White Paper: Corporatization in Radiology

Consolidation in health care has been widely recognized as having significant impact in the United States. A related trend is the corporatization of medical professional practices by companies in capital markets. Several medical subspecialties have been identified as attractive corporatization candidates, including radiology. The purpose of the white paper is to present information about the trend of corporatization in radiology. The real, recognized, and potential influences of capital investors in radiology need to be acknowledged as evolving and important considerations. Many radiologists and practices have already realized significant change as a result of corporatization. Corporatization presents significant practical, financial, ethical, and moral implications for those in and related to radiology.     

Magnetic resonance imaging in Canada: dissemination and funding.

OBJECTIVE: To determine the dissemination of magnetic resonance imaging (MRI) units in Canada, and the funding sources used to buy, site and operate them. METHODS: Review of available data in the medical literature and on the Internet to determine dissemination. Based on these data, a survey was faxed to all the MRI sites in Canada requesting information on sources of funding, hours of operation, numbers of examinations performed and expansion plans. RESULTS: There were 53 operating MRI sites in Canada at the end of 1997. There are 1.7 MRI units per 1 million population in Canada, compared with 4.3 per 1 million for a range of comparable European countries, and 9.4 per 1 million for a worldwide sample of similar industrial countries. The survey showed that a minority of sites received any government funding for capital acquisition (23%) or related building costs (19%). A direct government grant to at least partially cover operating costs was available at 42% of sites. The average numbers of examinations performed was 3653 per site per year, with average operating hours of 64 per week, and a throughput of 1.1 examinations per hour. These figures are equivalent to those from sites in other countries. CONCLUSION: Despite the fact that Canada has a state-funded health care system, the single payer--government--is the smallest participant in funding MRI. MRI is widely accepted as a major advance in medical imaging, with future expansion in its capabilities assured. The important role of MRI in medical diagnosis and treatment is undisputed. Canada's position as the country with the lowest dissemination of this technology, and the need for a strategy to fund future technology acquisition in the health care system, must be addressed by all levels of government.     

Seventh Annual Mario S. Verani,MD Memorial Lecture: “ASNC and integrating cardiac imaging”

Although cardiovascular mortality is decreasing over the last two decades, the cost of such care is escalating at a pace that is not sustainable for Medicare. Over this same time period, cardiac imaging has grown at an extremely rapid rate and is a leading contributor to this escalation in expense. It is now incumbent on both profession medical societies and individual physicians to demonstrate that cardiovascular care and the imaging growth lead to better patient outcomes and that the level of competent performance in these areas is documented. The development of physician certification and laboratory accreditation are key components to this effort and need to be supported and updated in a timely manner. The recent introduction of appropriateness criteria for patient imaging and treatment, especially in concert with the more established national clinical guidelines, appears to offer the best mechanism to deal with all the clinical and economic factors that we will need to address to continue our efforts to improve cardiovascular healthcare. Physicians can best serve their patients by practicing best standards of practice as well as being advocates for high-quality medical care in the setting of responsible healthcare funding. The article is the text of the author’s presentation at the 2008 ASNC national meeting for the Verani Lecture.     

Academic technology transfer and radiology: a strong partnership for the future

To date, technology transfer from academia to industry has been strongest in the biotechnology and pharmaceutical sector. The medical imaging and medical device industries have traditionally been smaller players and, as a result, some, perhaps many, investigators in radiology are unaware of the potential value of technology transfer and the opportunity to receive sponsorship for research from medical imaging companies. Many investigators are also unaware of opportunities to introduce important academic discoveries into clinical practice through licensing and technology transfer. These untapped opportunities are not only valuable, but also are becoming more and more important in light of the ever-increasing difficulties associated with sustaining and receiving new government funding. The goal of this article is to provide academic scientists in the field of radiology with insights about the key aspects of the technology transfer process, including observations about inventions, intellectual property, and industry-sponsored research.     

Simplifying the management of the environment of care

In 1995, the JCAHO introduced a new chapter for its manual called "Management of the Environment of Care (EC)." The chapter provides a common-sense organization to a department by grouping similar subjects around the common goals of safety, security, hazardous materials, emergency preparedness, life safety, medical equipment and utility systems. Its focus always remains on patient care. Forty-five individual standards are listed in the EC chapter under four categories: design, implementation, measuring outcomes and implementation, and social environment. Follow the step-by-step instructions to determine the policies and procedures you'll need to generate in your own organizational plan. Teaching becomes critical and requires nearly an almost continuous effort to maintain competency and ensure safety--no one can afford to take chances and put either patients or staff in jeopardy. For each of the standards in the design section, the JCAHO manual identifies exactly what to teach. Regarding medical equipment, the EC chapter indicates what to measure, along with the necessary steps for maintaining an information collection and evaluation system. When you design your quality improvement plans, evaluate how your medical equipment might improve the quality of patient care or staff safety. Evaluate your medical equipment plan (or policies) annually by asking your staff if it works.     

