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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Strong Data – Not Standards – Needed to Help Physicians use CT Imaging Intelligently, Reduce Unnecessary Scans

RE: NY Times op-ed on CT Usage in the US


As the chief medical officer of the nation’s largest radiology group(over 450 physicians reading more than 7 million studies a year),  respectfully disagree that more monitoring and regulatory guidelines are the solution. Such methods rarely take into account the important and nuanced specifics of any medical situation. They also represent an implied, unpopular second-guessing of ED
physicians’ decision-making and are intrusive additions to an already heavy workload. Since ED physicians face professional, medical, and legal
consequences for every outcome, their decisions must ultimately be left to them alone.

CT scans do have some level of risk and should not be used on every patient that walks into an Emergency Department (ED). However, let’s not forget that the diagnostic value of CT Imaging has almost universally replaced invasive and dangerous diagnostic procedures. Exploratory abdominal surgery is all but extinct thanks to CT Imaging. While an ultrasound or MRI may impart less risk to the patient, they are only useful in answering a specific clinical question. The enormous diagnostic net cast by CT, with thorough evaluation of essentially every organ in the imaged region, makes CT the preferred option in the diagnosis of almost all acute patient presentations.

To reduce the rate of unnecessary scans, we must focus on the decision-making process of
ED physicians. Our radiology group believes that providing clear positive CT findings data can help to influence a physician’s nuanced decision making. Such data must be based on a nationwide statistically significant sampling, including age, gender, body region and imaging procedure, among other factors. As a prior ED physician and a practicing radiologist I can tell you such findings-based indices are rare and that most imaging decisions are made without its guidance.

Here’s how this proposed process would work: If a pediatric female comes to the ED
with head trauma and the physician detects no concerning signs or symptoms, the physician may still be undecided about ordering a CT. However, it may help the decision-making process to know data exist today that show the head CT on a pediatric female has the lowest positive yield of any CT study performed in the ED. The physician can decide to send the little girl home with instructions for the parents, confident that the decision is better informed, while avoiding a long ER visit as well as an unnecessary scan. This approach helps the physician thought process with evidence-based guidance and allows him or her to ultimately make the final decision based on the assessment of the patient
rather than leaving that little girl’s fate in the hands of an “appropriateness criteria” computer algorithm or a non-physician financially motivated radiology business management (RBM) service.

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New RPC Indices Released

Have you seen the newest series of our RPCSM (Radiology Patient Care) Indices: regional and state-specific metrics (including Washington, D.C. and Puerto Rico) for the use and effectiveness of CT imaging in EDs nationwide? This release included state rankings based on % findings: Vermont had the highest overall findings % – vs. our nation’s capital, Washington, D.C., which had the lowest. Check out the new interactive infographics at www.vrad.com.

We continue to make the RPC Indices available for free and unrestricted use and have plans to release a new set of indices next month that include all imaging modalities.  Make sure to check back often for updates.

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Going to RSNA?

Are you confirmed or still deciding if you should go to RSNA 2013? The show is December 1-5 in Chicago at McCormick Place and you can still register by at www.rsna.com.

Here are the top 3 reasons why you should definitely attend:

1. We will have expert advisors in our both to discuss the new RPC (Radiology Patient Care) Indices

2. Dr. Ben Strong, our Chief Medical Officer, will be in the booth to give live demos.

3. vRad is reading the future of radiology – this is something you won’t want to miss.

Making your travel plans now? Great, and make sure to stop by booth #1529 to say hello
and learn more.

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Times Are At Last Changing in Healthcare and Radiology

I’ve noted before that big changes were coming in healthcare — not only in reimbursement models but also in the practice of clinical medicine. (Visit vRad’s YouTube page for more).

These changes involve how we care for patients and how we get paid to care for those patients. One thing is clear: in our new healthcare world, you won’t get paid for quality if you can’t prove it.  And you can’t prove it if you don’t measure it.  Analytics are no longer an option; they’re a requirement.

To help ensure Radiology’s seat at the table as we move from fee-for-volume to fee-for-value,  we have just released RPCSM (Radiology Patient Care) Indices, the industry’s first findings-based national benchmarking metrics for the use of radiology imaging.  And we’re giving them away for free – and unrestricted–use for radiology groups, hospitals, health systems and researchers.


The RPC Indices are:

  • A “living library” of statistically significant metrics that provide hospitals, Radiology groups and health systems with objective comparisons of their use of imaging to national averages and relevant peer groups.
  • Derived from vRad’s clinical database of more than 22 million imaging studies from over 2,000 facilities in all 50 states.  Our database is a national projection of the U.S. market; the RPC Indices are aggregated from radiology studies  normalized on key variables patient age, gender, body region, geography, hospital and IDN type, bed size, modality, reasons for study order, and findings status.

Given our size and scale, vRad had to adapt sooner than most Radiology practices.  We have known for a long time that we were going to be affected disproportionately by healthcare market shifts. We spent time creating data informatic tools, like the RPC Indices, because existing solutions to measure value in Radiology are, at best, subjective, and at worst, absent.

