Vendor agreements offer cost savings for cardiac catheterization

Hospitals continue to search for ways to save money at the same time they provide their physicians and clinical staffs with the variety and quality of supplies needed to do their jobs. St. Joseph's Medical Center in Stockton, Calif. watched expenditures for its cath lab increase while its activity stabilized. They looked at their high-volume use of balloon catheters, says Gary Boyd, service director. At a cost of $600 to $700 apiece, it made sense to carefully manage their supply. Choosing a prime vendor was the first step in controlling inventory. Materials management, which had previously had a hands-off policy in the cath lab, took an active role in determining choices for this product. Through a lengthy selection process, medical center management and physicians reached a consensus for a single vendor. Having a prime vendor policy may increase the vendor's commitment to the hospital and provide added advantages. For St. Joseph's, selecting a prime vendor has better positioned the hospital to arrange for inventory to be stocked on consignment: the vendor owns the shelved supplies, which the hospital pays for only as they are used. However, some vendors may reduce their discounts when they enter into a consignment agreement. The best way is to get the maximum discount on the invoice price first, and then work with the vendor to manage inventories at the lowest level possible. Smaller facilities have less leverage and less flexibility, but they can often piggy-back onto large bargaining agreements by partnering with a larger institution.     

The PACS committee: the all-important human element

The PACS committee plays a crucial role in attaining successful outcomes from a PACS implementation. However, most radiology departments do not organize and manage their PACS committees well. This has resulted in poor outcomes and inability to realize projected benefits and return on investment. Ideally, there are two PACS committees: a high-level strategic committee that aligns the goals for the PACS with institutional initiatives, and an operational PACS committee that makes a hands-on approach to the project and manages the entire PACS program. The chairman of radiology, an assigned radiologist or the radiology administrator heads both PACS committees. The strategic PACS committee consists of senior people from information systems, strategic and operational planning, radiology, physicians, nursing, critical care, and other related departments in the hospital. The operational PACS committee consists of people directly involved in radiology operations including the chief of radiology, radiology administrator, technologists, file room manager and other personnel whose daily routines will be affected by the PACS implementation. The operational PACS committee manages the PACS program from initial planning through the post-installation period. Committee tasks include: developing an implementation plan, establishing goals and objectives, conducting a cost/benefits analysis, developing functional specifications, generating an RFP, managing vendor selection and contracting, preparing the site for installation, performing project management functions, conducting acceptance testing, overseeing training, and evolving the PACS operations to meet predicted outcomes.     

Contract case managers prove cost effective in federal workers' compensation programs

OBJECTIVE: This pilot study examined whether contract case managers are cost effective in reducing workers' compensation (WC) costs and preventing injuries. METHODS: We placed contract medical case managers at four installations where they employed private industry best practices. A needs assessment was performed and site-specific targeted interventions were developed. Case managers improved WC program effectiveness by ensuring command support, and strengthening the case management process. They minimized lost work time and provided the WC team resources to review the oldest cases. RESULTS: Case managers cost $1.25 million and they generated $4.4 million in savings for a 3.52 return on investment. Case managers removed 73 workers from long-term rolls by making use of vocational rehabilitation, finding modified duty jobs, offering workers medical retirement, and terminating benefits when workers refused to work after being offered a job. CONCLUSIONS: This study of medical case managers demonstrates they can reduce WC costs.     

Implementing an in-house radiological equipment service program.

The pressure to control hospital costs extends to departments of radiology. One area of radiology in which costs may be reduced without cutting quality is equipment service. Equipment maintenance and repair expenditures can be lowered considerably through the implementation of an in-house service program. By developing an adequate data system to accompany the in-house service program, informed decisions can be made concerning vendor service contracts, lease options and equipment replacement.     

Implementation of an HDR brachytherapy–based breast IORT program: Initial experiences

PurposeA multidisciplinary team at our institution developed a novel method of intraoperative breast radiation therapy (precision breast intraoperative radiation therapy [PB-IORT]) that uses high-dose-rate brachytherapy with CT on-rails imaging to deliver high-dose, customized radiotherapy to patients with early-stage breast cancer. This report summarizes our program's experience developing and implementing PB-IORT.Methods and MaterialsLiterature on PB-IORT was reviewed including published articles and abstracts. To evaluate case volume, all patients with a breast cancer diagnosis who underwent breast surgery or breast radiation (2010–2017) at our academic institution were identified. Patients were stratified into pre-IORT and post-IORT eras with initiation of our PB-IORT program in October 2013. Overall trends in surgical and radiation therapy volume in each era were analyzed by linear regression. Travel distance for all surgical patients was calculated using Google Maps (Alphabet Inc.) and then compared between IORT and non-IORT patients.ResultsData from a PB-IORT Phase 1 trial found that the primary endpoints were met and that PB-IORT is feasible and safe. The direct health system's delivery costs for PB-IORT exceed those of 16-fraction whole-breast irradiation when accounting for consumable supplies (multilumen balloon applicator = $2,750 per patient). There was a significant increase in yearly growth of breast cancer surgical volume with PB-IORT.ConclusionsAccrual rates for the ongoing Phase II trial have been quicker than expected in an area where more research is needed. The rapid accrual indicates patient interest and demand for this treatment and that it is very feasible to get more data from randomized trials.     

