In many cases, it is impossible to know exactly what type of disease or condition is being treated until further testing is done. Pneumonia is a great example of this.

 “When sufficient clinical information is not known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code (for example a diagnosis of pneumonia has been determined but the specific type has not been determined),” the FAQ explains.

This is of course different from situations where the clinical information is known but it is not in the patient’s chart because a clinician treating the patient did not record the information or did not share the information with the imaging provider or radiology practice. There is lots of gray area here and radiology practices are understandably concerned about how Medicare Administrative Contractors will decide which information it is reasonable for a radiology practice claims coder to have access to and which isn’t.

Some resources from CMS that could prove useful as the leniency period comes to an end include:


Optimize Your Intranet Usage

(Management) Permanent link

Ah, the humble intranet. Businesses have used local, restricted communications networks for more than two decades to make sharing of information internally easier. It is a tried and true technology that is often unappreciated and underutilized, say Kevin and Lindsey Wynn of Acclaim Radiology Management in Longview, Texas. 

At the RBMA Fall Educational Conference, the Wynns will present on the use of intranet technology in radiology. Today, intranets can be more than repositories of company policies and procedures, they explain. They can be true collaboration tools. As an example, Lindsey Wynn cites how Acclaim is using its intranet to better serve customers and track clients.

“A specific radiology group will have interests that everyone who works with that client needs to be aware of,” she says. “Instead of having those specific details in our email inbox in 15 different emails, we have one central location that everyone has access to and can go to in order to find that information quickly. It is really a useful information resource and communication tool.”

Using your intranet instead of purchasing a combination of project management and communication tools can also save money and simplify processes for your staff. There are situations where more sophisticated tools are called for, but if the main purpose is simply to make information accessible, staying with a tool employees are already familiar with and not adding additional platforms with separate logins is a big advantage.

Intranets also offer security. Many of the products the Wynns investigated were secure enough to handle even legally protected personal health information (PHI) should the need arise, they say.
Kevin and Lindsey Wynn will present “Intranet – Is It For You?” from 1:45 to 2:45 p.m. on Tuesday, Sept. 27, 2016, at the RBMA Fall Educational Conference at the Hyatt Regency in New Orleans. On-site registration begins at 8 a.m. on Sunday, Sept. 25, at the Hyatt. Click here for the conference brochure.

 

Leading When You Don’t Know Where You Are Headed

(Leadership) Permanent link

In uncertain times, employees look to their managers and leaders for guidance. Will our business model survive? Will our jobs continue? Projecting strength and certainty to reassure staff and physicians can be hard when it is clear big changes are headed your way but you don’t know exactly what form those changes may take.

Such is the case with the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA). Radiology practices will overwhelmingly be in the Medicare Incentive Payment System (MIPS) model under the regulations published to implement MACRA. This we know. What is unknown is how groups will fare under MIPS.

MIPS merges existing government quality reporting and incentive payment programs like Meaningful Use and the Physician Quality Reporting System (PQRS) into one model. There is concern that radiology groups that were already struggling with some of the components of these programs, like getting enough quality measures for PQRS, will not be any better off under MIPS and could actually be at a significant disadvantage when made to compete on quality measures with other groups. The way MIPS is structured, incentive payments for high performing groups come from penalties levied on low performing groups. 

RBMA members have shared the struggles and challenges they’ve faced with existing programs. It is hard to imagine that rolling all these programs into one and raising the stakes in terms of impact on Medicare payment will make things easier, and staff and physicians may be concerned.

Mark Murphy, a well-known leadership lecturer, author and instructor, writes regularly for Forbes magazine on change management issues and says that a common mistake is that organizations believe they need to be quick and decisive about change. In the process, they neglect the cultural change that needs to happen for the change to be supported. 

Murphy advises leaders to focus on the why, where and how of change. Applied to radiology, this might mean starting by sharing more with employees and physicians about the implementation of MIPS. What is known, what is uncertain and what it could all mean for even very successful practices. Good sources of up-to-date information on these issues include RBMA conferences and the RBMA Washington Insider email newsletter, which now covers both state and federal issues. 

The next concept is where. “People don’t need every tiny detail about the future state, but they do need a rough idea of where we’re going,” Murphy writes in Forbes.
Without getting too into the weeds, radiology leaders can speak to the overall goals of the Centers for Medicare and Medicaid Services (CMS) administrators and the drive toward value-based medicine. A great source for information on this is CMS’s own blog where administrators write about successes so far and their program goals. 

“How” is the last concept and it is the hardest. According to Murphy, leaders need to create a bridge between the present state (in health care, fee-for-service reimbursement) and the future state (MIPS and value-based medicine) so that employees and physicians can understand how the organization will transform. But in building that conceptual bridge, leaders can be wrong. 

Deidre Maloney, author of Tough Truths, spoke at the 2016 RBMA Building Better Radiology Marketing Programs and her advice was to not get hung up on the fact that you could be wrong and instead focus on laying out your case for a specific course of action. People know that even the best leaders are human. What makes a great leader is not never being wrong but being well-prepared and thoughtful. 

“It is a mistake if you say, this is absolutely going to work. We are going in this direction and I am certain it is right, because you may not be,” Maloney says. “But if you can confidently move forward as a leader and say, this is the direction I believe we should head because of A, B and C, and we are here to help you manage through this change, it will reduce confusion and create confidence.”
 

©2016 Radiology Business Management Association (RBMA). All rights reserved. | RBMA 9990 Fairfax Blvd., Fairfax, VA 22030 888.224.7262 contact us