We needed insight to make better decisions for our patients and our practice.  The RPC Indices are one of the many tools we use to improve utilization, decrease costs and positively impact the quality of our patient care.

We believe it is our obligation to provide these tools to the industry in order to help
those also dissatisfied with the status quo.

Maintaining the status quo means working harder for less as reimbursement rates continue their downward trend (rates have declined 25% over the past 5 years).  A “tread water” approach is simply not sustainable, even in the proximate future. Radiology must be seen to provide value as healthcare shifts to fee-for-value and away from fee-for-volume.  It must measure and document quality and performance to be seen as a strategic partner to be heard from, rather than a cost center to be managed.

A February 2013 Commentary piece in the Journal of the American College of
by Alan H. Matsumoto, MD, MA, et al noted that:

“…there is definite concern that too many radiologists and radiation oncologists are
continuing an ‘old-world’ practice rather than adapting to the challenges and
changes of the ‘new world’ of health care expectations, economics, and reform.”

It also noted that:

“Political, economic, and patient care forces are arrayed against the costs associated with imaging and image-guided therapy and will continue to erode reimbursements for
radiology and radiation oncology. Therefore, successful radiology and radiation
oncology practices have moved beyond the aforementioned 3 A’s [being available,
able, and affable], incorporating 3 new A’s into their new-world practices: affordability,
alignment, and accountability. Affordability is a key component of the current
health care calculus …”

In the new world Radiology must balance cost, performance and quality to provide a better
product or individual practices and we as a specialty are not going to survive.

Check out our first set of interactive RPC Indices The use and effectiveness of
computed tomography (CT) imaging in the Emergency Department (ED) nationwide – with a specific focus on the impact of gender, location (urban/rural) and age (pediatric/adult/senior).  They’re at
www.vrad.com (Warning: you might never want to leave the site.  I’ve never seen clinical information presented in such a unique way). 

What do you think? Will these RPC Indices help Radiology be more accountable and
strategic? Will it give us a seat at the table?  It is a discussion I predict many interest
groups will eschew, but which will be sought by anyone actually accountable in
this new environment.

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My Favorite RAD Tweets

I started a Twitter account about four years ago, not really knowing all that much about the social media application at all, and definitely not how to use it.  However, it seems that the technology has caught hold, even amongst us
older-than-teenager crowd — and there is a definite radiology presence.

Do you use Twitter? If so, follow me! @ssshahmd

Here are my favorite producers of radiology related tweets:

Virtual Radiologic - @vRad  A technology-enabled national radiology practice working in partnership with local radiologists and hospitals to optimize radiology’s pivotal role in patient care.

RBMA - @RBMAConnect  RBMA provides resources to keep radiology business professionals on the leading edge through exceptional education, products and networking.

imagingBiz team - @imagingBiz  Written by editors of the imagingBiz family of publications — Radiology Business Journal, ImagingBiz.com and more!

John Pron - @Radiologist_MD  MSK Radiologist – Go Radiology! Trying out Twitter for radiology. Tweet me your best cases, especially Aunt Minnies!

Geraldine McGinty - @DrGMcGinty  Radiologist, advocate for quality imaging.

Dr. Rich Duszak -@RichDuszak CMO @NeimanHPI  Radiologist, researcher, teacher. Seeking value & intelligent healthcare through data-driven innovation.

Radiology - @radiology_rsna  Monthly journal devoted to clinical radiology and allied sciences, owned and published by RSNA.

Radiology Today - @RadiologyToday  Monthly magazine reporting on the latest news and info affecting the radiology industry. Issues offer feature stories, topical news, technology updates and more!

Aunt Minnie - @AuntMinnie  An online radiology portal for medical imaging professionals.

ACR Radiology - @RadiologyACR  Official Twitter account for the American College of Radiology. The ACR is committed to making imaging safe, effective and accessible to those who need it.

Nate Margolis -@NateMargolisMD  Radiology, quality, safety, football, futurism, serendipitous New York City curiosities.

RADPAC -@RADPAC  Political Action Committee (PAC) for American College of Radiology Association.

RLI -@RLI_ACR  The Radiology Leadership Institute is the first leadership academy designed specifically for radiologists, radiation oncologists and medical physicists.

Rasu Shrestha, MD, MBA - @RasuShrestha  Physician, Informatician, Pragmatic futurist. Driven by the pursuit of value-based intelligent healthcare.

Imaging Economics -@ImagingEconMag  Imaging Economics is the leading information source for radiology thought-leaders and decision makers.

Garry Choy, MD, MBA -@GarryChoy  Physician / Radiologist with interest in #HealthIT, #mHealth, #hcsm, and#GlobalHealth @ Massachusetts General Hospital, Harvard Medical School

Jim Rawson,  MD -@Jim_Rawson_MD  #HealthPolicy, #Healtheconomics, #Radiology, #Imaging, #PFCC, #Medicare, #Medicaid, #publichealth, #CER, #ACA,#HCR, #bigdata, tweets on behalf of myself

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