Mastering the PACS RFP

The level of a realized picture archiving and communications system (PACS) benefit is dependent upon a careful approach to choosing a vendor that will satisfy the specific requirements of an organization, including architecture, storage, networking, hardware specifications, user interfaces, and workflow. The request for proposal (RFP) process serves to provide a systematic approach to requesting, receiving, scoring, and awarding competitive bids for contracts. Typically, administrators (and vendors) must endure a very arduous process before a vendor is ultimately selected. This can take as much as 9, 12, or even 18 months. A significant problem with the legacy RFP is the length of time the process can take. If the decision point is determined to be 12 to 18 months in the future, much of the data in a fast-changing industry will be irrelevant right now. A dynamic RFP is conducted in 3 to 5 months, depending on the product or service being reviewed. This shortened timeline will provide a better chance of having the right people on the steering committee. A shorter timeline also increases the accuracy of the steering RFP decision. The dynamic RFP creates a level playing field that will enable the committee to select the right vendor. This level playing field can be created through weighting, on-site demonstrations, and vendor presentations.     

Integrating digital systems: commitment and collaboration

One year ago, the radiology department at Ball Memorial Hospital, a 350-bed facility in Muncie, IN, was completely film-based. The need to support a new all-digital, 35-room emergency department (ED) hastened the facility's transition to a digital environment. Today, with the exception of mammography, the hospital's imaging services are now digital. To develop and implement the project, the hospital formed an internal implementation team. An independent consultant was also hired to evaluate the impact of these new technologies and to provide an estimated cost payback. After research, site visits, and vendor demonstrations, the hospital selected a single vendor for its picture archiving and communication system (PACS), digital radiography (DR), computed radiography (CR), and overall project management. The DR system was installed in the ED to provide digital image capture for a full range of trauma exams. The ED also initially began utilizing a Web-based PACS distribution originally implemented for after-hours teleradiology. The majority of the hospital's imaging studies are captured with 2 multi-cassette CR systems that serve 7 exam rooms in the radiology department. The hospital also installed remote operations panels to expedite entry of patient and exam information. Technologists readily embraced both CR and DR systems. The Web distribution system now transmits images to hospital-based computers and to 150 remote referring physicians. The PACS platform automatically e-mails key images and radiology reports to referring physicians. Authorized physicians can also request reports and images on an as-needed basis. The PACS vendor had previously performed multiple integrations with the radiology information system (RIS) vendor; the integration of PACS and RIS was extremely smooth. One of the critical components of a successful conversion is experienced, dedicated management. The hospital retained professional project management services to facilitate implementation and to ensure adequate training for all users.     

A tale of two CRs: hospital conducts side-by-side test

While we elected to install a digital radiography system in the busiest exam room in emergency room (ER) suite at our 535-bed hospital, we selected computed radiography as the primary platform for digital capture throughout the facility because of its flexibility, productivity and cost-effectiveness. We now use CR systems to handle six exam rooms and portable exams conducted by the radiology department, as well as imaging studies conducted in two ER exam rooms. Before committing to a CR vendor, we conducted an eight-week, side-by-side pilot study with two vendors' systems. One CR system was located in the emergency room and the other unit was located in the main radiology department. Our staff received education and training from both vendors. I led an evaluation team that included representatives from the radiology group, the information services (IS) department, biomedical engineering, staff physicians, ER physicians, pulmonologists and orthopedic specialists. Our team met to design the trial and develop a list of factors that technologists would use to evaluate the two systems. The team met after installation and again after the trial was complete to provide verbal input on each vendor for each category and to review feedback from the technologists' survey. Categories included image quality, interactions with each vendor's sales and service staff, workflow, time studies, durability of cassettes and plates, entry of John Doe patients for ER, and other factors. After the trial, we chose a system by unanimous vote. We learned a lot about CR technology throughout this process. Overall we are extremely satisfied with the platform we selected and with this method of evaluating the two systems prior to making this important decision.     

