Examining Breasts: A Teaching Moment on the Mammographic Signs of Breast Cancer

Earlier this month, I gave my fourth annual national CME WebEx lecture on Breast Imaging and Intervention through the University of Arizona. I have always enjoyed teaching and part of my current responsibilities includes teaching radiology residents.

I consider it a success when at least one resident in each class decides to go
into breast imaging as a specialty. It makes me feel like I have done my job
well. This year’s lecture was a bread-and-butter one. It is a back-to-basics
lecture on the mammographic signs of breast cancer. There are so many
additional wonderful tools for helping us find and treat breast cancer; however
the single best screening tool still remains mammography.

We may have dressed up the modality by making it digital or making it three
dimensional, but it is still the basic two views of both breasts that serve us
the best. While it is not perfect, it is about 90 percent sensitive or accurate
in finding breast cancer. We need to continue to educate those around us to its
continued and timed earned value in our fight against breast cancer.

You can find a recording of this year’s talk about mammography and the mammographic
signs of malignancy on vRad’s site by clicking here.

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vRad supports move to make it easier for doctors licensed in one state to treat patients in other states…potential positive effect for teleradiology and improved patient care.

In response to a June 29 New York Times article, Dr. Strong submitted the following letter. In it, he notes the positive benefit of removing complexity that affects underserved health facilities and their patient communities.

To the Editor:

As the chief medical officer of vRad, the nation’s largest telemedicine practice, I am encouraged by the move to create an interstate licensing compact that reflects the impact of technology on our practice of medicine. (Medical Boards Draft Plan to Ease Path to Out-of-State and Online Treatment, Robert Pear, June 29, 2014)

Our 450 US board certified radiologists will collectively read over 7 million client studies this year – diagnosing via a patented cloud-based network to provide critical clinical care to patients in over 2,000 healthcare facilities in all 50 states (plus Puerto Rico and the District of Columbia).  On average, each of our radiologists has 14 state licenses and credentials to read for 175 different facilities. I am personally licensed in all 50 states and read for over 900 facilities.

The complexity of current state licensure processes means time and money for our practice – and that means delays in getting doctors up and running quickly for patient care.  Once hired, it takes an average of 4 months (as many as 9 months, depending on the state) for a radiologist to be fully operational because of the current state licensing model.  Processes vary by state (paper-based vs. online), as well as required information.  For example, to be licensed in certain states, our physician-applicants must appear in-person solely to present a photo ID – and sometimes their original medical school diploma.  That’s onerous for our practice and a disservice to underserved healthcare facilities and their patients.

While the bar for certification must be high in any interstate compact, the consolidation and simplification of investigatory and certification processes would be welcome to reduce the time required for licensing board and credentialing committee approval, lower processing costs, provide greater mobility for physicians – and ultimately, deliver exceptional patient care by matching patient to physician as quickly and as efficiently as possible.  At 3AM in an emergency room when an ED physician is waiting to have an image read to determine if a patient is having a stroke, does it really matter if the radiologist is reading and diagnosing from the basement of the hospital, an in-state office or a home office equipped with state-of-the art diagnostic tools across the country? Seconds count. With today’s cloud-based tools, geography should no longer be a barrier to excellent clinical care.

Benjamin W. Strong, MD (ABR, ABIM)
Chief Medical Officer, vRad

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Are You Innovating Your Radiology Practice? Find out on May 22

Many forces in the U.S. healthcare market—from declining reimbursements and volumes to value-based accountable healthcare models—are pushing radiology into a corner.

But these challenges are being embraced by some as an opportunity to innovate for continued growth – and to become an indispensable partner to referring physicians, hospital administrators and the patients they collectively serve. Innovation allows radiology the ability to be seen as a strategic partner vs. a cost center to be managed by their hospital and physician clients.

Our latest webinar — “Innovating Radiology: Is it in You?” — is designed for radiology administrators and leaders that want to hear how innovation can address seismic shifts, drive continued growth, and foster alignment with referring physicians, hospital administrators and the patients they collectively serve.

