PaRADigm Attendees Celebrate 50 Years of the Power of Friendship
April 8, 2018

The chandeliers sparkled, the champaign bubbled and the band played, but the RBMA members at the Association’s 50th anniversary gala hardly needed the party atmosphere. They arrived already smiling and excited on a lovely San Diego evening with the sun setting on the ocean behind them. 

Looking around at the crowd of people greeting each other with broad smiles. President-elect Christie James, FRBMA, of Massachusetts General Physicians Organization, marveled at all the happy memories that came to mind as familiar faces filled the tent where the gala was held. It was more than a gathering of colleagues. These were friends who felt like family. 

Friendship is indeed powerful. Earlier in the day, Geraldine McGinty, M.D., chancellor of the American College of Radiology, discussed leadership and the very important role friendship between the RBMA and the ACR played in her presentation at the PaRADigm conference.

“We [the ACR] are just one voice and our voice is amplified when we are engaged with other stakeholders,” she said. 

Being a leader means fostering strong teams where people help each other reach a shared goal, and it is no accident that on the best teams, friendships form. This is part of how you get to double digit growth for your practice, as Jennifer Day, a sales force expert, explained in her PaRADigm presentation. It is how you develop a symbiotic relationship with your hospital for quality data sharing, as Christy Rtichie, of Integrated Medical Partners, talked about in her talk, “The Value-Added Juggernaut.” Friendship can help different generations work together, as Lisa Csencitis, associate director in executive education at Cornell University's School of Industrial Relations, discussed in her presentation. And of course, friendships can be a big part of how legislative and policy objectives are accomplished. In his update on lobbying activity, Ted Burnes, director of RADPAC, reminded RBMA members that the large turnover in Congressional seats expected in the midterm election means that radiology will be starting over with a new crop of legislators that need to be educated about what radiologists do and how radiology practices operate. 

“They often think the tech is the radiologist,” Burnes said.

Having members of congress visit radiology business (especially in an election year) and making sure radiology is represented at election fundraisers is key to establishing relationships that only grown stronger over time. Several of the legislators planning retirement this year had strong relationships with RADPAC. 

“When you look at the quality of the people leaving, it is even tougher,” Burnes said.

But don’t think this or the dozens of other challenges radiology faces means that the field’s good old days are behind it. Far from it said the 17 past RBMA presidents who gathered for the gala. 

“I think you make your own golden days,” said past president Jim Hamilton, FRBMA. “It comes down to attitude.”

Pat Kroken, FRBMA, another past president, echoed Hamilton’s view. “These will be the good old days 10 years from now she said. Part of the joy is helping each other.” 

Friendships really do make the RBMA.

PaRADigm Attendees Get Real About AI and More
April 7, 2018

In an era of big data, artificial intelligence (AI) and mega mergers, do human connections even matter? On the second day of the RBMA PaRADigm conference in San Diego, the attendees and speakers held the concepts presented by the first-day general-session speakers, like the importance of heart, goals and team, up to the hard lens of technology and economics. What they found was that yes, human connections matter. In fact, they may matter more than ever before.

According to Keith Dreyer, D.O., Ph.D., FACR, FSIIM, director of the Center for Clinical Data Science at Massachusetts General Hospital and a leading expert on AI in radiology, the pace of development of AI has really speed up over the past 12 to 18 months to the point where there are several AI tools already available to help review radiology images. But these tools are “narrow AI.” They can’t learn independently. They need humans to provide specific data sets and instructions. Your iPhone, for example, may right now be able to find pictures of poodles and penguins, but it can’t find pictures of giraffes and lions because humans have not yet given it enough image data to learn those animals. Likewise, imaging AI has learned only a few specific diagnoses on a few modalities, and worse, there is no standard between systems for how AI tools should report what it found in the image.

“We need to quickly get involved in AI to make sure this doesn’t turn into a tower of Babel,” Dr. Dryer warned. 

In the executive idea swap session, Charles McRae, CEO of Columbus Radiology in Columbus, Ohio, shared that Columbus Radiology has been testing AI tools and found that so far, these tools can typically do one little thing really well, but they are limited to that one task. Although he saw a lot of potential — such as one tool that can check head CTs coming in for potential bleeds in the brain and put those images at the very top of the queue to be read — his conclusion was that right now “few are ready for prime time.” 

Humans will remain central to imaging, and quoting Dr. Dryer, McRae noted “AI is not going to replace radiologists, but radiologists who use AI are going to replace the ones that don’t.”

In addition, human connection remains as important as ever to the business side of radiology. The best technology and most efficient workflows will not help you if the hospital puts out a request for proposal (RFP) and you do not have a good relationship with the hospital staff, noted several of the participants in the executive idea swap.

What technology can do is further enhance human connections. In a general session imaging’s future, Mark Olszewski, senior director of Strategic Marketing for Diagnostic Imaging at Philips, described his company’s focus on using advances in technology to see if they could lower the barriers between the healthcare provider and the patient. The imaging equipment, in their ideal world, would not be some bulky scary metal object that is between the patient and the technologist, but something that actually enhances the human relationship. 

“I believe our brightest days are ahead of us,” he noted. “How we innovate comes down to how we listen.”

John James of CDI (a Philips customer) shared the presentation with Olszewski. He noted that as much work as CDI puts into efficiency, they have found that they cannot shorten the time it takes to place the patient on the equipment below 11 minutes. People need that time to make the process warm and human.

“If a patient has a bad experience, they are going to tell 10 people, but if they have a good experience, they may not tell anyone,” he warned. 

And if there was any more doubt about the importance of the human element, it was quickly erased at the panel session on practice models where Randal Roat, FRBMA, COO of Strategic Radiology, jokingly, but also a bit enviously, pointed to fellow panelist Jennifer Coleman, executive director of Grand Traverse Radiologist in Michigan, an independent practice, and said: “Notice how Jennifer just said her group has no intra-group conflict.” 