Emergency radiology fellowship training in the USA: a web-based survey of academic programs

Interest in emergency radiology as a distinct subspecialty within radiology continues to rise in the USA and globally. While acute care imaging has been performed since the earliest days of the specialty, fellowship training in emergency radiology is a relatively new phenomenon. The purpose of this study was to examine the current status of emergency radiology training in the USA, using data derived from the official websites of US residency training programs. The most current list of radiology residency programs participating in the 2017 match was obtained from the official Electronic Residency Application Service (ERAS) website. The total number of emergency radiology fellowships was recorded after visiting available websites of each academic radiology program. The total number of subspecialty fellowships offered by each academic radiology program was also recorded. There were 12 confirmed emergency radiology fellowships offered in the USA for a combined total of 22 fellowship positions. Eleven programs were 1 year in duration, with one program offering a one- or two-year option. One hundred eight of the 174 (approximately 62 %) surveyed academic radiology programs offered at least one subspecialty fellowship. Emergency radiology fellowships are on the rise, paralleling the growth of emergency radiology as a distinct subspecialty within radiology.     

Global Radiology Training Prevalence Among Radiology Residency Programs

ObjectiveGlobal Radiology aims to enhance access to medical imaging services and education, worldwide. To date, few reports have evaluated Global Radiology Training (GRT) in radiology residency programs. Here, we examined how radiology residency programs perceive and incorporate GRT into their curriculum, and how this information is promoted online.MethodsTwo methods were used to examine the current state of GRT. First, radiology residency program directors (identified via the Association of Program Directors in Radiology) were surveyed on topics including: Electives, institutional partnerships, resident and faculty involvement, inquiry by prospective residents, and barriers to implementation. Second, radiology residency program websites (n = 193) were examined for existing GRT on the programs’ publicly available webpages.ResultsThere were 62 survey responses (response rate of 19%). Thirty-eight percent (24/62) of residency programs offered a Global Radiology elective to their residents within the past academic year and 27% (17/62) of programs have active affiliations with medical institutions outside of the United States. Eighty-four percent of program directors (52/62) received questions from residency applicants regarding opportunities to participate in Global Radiology. Furthermore, only 13% (26/193) of all radiology residency programs listed at least one GRT elective on their webpage.DiscussionGRT in radiology residency is more widely available than previously reported and has been underrepresented on residency program websites. In the present survey, the majority of radiology residency program directors reported that radiology is an important component of Global Health, one-third of whom have already incorporated the subject into their curriculum. However, most common barriers to GRT include, perceived lack of time in the curriculum and lack of faculty interest. The high prevalence of inquiry from residency program applicants about GRT suggests that it may be a notable factor for applicants during the ranking process. Programs build up GRT may choose to share related information seeking to may choose to emphasize work in Global Radiology on their program webpages.     

Operating expenses for the diagnosis and treatment of peripheral vascular disease in an academic interventional radiology department: cost calculations according to a microeconomic method

PURPOSE: A correct understanding of the true costs of a procedure is necessary to make informed decisions in cost-effectiveness analyses. The actual comprehensive costs of performing cardiovascular and interventional radiology (CVIR) procedures were analyzed in the present study, as opposed to charges or ratios of costs to charges (RCCs), as often used in the literature. MATERIALS AND METHODS: Costs included labor, equipment, administration, facility establishment and maintenance, overhead, and consumable supplies. Cost identification was initially performed with use of an hourly rate that reflected the cost of operating the CVIR section. This was then combined with the costs of the consumable supplies used during each type of procedure. Eight types of vascular procedures were studied in 235 consecutive patients to determine mean procedure duration and supplies consumption. Costs were then compared with charges and RCCs of these procedures. RESULTS: The hourly rate for operating one angiography suite was 690 dollars. Average cost by procedure, including hourly rate plus consumable supplies, were: aortic arteriogram, 1,442 dollars; aortobifemoral arteriogram, 1,554 dollars; unilateral limb arteriogram, 1,307 dollars; simple iliac or femoropopliteal angioplasty, 2,119 dollars; arterial stent placement, 2,780 dollars; percutaneous thrombectomy, 1,998 dollars; arterial in situ thrombolysis, 3,133 dollars; and arteriogram after thrombolysis, 926 dollars. RCCs calculated for each procedure ranged from 0.39 (thrombectomy) to 1.92 (control arteriography during or after thrombolysis) and were lower than expected based on previous reports. CONCLUSIONS: The average actual costs of several common diagnostic and therapeutic procedures for peripheral vascular occlusive disease were established, allowing determination of the relative importance of different cost components. This methodology may serve as a template for future cost analyses.     

