Check Out Quality Improvement
Tools from RSNA
RSNA offers many resources to aid physicians embarking on quality
improvement projects in their practices. Go to RSNA.org/quality to learn more about:
- Team building
- Target identification
- Measures
- Interventions
- Sustaining improvement
Also available online are quality improvement tools such as the Cause
and Effect Diagram and Prioritization Matrix, and links to helpful
organizations such as the Institute for Healthcare Improvement and
Center for Evidence-based Medicine.
And don't forget RSNA will present a daylong Quality Improvement
Symposium at RSNA 2009. Topics this year include safety and risk
management, professional assessment and challenges, financial aspects
of quality and implementing quality programs in private and academic
practices. To enroll, go to RSNA.org/register.
Headlines
Leading the News
Research
Technology
Medical-Legal Issues
Clinical Practice
Leading the News
HHS Office of Inspector General Uncovers
Potentially Fraudulent Ultrasound Claims
The U.S. Department of Health and Human Services (HHS) Office of
Inspector General has just completed an analysis of ultrasound claims
from 2007, finding potentially fraudulent claim activity, especially in
20 U.S. counties that accounted for far more than their share of
ultrasound claims. Based on these results, HHS may begin taking steps
to revoke a provider's Medicare number if too many signs of ultrasound
fraud surface. The 20 counties received 16 percent of Medicare spending
for ultrasounds, despite having 6 percent of the country's Medicare
beneficiaries. Those 20 counties also were in the top 1 percent of
counties nationwide for both average allowed charges for ultrasound per
Medicare beneficiary and percentage of beneficiaries getting ultrasound
services. The analysis noted five characteristics that distinguished
potentially fraudulent ultrasound claims from legitimate ones,
including that there was no prior service claim, such as an office
visit, from the doctor ordering the scan; billing for combinations of
ultrasound services that were duplicative or not effective in adults;
claims for more than five ultrasounds for the same beneficiary on the
same day for the same provider; bills for ultrasounds for more than
five providers for a single beneficiary in a single year, suggesting
misuse of a Medicare number; and missing or invalid data in fields
identifying the doctor ordering the service.
From "Medicare Part B Billing for Ultrasound"
U.S. Department of Health and Human Services
(07/24/2009)
Research
Radiation for Childhood Cancer Raises Breast Tumor
Risk
The higher long-term risk of developing breast cancer for girls who
undergo radiation therapy for cancer in childhood, no matter how old
they are at the time they are treated, has been verified by the results
of a childhood breast cancer survivor study. National Cancer Institute
researchers observed that teenagers and adults who receive radiation
treatment for cancers such as Hodgkin's lymphoma are known to be at
greater risk of developing breast cancer late in life. The study
involved 120 women diagnosed with cancer before they were 21, received
treatment between 1970 and 1986, and survived for at least five years.
These cases were contrasted with four women who developed cancer at the
same age but did not get radiation. The more radiation a woman received
as a child, the greater her risk of developing a tumor later, the
researchers determined. However, initial cancer treatment that included
a high radiation dose to the ovaries appeared to greatly reduce women's
future breast cancer risk.
From "Radiation Dose and Breast Cancer Risk in the Childhood Cancer
Survivor Study"
Journal of Clinical Oncology (07/09) Inskip, Peter D.;
Robison, Leslie L.; Stovall, Marilyn; et al.
Sonographic Imaging and VCI Improve Analysis of
Fetal Hard Palate
A group of Italian researchers note that cleft lip and cleft palate are
the fourth most common birth defect in the United States. They say that
the analysis of fetal secondary palate has reached a new level of
potential through tomographic sonography imaging and volume contrast
imaging (VCI), and they conduct a review to define the
three-dimensional (3D) sonographic environment for a systematic study
of the fetal secondary palate during second-trimester pregnancy. The
researchers contend that the sonographic study of the fetal secondary
palate should become an essential component of the second-trimester
scan. Technically, the axial and coronal sections are those that better
display the 3D reconstruction, especially when the fetus is facing the
transducer. The researchers conclude that static VCI ought to be
integrated in the target examination because it may augment tomographic
sonography imaging of the fetal secondary palate.
From "Sonographic Imaging of the Fetal Hard Palate During the
Second-Trimester Pregnancy Scan"
Journal of Diagnostic Medical Sonography (07/09) Vol.
25, No. 4, P. 179; Tonni, Gabriele; Ventura, Alessandro; Centini,
Giovanni; et al.