Call a medical physicist: a guide to troubleshooting

A catastrophic problem may occur when an imaging system suddenly fails. In most cases, however, a problem comes on gradually until the imaging quality is so far degraded it becomes clinically unacceptable. In that circumstance, pressure is put on the technologist to do something quickly to improve the quality of the images. There are several guidelines to follow when a similar situation occurs in your workplace. First, any correction should be made rationally using the data at hand. Don't rush to change a lot of things all at once or you'll never know what did work. Putting in a call to a physicist may be in your best interest as the second step to follow. A qualified diagnostic medical physicist has an overview of the principals and applied technology of the imaging process. Both the radiologic technologist and the technical representative from film or x-ray and film processor companies have training in all areas of x-ray technology. It is the physicists' many years of training in the application of scientific methods to medical imaging problems that provide an edge in diagnosing technical problems. Their strength is that they are good with scientific concepts and numbers. Don't let the physicist leave until the problem has been shown to be solved. Bring in the service engineer to run a control strip to show that the remedy has indeed had the desired effect with no undesirable side-effects. Document the problem and the solution is the fourth rule, while rule five is to use the physicist to coordinate the process, objectively measure and assess the results of any change. You'll be back on line more quickly and will know what went wrong.     

The operation of a corporate medical department

Medical departments within industry vary widely. Some large companies have virtually no medical department. Some have a dispensary-type set up, where band aids or aspirin are dispensed, and the nurse refers out anything more serious. In contrast to this, some companies employ full-time internists or preventive medicine specialists, part or full-time orthopedists, part or full-time psychiatrists, and even offer the services of full-time dentists. The purpose of this article is to describe an industrial medical department which functions somewhere between the two extremes above in an average-size company involved in the aerospace field.     

Absenteeism: causes and cures.

Absenteeism can be categorized as either uncontrollable or controllable. Uncontrollable absences include family illness, accidents, jury duty and unexpected emergencies. A typical controllable absence may be dissatisfaction with the job. No matter which type, absenteeism is disruptive to the organization, reduces the quality of patient care and raises operating costs. The Bureau of Labor Statistics has established a standard for comparing the rate of absenteesim with other departments or organizations. The rate is equal to the number of days absent times 100, divided by the number of days worked. Four percent or more is considered excessive. Absence policies are often not used for the purposes they were intended. Managers may want to take a critical look at their policies, rather than accept abuse as routine or over-hiring staff to make up for absent staff. If, in fact, it's time to change your policy, you'll want to run possible changes by a legal advisor. You may also want to take a look at your corporate culture. Is it encouraging absenteeism? One company that paid employees who didn't use their sick time had to eliminate this benefit for budgetary reason. Its average sick time then increased 60%. You may want to use your culture to spread corporate norms. Employees are expected to be at work: those who are there on the job are more likely to receive promotions, for example. Paid-leave banks have been introduced by many companies to allow broader time-off flexibility for employees. Such a bank includes holidays, sick and vacation time, grouped together for use by the employee. A final word: employees will rise or sink to the level of your expectations.     

Commercial research and development in times of financial restraint

More than most other areas of medical practice, radiology depends on technology for the practice of its specialty, the effectiveness of its specialists, and the contribution it can make to medical care. Consequently, manufacturers of diagnostic imaging equipment and supplies have special importance to radiologists, and there has long been a productive interrelationship between those vendors and radiologists, resulting in rapid growth in the sophistication and effectiveness of diagnostic imaging products. Presumably because the market for imaging equipment and supplies is narrowing, in the past three years there has been some redirection of research expenditures away from pure research into applied research and product development, although absolute levels of research funding have not decreased. Understanding the theory of the firm provides an insight into how vendors might respond to changes in the size of the equipment market or the certainty of the market in the future. Because the research and development activities of these vendors are important to radiology practice, radiologists need to understand corporate behavior, just as managers of companies providing imaging equipment and supplies need to understand the requirements and concerns of their market. Finally, individuals and agencies that determine the ultimate reimbursement for diagnostic medicine should be mindful of the effect their decisions have on costs and efficiencies in this area, particularly the risk that the long-range effect on the cost and quality of medical care is quite different from that intended.     