Attendees will also:
• Learn why innovation is vital to radiology’s long-term growth prospects and how it builds a culture of engaged innovators.
• Hear “Lessons Learned” from the nation’s largest radiology group as it defined and designed a strategy based on analytics, collaboration and communication for better alignment with its healthcare partners.
• Discover new growth opportunities for radiology, such as direct-to-patient remote diagnostic services, and extension to other global telemedicine platforms and models.
Register here for our May 22 Webinar at 10:00 AM ET.

Our speakers include:
• Nadim M. Daher, Principal Analyst from Medical Imaging and Imaging Informatics, Frost & Sullivan
• Raymond Montecalvo, MD, one of vRad’s Medical Directors
• Michael Ge,  Executive President & CTO of E-Techco Information Technologies Co., Ltd.
(E-Techco), a leader in consumer telehealth solutions in China.

vRad recently partnered with  E-Techco to offer E-Techco customers 24/7 access to subspecialty radiology for second opinions. This innovative partnership, for the first time, allows for Direct-to-Patient remote radiology services in China from US-trained radiologists.

Hope you can attend and learn about the latest developments to innovate the practice of radiology.

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Sylvia Mathews Burwell on Building a Better Model of Care: Data, Analytics and Transparency on Capitol Hill

Sylvia Mathews Burwell said it is "important" to base decisions on data to ensure you "get the largest impact you can."

During her confirmation hearing last week for HHS Secretary, Sylvia Mathews Burwell said it is “important” to base decisions on data to ensure you “get the largest impact you can.” Listen to her philosophy around data and its importance (go to 57:38 in the video).

Data is the cornerstone of “managing what you measure.” Starting with normalized data, vRad was able to measure what we do and then make informed decisions to better
manage our radiology practice. We had to because it was necessary for us to build – as Sylvia Mathews Burwell noted — a “successful model that can scale.”

Data lead to insight – radiology requires insight into the practice of medicine so that leaders and managers can make informed decisions and take actions that deliver the best care and drive the best value for their patients, ultimately at an overall lower cost.

vRad and our clients must shine the spotlight on imaging use, analyze the data, and partner on operational decisions to improve efficiency and value to patients and hospital
administrators. If we don’t, someone else will do it for us. And it just might build a model that does not benefit radiology and its benefits to overall patient care.

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Thinking of Sending Your Teleradiology Provider Packing? Think Again.

Is your practice considering taking back night-time reading to meet new hospital demands or to improve your bottom line? Think it will help your economics?

Well, think again. Or better yet, “analyze the data” first – and then think.

Why? Not all radiology shifts are created equal when it comes to reimbursements, RVUs or volumes.

Hospital expectations of all physician groups, including radiology, are shifting quickly as new market realities of healthcare reform come to fruition. Many times, groups overlook the underlying economic realities of what it means to “take back the night” from a teleradiology provider.

Our new whitepaper “Rethink the Night: An Evidence-Based Discussion on Teleradiology
” looks at this issue in detail. It can help your practice to:

  • Build an operating plan to drive and manage growth in the new “Wild West” healthcare market.
  • Understand how economic realities and hospital service-level requirements affect your practice’s value and performance. (And make no mistake—they do.)
  • Make data-driven decisions about coverage and service-level commitments, which will allow your practice to become indispensable and better aligned with your hospitals and their patients.

So before you send your teleradiology provider packing, look at the data. You will be surprised by what you find.

We were… and it made our practice better.

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vRad Alliance Radiologist Newly Selected as Fellow of the Society of Interventional Radiology

vRad is pleased to recognize Aaron Shiloh, M.D., FSIR, for being chosen as one of only
29 new Fellows by the Society of Interventional Radiology (SIR). The announcement was made at SIR’s Annual Scientific Meeting in San Diego last month.

The honor, achieved by fewer than 10 percent of SIR’s membership, goes to those who demonstrate excellence in research and published works, or teaching and leadership within the field of interventional radiology and/or the society.

Dr. Shiloh is part of Diagnostic Imaging Inc. (DII), founded in 1975, which has grown to be
the largest private practice radiology group in Philadelphia, serving clients in Pennsylvania and New Jersey. In September 2011, DII joined the vRad® Radiology Alliance, the premier integrated national specialty network for radiology. The vRad Alliance program provides DII with innovative technology infrastructure and clinical and operational support.