Radiology practices and their contracts with hospitals, 1989-1990: a representative sample survey

Because of concern about pressures from hospitals for changes in their contracts with radiology practices, the American College of Radiology undertook a stratified sample survey of radiology practices and their contracts with hospitals in late 1989 and early 1990. After three remailings, the survey obtained 904 valid responses for a 64% response rate. It found (weighting data to represent all radiology practices in the nation) that 91% of radiology practices provide services in hospitals. There are contracts at 57% of these hospital sites, and hospitals use tax-exempt bond financing in 54% of the sites with contracts. One year is the most common duration of contracts, and 90 days is the most common cancellation period (89% of contracts can be canceled during the contract's term). Eighty-six percent of contracts are exclusive; 73% are automatically renewable ("evergreen"). Separate billing exists in well over 90% of hospitals with contracts. Two percent of contracts require radiologists to provide equipment; 4% require them to provide support staff. There are fixed-fee arrangements in 9% of contracts and percent compensation arrangements in 3%. Hospitals share in radiologists' fees as a charge for contractual privileges in 5% of contracts. Twenty-seven percent of contracts require hospital approval for radiologists' fee increases; 19% require radiologists to participate with Blue Shield or Medicare. If a contract characteristic is predominant nationally, it is predominant in every region, for solo, small, medium, and large practices, and whether or not hospitals use tax-exempt bond financing. There is, however, some modest variation in frequency of contract provisions. Multivariate analysis shows that most such variation reflects true effects of region and other variables, not statistical artifacts. Region was a statistically significant determinant of 11 of 17 contract characteristics studied. Practice size was a statistically significant determinant of only about half as many characteristics. The survey found some interference in the independence of radiology practices (e.g., required hospital approval of fee increases), questionable clauses (e.g., mandated provision of equipment), and even illegal ones (hospitals charging a fee for contract privileges). Knowledge of the survey findings can make individual radiology practices more effective in negotiations with hospitals and assist the profession in forming a strategy to oppose disadvantageous and illegal provisions.     

PACS strategy for imaging centers

Picture archiving and communications systems (PACS) have been available in imaging centers for many years, but they often were less functional, were not well integrated into patient information systems, and lacked the network backbone to implement a system. As modalities are replaced and technology improves, the ability and time for an imaging center to acquire, integrate, and utilize PACS has arrived. However, each imaging center must determine why it should invest in PACS. A business plan is the fundamental need. Each imaging center must understand its target market, growth rate, and staffing plans. Additional considerations lie in current and future modality availability, the need for offsite delivery of images and reports, and the potential need for remote transmission of images. These issues must be identified and prioritized. A multidisciplinary team is essential. The most successful PACS implementation begins with complete involvement from all levels. The team should be comprised of people with complementary skills who are committed to a common purpose, set of performance goals, and approach for which they hold themselves mutually accountable. The team must jointly decide on the project's objectives. These objectives fall under 4 categories: clinical, service, financial, and performance. PACS must be considered a tool to help accomplish each objective. The imaging center must determine its top priorities, then translate them into a technology "wish list." The center can then list those pieces of technology that are most important and prioritize them. There are even more considerations for connecting multiple imaging centers. The team must create a comprehensive request for proposal (RFP) and determine the vendors that will receive the document. Once the RFP responses have been received and the vendor has been selected, an effective training plan must be executed. Training plans should be competency-based, ensuring comfort and competency among all staff. Upon the project's completion, it is essential for the imaging center to evaluate PACS' effect upon its services and relationships with patients, staff, and referring physicians. Marketing and demonstrating the latest technology can positively impact all these areas.     

Relative value of analog and digital teaching files

RATIONALE AND OBJECTIVES: This study was performed to determine if it is financially reasonable for radiology residency programs that create and maintain their own teaching files to switch from analog teaching files (ATFs) to digital teaching files (DTFs). MATERIALS AND METHODS: Radiology residency program directors were surveyed electronically about the monetary value and importance of conventional ATFs and DTFs. The costs for maintaining each type of file were calculated at the authors' institution. RESULTS: Surveys were sent to the program directors of all 197 accredited radiology residencies. Responses were received from 48 (24%). DTFs were scored as more important than ATFs, but the difference was not significant (P = .22). DTFs were rated as less complete (P = .01) but more current (P < .001) than ATFs. DTFs included the American College of Radiology Learning File (85%), in-house productions (77%), and other commercially available products (63%). Thirty percent of respondents had a DTF integrated into a picture archiving and communication system, and 28% reported having a technician dedicated to the teaching file. Program directors ascribed total median dollar values of $250 and $3,000 per year to their ATFs and DTFs, respectively. The annual costs at the authors' institution were much higher than these ascribed values: $44,720 ($91 per case) for maintaining a DTF produced in house and $24,601 ($50 per case) for maintaining an ATF, excluding physician time. CONCLUSION: Program directors are more willing to pay for a DTF than an ATF. For both, the costs of maintenance are great and the relative monetary value is low.     