Information needs of naval primary care providers and patients at sea

OBJECTIVE: To optimally practice medicine, and to live healthy lives, providers and patients need convenient access to authoritative information. The goal of this study was to determine the information needs of naval primary care providers and patients at sea to aid development of a digital health sciences library for naval primary care providers and patients. METHOD: A literature-based needs assessment was conducted from articles identified using MEDLINE searching and U.S. Navy health care information sources. Recurring medical problems/diseases/topics were identified and categorized. RESULTS: Eighty-one articles and books were reviewed and abstracted, representing a broad base of naval medicine. Twenty-one medical and surgical theme areas and 125 medical problems/diseases/topics were recurrently identified. CONCLUSIONS: The common naval medical problems identified are nearly identical to the common medical problems in the general population, have changed little from the 18th century, and were consistent with first-hand information from naval primary care providers.     

The Bassler Hypothesis: A Eulogy

Sportsmedicine Forum is intended to provide a sounding board for our readers. Perhaps you have a special way to treat a common medical problem, or you may want to air your views on a controversial topic. You may object to an article that we have published, or you may want to support one. You may have a new trend to report, identified through an interesting case or a series of patients. Whatever your ideas, we invite you to send them to us. Illustrative figures are welcomed. Address correspondence to Sportsmedicine Forum, The Physician and Sportsmedicine, 4530 W 77th St, Minneapolis, MN 55435.     

Evaluations over the medical emergency responding to chemical terrorist attack

The use of chemical warfare agents intentionally has become a great concern in the arena of the cold war. On the other hand, there has always been a threat on civilian population due to their mass destruction effects, including psychological damage and a great deal of discussion how to respond to it in terms of medical management. It is very important to provide the best lifesaving medical care and triage in a chemical-contaminated area. Mass casualties exposed to chemical agents require immediate medical intervention to save their lives and should be classified in accordance to medical care priorities and available medical sources, including antidotes and sophisticated health facilities. Establishing the decontamination area for chemical casualties where it is located at the suitable place with respect to the wind direction is necessary. To overcome the mass destruction effects of chemical warfare agents following the terrorist attack, we must have the emergency medical response plan involving experienced triage officers and medical care providers to be able to perform medical management in the chemical-contaminated area and health facilities.     

Sportsmedicine forum

Sportsmedicine Forum is intended to provide a sounding board for our readers. Perhaps you have a special way to treat a common medical problem, or you may want to air your views on a controversial topic. You may object to an article that we have published, or you may want to support one. You may have a new trend to report, identified through an interesting case or a series of patients. Whatever your ideas, we invite you to send them to us. Illustrative figures are welcomed. Address correspondence to Sportsmedicine Forum, THE PHYSICIAN AND SPORTSMEDICINE, 4530 W 77th St, Minneapolis, MN 55435.     

gameplan

Sportsmedicine Forum is intended to provide a sounding board for our readers. Perhaps you have a special way to treat a common medical problem, or you may want to air your views on a controversial topic. You may object to an article that we have published, or you may want to support one. You may have a new trend to report, identified through an interesting case or a series of patients. Whatever your ideas, we invite you to send them to us. Illustrative figures are welcomed. Address correspondence to Sportsmedicine Forum, THE PHYSICIAN AND SPORTSMEDICINE, 4530 W 77th St, Minneapolis, MN 55435.     

Evaluation and Treatment of Lateral Ankle Sprains

Sportsmedicine Forum is intended to provide a sounding board for our readers. Perhaps you have a special way to treat a common medical problem, or you may want to air your views on a controversial topic. You may object to an article that we have published, or you may want to support one. You may have a new trend to report, identified through an interesting case or a series of patients. Whatever your ideas, we invite you to send them to us. Illustrative figures are welcomed. Address correspondence to Sportsmedicine Forum, The Physician And Sportsmedicine, 4530 W 77th St, Minneapolis. MN 55435.     

Sportsmedicine forum

Sportsmedicine Forum is intended to provide a sounding board for our readers. Perhaps you have a special way to treat a common medical problem, or you may want to air your views on a controversial topic. You may object to an article that we have published, or you may want to support one. You may have a new trend to report, identified through an interesting case or a series of patients. Whatever your ideas, we invite you to send them to us. Illustrative figures are welcomed. Address correspondence to Sportsmedicine Forum, THE PHYSICIAN AND SPORTSMEDICINE, 4530 W 77th St, Minneapolis 55435.     

Sportsmedicine forum

Sportsmedicine Forum is intended to provide a sounding board for our readers. Perhaps you have a special way to treat a common medical problem, or you may want to air your views on a controversial topic. You may object to an article that we have published, or you may want to support one. You may have a new trend to report, identified through an interesting case or a series of patients. Whatever your Ideas, we invite you to send them to us. Illustrative figures are welcomed. Address correspondence to Sportsmedicine Forum, The Physician and Sportsmedicine, 4530 W 77th St, Minneapolis, MN 55435.