Click here to see the full announcement.

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What a difference a month and six days make.

On February 25, Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS), told an audience at the Healthcare Information and Management Systems Society’s annual conference there would be no more delays to ICD-10 compliance deadline of October 1, 2014.

Then on March 27, the House of Representatives passed HR 4302, a bill that implements a temporary fix for Medicare’s sustainable growth formula and delays the ICD-10 compliance deadline until 2015.

Yesterday the Senate passed the bill, now known as the Protecting Access to Medicare Act. This bill caught the Healthcare industry by surprise. The healthcare industry may be relieved to see the “fix” for Medicare’s Sustainable Growth Rate (SCR) extended for a year, but they are clearly divided on the extension of the ICD-10 implementation date, depending on how confident they are about being ready for the switch to the new
voluminous code sets.

Be that as it may, what should you do with the Extra Year? We have four thoughts.

1.       Use the Time Wisely: Introduce Meaningful Use to ICD-10

Instead of rushing to implement a fix to meet a date, we have a chance to implement changes that will enhance patient care.  After all, part of the reason for moving to
ICD-10 is to improve quality of care. The additional time allows your practice
to participate in Meaningful Use if you are not already. There are similarities
in physician documentation in Meaningful Use and ICD-10. Use them to your

2.       Build up the ICD-10 “War Chest” and Work Out Your Pretest Strategy

Take advantage of the extra time to protect your finances by building up a cash buffer and to proactively and aggressively pretest with large payers. Consider extending your testing phase and engaging with more payers.  

3.       Engage with Physicians. Now.

You have more time to code final radiology reports in ICD-10, get clinician feedback and educate people on documentation quality. Identify referring physicians that are not providing the detailed medical conditions for the studies they order. Reach out and educate those referring physicians.

Reevaluate your training programs by getting feedback from your physicians and
coders so you have time to make the necessary improvements and adjustments.
Those that started training physicians will now be faced with repeating the
training next year. Physicians are more likely to balk at completing training, saying
that the implementation has been delayed twice before. Prepare to address these

 4.       Build up your cadre of coders.

Calculate how many more coders you will need. The extra year allows more time for recruiting certified codes, where there is a tight market for coders with experience.

We encourage you not to procrastinate. Use the additional time wisely!

The year will be up before you know it.

Sharon M. Roeder, CPC
Manager Health Information Management | vRad


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vRad Receives a 2014 Gold RBMA Quest Award for Radiology Patient Care Indices Web Site … Recognized for Creativity, Originality and Innovation

vRad is pleased to announced it has received a Radiology Business Management Association (RBMA) Gold Quest award for its Radiology Patient Care (RPCSM) Indices web site. The award recognizes companies for the best use of a web site for patient and physician education. The RBMA judges evaluated each entry according to the degree to which it met or exceeded the strategic objective; overall creativity and originality; and quality of execution. Judging is based on overall effectiveness, innovation, performance and success.

With the healthcare and radiology markets undergoing rapid change, status quo marketing tactics are no longer an option. Innovative delivery of innovative ideas has helped vRad
engage with its radiology and hospital partners more effectively. Since vRad launched the RPC Indices, vRad has seen an increase in its web site traffic, with more engaged visitors spending 75 percent more time on the web site and looking at 30 percent more pages.

As RBMA’s announcement notes, “Radiology practices both small and large show incredible creativity and ingenuity in developing and deploying their marketing campaigns, and this year was no exception. We look forward to seeing how these ideas are disseminated throughout the radiology community to further the success of practices

Click here to read the full announcement from RBMA.

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Get Away from the “What and How.” Get to the “Why”

This latest RPC Indices announced on February 26th has me reflecting on a number of my prior publications about healthcare IT, and the need to be better at operational planning – the “why” behind the “how” and the “what.”

Why make the RPC Indices available? vRad wants to provide data that helps radiologists and hospitals ask better questions. This applies not just to clinicians but also to IT. Many times, IT approaches clinical services as merely another project to be completed. Often IT doesn’t have a complete picture therefore starting with the wrong question – a smaller
question – “How do I complete this implementation?” Or “What technology do we need to solve this problem/opportunity” – often times not realizing it is actually tied to a bigger set of issues.

