Q
I am looking for some information please. I run a small lab for a physicians office, and we have been looking at adding bone density testing in-house. I need some information on DEXA forearm testing versus whole-body scans. Do you know of any articles or studies that deal with this subject? Thank you very much!

A
If you haven't already, try searching through the RadiologyInfo Web site, a joint effort by the American College of Radiology (ACR) and the Radiological Society of North America (RSNA). Also try the National Osteoporosis Foundation and the International Osteoporosis Foundation. You'll probably find what you're looking for on one of those three sites.

Q
Are most imaging centers renting, leasing, or buying imaging equipment? Can you give me a percentage of each that you have encountered?
Thank you.

A
How an imaging center handles equipment procurement must be based on its own specific needs and situation. A standard lease versus buy analysis is always a great starting point inhelping one make a decision,
as there are advantages and disadvantages to both aproaches. Two key questions to ask yourself are:
1) Competitive environment—do you need to stay cutting edge to compete? If the answer is yes, then leasing is typically better;
2) Cash situation—are you concerned about cash flow? If the answer is yes, then leasing is typically better.

Keep in mind that the decision process can vary across modalities. For example, you might find that you want to keep your X-ray and digital mammography units for a long time and don't anticipate needing to change this technology within 5 years. If that is the case, you could be better capitalizing ($1 buyout) this equipment. Conversely, if you feel that you want to start with a 16-slice CT scanner but then want to "upgrade"
within 5 years, then leasing is better. Hope this helps.

Q
The Deficit Reduction Act (DRA) of 2005 and, more generally, the reduction in reimbursement drive the need for leaner and more cost-efficient imaging centers. It challenges the ability to finance new projects, but it also forces the imaging centers to invest in PACS and RIS projects to enhance productivity. What is your analysis of the impact of the DRA in the spending of outpatient imaging centers?In particular, will the DRA reduce or increase the number of PACS and RIS solutions sold to the outpatient imaging centers?

A
You are definitely thinking in the right direction: cost. However, although there are exceptions, most imaging centers are already “lean and mean” in comparison to outpatient hospital-based radiology departments that are challenged by a 24/7 unpredictable workflow, not to mention administrative\organizational bureaucracies. A RIS/PACS solution is a tool to help imaging centers achieve efficiencies, and it should be viewed as a must have. However, the savings as a result of the RIS/PACS in an inherently efficient delivery system by design (again, in most cases) won’t even scratch the surface of making up for lost revenue due to DRA reimbursement cuts and other cost-saving initiatives of major insurance companies. So, ask this question: What are the biggest line item expenses (aside from labor and professional radiologist fees) for a freestanding imaging center? Answer the question, and you’re getting warm.

Q
In regard to training staff, where do you see the greatest need for Imaging Professionals?

A
It would help to know if you are referring to cardiac CT imaging or CT imaging in general. If you are interested in cardiac CT, a good source of information is the Society of Cardiovascular Computed Tomography, available online at www.scct.org. The SCCT has a list of training courses and programs posted on the site. Hope this helps!

Q
What is the best way for imaging professionals to inform their referring physicians of the cost benefits and advantages of their imaging capabilities, as well as the advantages of the newest imaging techniques, such as PET/CT?

A
Nothing beats direct radiologist-to-referring-physician interaction. However, formalizing these exchanges can be problematic. Trying to get referring physicians to attend “dinner informational sessions” can be tough, given demands on professional and personal time. One method we have found to be quite effective is the development and implementation of “quick facts.” This approach involves providing a single sheet of film in a film jacket with images specific to the solution you are offering, and then attaching a “quick facts” sheet to the film jacket. This sheet should clearly and briefly summarize the advantages to using your imaging service. A lay marketing person could then deliver this informational packet to referring physicians' offices. It only takes a physician less than a minute to review, and you can provide a follow-up phone number (direct line) to the radiologist to answer any questions that the referring physician might have (if interested). Good examples of this type of effort for MRI include MRCP (for gastroenterologists), 8-channel or 3T MRI knee exams (for orthopedic surgeons), and 8-channel or 3T MRI neck and back exams (for neurosurgeons). For PET/CT, you could develop a quick sheet for any given number of indications, including solitary pulmonary nodules (for pulmonary medicine), head and neck cancers, colorectal cancer, and more. Hope this helps!

Q
What is your opinion on doing I131 therapys at an OP IDTF that does CT/PET scans (so, in turn, has a hot lab in place)? I would like to move these from the hospital side OOPS to the MC Part B, due to time and camera constrants in the hospital. Thanks so very much!

A
With the anticipated implementation of the DRA beginning in 2007, which states that an IDTF will be paid the lesser of the hospital fee schedule versus the physician fee schedule, I would suggest that you talk with your billing personnel and have them look up the current OOPS payment versus the Medicare Part B payment for the procedure. You also need to consider the contracted rates through your major insurance company payors. Typically, you are receiving a much higher level of reimbursement through your hospital contract than what the IDTF is getting paid. Once you have this information, you will be in a much better position to make a decision. Hope this helps!

Q
How could I educate/train myself as a 25-plus year transcriptionist/medical secretary/coder (specializing in radiology) to enter into a management position in radiology—without becoming an RT?

A
Most hospital radiology managers are clinical by formal training; however, there are some exceptions. We have found that a greater percentage of nonclinical managers (in comparison to hospitals) exist in the freestanding imaging center market. The most important thing for you to do is get experience managing both people and a budget. Have you considered a medical records supervisor position at a hospital? How about a radiology clerical department supervisor at a hospital or at a large imaging center? These could be great starting points for you. Hope this helps!

Q
What is your opinion on opening a medical-imaging clinic? I have considered opening an ultrasound clinic and would appreciate your input.

A
I applaud your entrepreneurial spirit. However, what you are contemplating requires some very serious consideration. Venturing in to outpatient imaging poses many significant challenges. In most cases, huge dollars are at risk, and operational requirements demand extensive expertise. Additionally, the highly competitive nature of the market requires real differentiation for success. This differentiation must be carefully planned and implemented. Below is a very "short list" for you to think through:

1) What is my objective? If the primary answer to that question is income, you might want to reconsider. "At the end of the day," you could find that-based on the time and effort it takes to run your own business, coupled with the financial risks involved-it is simply not worth it. Ultrasound techs (I presume you are one) can command a healthy salary today, and if you are willing to work a little extra (eg. on-call, evenings, etc), you will most likely make more money working for someone else than by having your own business.

2) What are my family and personal commitments? If you have any, you better plan for some major contingencies regarding them. Running your own business can consume the majority of your time and energy.

3) If you decide to pursue the business, what is the "need" that you will be satisfying? What is your differentiating strategy? What competitive or market advantage will you have? If you can provide qualified answers to these questions, then you could have an opportunity worth pursuing.