PACS需求方案的设计方法和原则

目的结合我们的ＰＡＣＳ设计实践探讨ＰＡＣＳ系统需求方案的设计方法和原则。材料与方法搜集和分析各类ＰＡＣＳ有关的信息和数据,建立对ＰＡＣＳ发展技术和动向的深入理解,基于此确立将构建的ＰＡＣＳ系统的规模、结构和功能方面的实际需求。结果ＰＡＣＳ的ＲＦＰ中主要的组成包括：放射科以及医院状况的概述和对ＰＡＣＳ的一般需求;对新建ＰＡＣＳ及其亚系统的结构和功能需求的细节描述;对ＰＡＣＳ集成／提供商的能力和产品支持的具体要求的描述和说明。结论建立基于放射科和医院实际需求的ＲＦＰ,是完成适用并具较高性价比ＰＡＣＳ设计方案的可靠保证。     

Computer-aided administration of a radiology equipment insurance program

The Medical College of Georgia's radiology department has developed computer software that helps the department manage its radiology equipment insurance program. By providing clear menus and choice boxes instead of manual typing wherever possible, the software minimizes the time spent on data entry and management functions. In addition, the software helps track vendor invoices and unreimbursed claims, and maintains a service call log. It also provides a bar-coded service ticket for use by in-house engineers. Completed tickets, which are copied and filed, have replaced ledger books. Furthermore, the software helps the department comply with JCAHO requirements, since service tickets link the documentation of quality control problems to their resolution.     

Multidisciplinary Approach in Teaching Diagnostic Radiology to Medical Students: The Development,Implementation, and Evaluation of a Virtual Educational Model

PurposeThe aim of this study was to develop, implement, and evaluate the effectiveness of an online multidisciplinary approach for teaching diagnostic radiology to medical students.MethodsAn online 10-session case-based learning course was designed and taught by a multidisciplinary team of radiologists, surgeons, and internists. Session topics included common clinical case scenarios for different systems and were hosted on a videoconferencing platform. Students from six medical schools across Texas enrolled in the course. The effectiveness of each session was evaluated using a pretest-posttest design. Students completed a final survey after the course to evaluate their experience.ResultsAn average of 108 attended the live sessions, with attendance peaking at 220. On average, 75 students completed both the pretest and posttest of each session. Posttest scores were an average of 46% higher than pretest scores. A total of 109 students completed the final survey; more than 90% of participants agreed that the program was relevant, that its multidisciplinary approach was valuable, and that it increased their knowledge of imaging as a diagnostic tool. Seventy-four percent said that the program increased their interest in radiology. Almost all participants said that the topics presented were thought to be “excellent and clinically important to learn” by most of the students (70%). Participants reported increased confidence in basic radiology skills after completion of the program.ConclusionsAn online multidisciplinary approach can be feasibly implemented to address the radiology education needs of a large number of medical students across a group of medical schools.     

Developing radiology procedure cost standards

Containing costs is at the forefront of healthcare management, particularly as managed care replaces fee-for-service care. The first step in costs is to gain an understanding of the "building blocks" or components of procedure costs. The department of radiology at Duke University Medical Center and Health System, in conjunction with the department of management engineering, developed labor and supply standards to predict direct procedure costs throughout the radiology department, where 285,000 procedures are performed annually. This team concept resulted in a consistent approach to building procedure standards that predict direct costs across all sections. Step by step instructions are given for the following standards. Variable labor standards represent the average amount of staff time required for each procedure. Variable supply standards represent the average amount of consumable supply resources required per procedure. Fixed labor time standards predict the amount of fixed time resources necessary to operate the department of radiology at Duke University hospital. Cost per procedure uses the standards developed in the other sections. These basic steps will help readers determine their own direct costs per procedure for most radiology procedures (excluding capital and indirect costs). When these standards and costs are identified, the next step is to identify the areas to reduce such costs without affecting the quality of patient care.     

Materiel management and radiology: building a teamwork relationship

Mr. Burke and Mr. Cirino explain how a teamwork relationship between radiology and materiel management can serve both well--radiology can continually strive to provide high quality diagnostic data and superior patient care, while materiel management can provide a continuous flow of supplies and services, keep inventory investment low, and develop a competent supplier base. Effective communication is the necessary element that will allow each to achieve its respective goals.