The question to consider at a higher level is this: “Why are we doing this?” “Why are we completing this project?” “Why will this make radiologists, ED physicians (or fill in your favorite clinician here) more efficient?” “Does it make sense economically for clinicians and patients?” “Why are we building a radiology service line instead of hiring an outside group?”

It’s no secret Big Data and analytics driving outcomes analysis is changing healthcare; the Patient Protection and Affordable Care Act (PPACA) and healthcare reform (fee-for-value will trump fee-for-service) are factors driving the need to harness data. But hospitals are still trying to figure out how to tame the data, turn it into information and eventually knowledge.

Why must they figure out how to turn data into information and knowledge? Because analytics will be at the core of what drives radiology and its influence in healthcare in the future. ED physicians and radiologists outside vRad are telling us they WANT the information and knowledge the RPC Indices represent.

Why? Here’s one answer:

“Access to normalized data and benchmarks, like the RPC Indices, has been challenging with our existing systems. But it is exactly this level of insight that we need in order to be in control of our future,” explained Richard Maenza, MD, FACEP, an ED physician at Sharon Regional Health System, in Sharon, Pennsylvania. “I want to be the one shining the spotlight on our use of imaging as referring physicians, comparing ourselves to our peers and partnering with our radiologists on operational decisions to improve efficiency and value to patients and hospital administrators. If we don’t do it, someone else will do it for us.”

They believe this kind of data can help them not only work better with radiology but also run their EDs more effectively. Can you imagine what will happen if radiology and the ED collaborate to improve efficiencies and care?

Can you imagine what kind of goodwill it will engender if health IT people are part of this alliance?

What do you think? Is this possible in your facility? Before you set IT off to solve a technology problem (replace the PACS, implement a VNA, and deliver data sharing) make sure to ask yourself the “Whys”.  Technology can enable the ED and radiology, sure, but empowering the process with the knowledge necessary to build an appropriate radiology service line will be a game changer driving efficiencies that far exceed anything technology on its own can provide.

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Latest RPC Indices, “Day in the Life of Radiology, ” Reveal Interesting Findings, Inconvenient Truths about How Radiology is Practiced Today

Today, vRad announced an exciting new addition to our RPCSM (Radiology Patient Care) Indices: “A Day in the Life of Radiology.” It offers a 24/7 view inside a radiology department, using interactive infographics that show study RVUs (Relative Value Units, which are a critical measure of an imaging study’s economic value), modality mix, patient type and reading location by three distinct radiology shifts.

For the first time we also including all modalities – not just CTs –to better understand the entire picture. How can we do this? We have normalized data across our entire database as part of our RG2 Analytics module. This normalization allows us to See Inside Data and provide custom views into vRad’s clinical data repository. It is a core module of our RG2 solution, vRad’s vision for the next generation of radiology group management. More to come later in the year.

vRad developed the “Day in the Life” concept from its experience as a large 24/7 radiology group. Normalized data from vRad’s clinical repository of more than 23 million imaging
studies can divide radiology into three shifts. Each has distinct characteristics affecting optimal workflow and operating plan design and management:

  • “Onsite” (Mon.-Fri. 7:00 am – 6:00 pm; Sat. 8:00 am – 12:00 pm),
  • “Midhawk” (Mon.-Fri. 6:00 pm – 12:00 am), and
  • “Deephawk” (Mon.-Fri.12:00 am – 7:00 am; Sat. 12:00 pm – Mon. 7:00 am).

For example, while the “Deephawk” shift accounts for nearly half of all working hours, this shift drives only 11% of total RVUs. By comparison, the “Onsite” shift is the most productive, accounting for 70% of all RVUs with only 35% of total working hours. 

Finally, there will be a free “Day in the Life of Radiology” Webinar on March 6 at 12:00 pm EST to provide an overview of the new Indices. You can register for this webinar here.

We continue to make the RPC Indices available for free and unrestricted use. Check them out at www.vrad.com.

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