From large independent practice collaboratives to corporate practices and equity-backed practices all the way down to the small independent practice, the problems faced by radiology business managers are still much the same and while different practice models each had their advantages, it was not a given that a large organization would always have an advantage over a small independent. What was certain was that company culture — including heart, goals and team — mattered a lot.

“Don’t underestimate the support RBMA gives [independent practices],” said Kirk Hintz, CEO of Radiology Alliance, P.C., who was representing the large corporate practice model on the panel. “You are going to be fine because you are great people. It just may be a little harder.” 

PaRADigm Attendees Go for the Gold Medal Mindset
April 6, 2018
How do you achieve success in a challenging and rapidly evolving healthcare landscape? When speaking to RBMA members at the second annual PaRADigm conference in San Diego, Olympic gold-medal winner Shannon Miller said that it was not enough to just set a goal. You have to do the work and accept help from your team. 

According to Miller, your team is not just your coaches and your fellow team members up on the podium with you. It is all the people that helped you get there. It is the mentors, the friends and even just the person who was there with a kind word or gesture when you were feeling discouraged. It is your fellow RBMA members, who live the association’s motto: Progress through sharing.

“Team is important,” Miller said. “When you are having a bad day, they are the ones who will help you rally.”

On the first day of PaRADigm, RBMA members heard from presenters and each other about plenty of challenges:

• How do you get business analytics you can actually use when getting data out of your hospital partners can be struggle? (“Non-Interperative Side of Artificial Intelligence and Machine Learning” presentation)
• How do you avoid having a civil penalty if you discover an overpayment from Medicare and fail to report it in 60 days? (“Health Care Fraud Enforcement” presentation)
• What can realistically be done to address physician burnout when the factors driving a lot of the stress are beyond the control of any one practice or group? (“Provider Resiliency in a Time of Constant Change” presentation)
• How do you get your diagnostic radiologists to understand the value of the one interventional radiologist in your group when their measure of productivity is number of images read? (The IR Trifecta: Three Key Elements for Success” presentation)

But they also got solutions from each other along with support and encouragement. These types of heartfelt connections are significant, Miller said. She related how her coach had once told her that she was far from the best gymnast he had ever trained. She had many strikes against her, from her height, to her lack of muscle, to her low (for a gymnast) flexibility. But she worked harder than anyone he had ever trained because she was so goal oriented.

“Why don’t we succeed?” she asked. “It is not the big stuff, like injuries for a gymnast. No, those big challenges make us work even harder. It is the little every day mundane things that grind us down.” 

To overcome the small stuff, you need a goal and to lead with both your heart and your head. The people around you can help you do that, related Patrick Combs, the author and professional speaker that kicked off PaRADigm, in a presentation that would echo many of the themes of Miller’s presentation later in the day. We are now in the “connection economy,” he said, and what distinguishes the companies that are the top in their fields — the gold medalists if you will — is that they make meaningful emotional connections with their customers, with their employees and with others in their field.

“The saying ‘when it comes from the heart, it goes to the heart’ is true,” he said. “If you get lost in just efficiency, someone is going to beat you with heart and efficiency.”

Coding Draws Crowd at PaRADigm Pre-Conference Session Good luck finding an open seat at the PaRADigm
April 5, 2018
Good luck finding an open seat at the PaRADigm pre-conference coding academy on Wednesday. The full-day of coding education preceding the 2018 PaRADigm conference in San Diego drew even more attendees than the organizers were expecting, and Lori Shore, CPC, RCC, the current RBMA Coding Subcommittee Chair, was delighted.

Reflecting on the day, she said she liked the practical nature of the presentations. One of her wishes had been that attendees would be able to take things they’d learned at the conference home and apply them right away in their practices. The other thing she liked was the open discussions that happened during the question and answer sessions at the end of the presentations. 

“I hope the Coding Academy is very successful and continues at future meetings,” she said beaming.

Not only did the lineup include well-established names in coding education, like Walt Blackham, RCC, who helped create the Radiology Certified Coder (RCC) credential, but it also featured hot topics for coders like the procedures most likely to cause coding problems.

In an afternoon session before the final roundtable discussion with the presenters, Jennifer Bash, RHIA, CPC, CIRCC, RCC, and Debby Mann, CPC, RCC, ROCC, of Advocate went through point by point all of the risk areas where they saw the most problems with insufficient or wrong documentation. In no particular order, their top list of risk areas was:

• CTA
• 3D Reconstruction
• Abdominal Ultrasound
• Ultrasound Retroperitineal
• OB Ultrasound
• Duplex Ultrasound
• Duplex with Non-Vascular Ultrasound
• Noninvasive Physiologic Testing
• Vascular Ultrasound Guidance
• Moderate Sedation
• Clinical History and Final Impression

Each procedure group has its own unique issues with problem documentation, but what they all have in common is a breakdown in communication between staff, the physicians and the coders. If the communication failure originates with the radiologists, educating the doctors will sometimes help. Not all doctors, for example, fully appreciate that the radiology report is both a way to communicate about care to a fellow doctor and a legal document that documents what care they actually provided so that they can be paid fairly, Mann explained.

However, often the problem is that the radiologist dictating the report does not have all the information he or she needs and can’t just make things up. In these cases, it is important to understand where the problems are coming from and addressing that at a system level, Mann and Bash said. For example, a problem with how charge nurses in the ER set up the orders the ER physicians sign off on is not going to be solved by talking to the radiologists or even the ER doctors.

“Improving documentation has to be a collaborative effort,” Bash said. “From schedulers, to techs, to the physicians, to the coders, there has to be open lines of communication.”