CT Adds Little of Consequence in Diagnosing
Acquired Lung Disease in Children
A group of physicians collected clinical and imaging data for children
who underwent chest computed tomography (CT) for the diagnosis of
pediatric lung disease and found that the method has little benefit in
terms of identifying new findings or spurring changes in the treatment
plan. The overall positive yield of CT was 61 percent, with a yield of
23 percent for nonbronchiectatic diffuse lung disease and 46 percent
for nonbronchiectatic focal lung disease. For congenital lung disease
the positive yield was 98 percent, for mediastinal disease it was 100
percent, and for pleural disease it was 50 percent. "In the majority of
cases of undiagnosed diffuse lung disease, however, the contribution of
CT to the diagnosis was disappointing," said the researchers. "In many
such cases, the final diagnosis depends on histologic definitions that
do not necessarily have a specific or pathognomonic radiologic
pattern." The researchers noted that children are more likely to face
greater risk than adults from a given radiation dose, because they have
a longer life span during which cancer caused by radiation may develop,
and "children have more dividing cells at a sensitive neoplastic
transformation phase." The physicians said that chest CT should be used
more judiciously in children.
From "Use and Yield of Chest Computed Tomography in the Diagnostic
Evaluation of Pediatric Lung Disease"
Pediatrics (07/09) Schneebaum, Nira; Blau, Hannah;
Soferman, Ruth; et al.
Technology
Nanoparticles Could Improve Breast Cancer Diagnosis
Via MRI
Emory University School of Medicine researchers have devised tools for
enhancing breast cancer diagnosis through magnetic resonance imaging
(MRI) by attaching onto iron oxide nanoparticles, which are clearly
visible under MRI. The nanoparticles boast an iron oxide core that has
a 10-nanometer diameter and a polymer coating. Attached to the
particles' surfaces is a piece of a natural human protein, urokinase
plasminogen activator (uPA), which binds to its receptor on several
types of cancer cells, enabling discrimination between healthy and
cancerous cells. Tests with tumor-implanted mice showed that particles
coated with a fragment of uPA are picked up by breast cancer cells as
well as by the liver, and the nanoparticles linger in the blood for
several hours. Uptake of the nanoparticle probes by the tumor is
non-uniform, and the areas exhibiting the most contrast with
uPA-conjugated iron oxide nanoparticles are on the blood vessel-heavy
outer layer of the tumor. One of the researchers says the technology
must be tweaked and authenticated before human testing can proceed, but
the test could be potentially beneficial to women at higher risk of
breast cancer.
From "Receptor-Targeted Nanoparticles for In vivo Imaging of Breast
Cancer"
Clinical Cancer Research (07/09) Vol. 15, No. 14, P.
4722; Yang, Lily; Peng, Xiang-Hong; Wang, Andrew; et al.
Medical-Legal Issues
AMA Ranks Payers' Claims Processes, Which Are Often
a 'Murky Mess'
The American Medical Association (AMA) has released its latest rankings
of seven large health plans and Medicare in terms of promptness and
accuracy in paying claims. The survey found a wide variation in
practices among the payers, with each using a different set of rules,
different timelines, and confusing and inconsistent processes. AMA is
calling for a simplification of the claims process, noting that
physicians now spend a total of three weeks a year, sometimes as much
as 35 minutes a day, trying to figure out what codes to use and what
insurance plans will cover, at a cost of $200 billion a year.
"Physicians are now bogged down in paperwork," requiring they divert as
much as 14 percent of their gross revenue to assure accurate payments,
says William Dolan, MD, a member of the AMA board of trustees. AMA
wants to reduce physician expenditures on such processes to only 1
percent of their revenue.
From "AMA Ranks Payers' Claims Processes, Which Are Often a 'Murky
Mess'"
HealthLeaders Media (07/22/09) Clark, Cheryl
HASC Describes How Billions Wasted on
Administration of Healthcare
The Healthcare Administrative Simplification Coalition (HASC), a
public/private partnership of organizations committed to reducing the
administrative costs and complexity of healthcare, has released the
"Bringing Better Value: Recommendations to Address the Costs and Causes
of Administrative Complexity in the Nation’s Healthcare System" report,
which estimates that reducing administrative costs by just 10 percent
could save as much as $500 billion over 10 years. HASC says that as
much as a 25 percent of U.S. healthcare spending goes to administrative
functions and that much of administrative activity is duplicative.
Standardization could help reduce costs and, as such, the organization
is recommending that stakeholders voluntarily adopt a coordinated
nationwide approach to conducting key administrative processes for
credentialing physicians and other clinicians, determining and
verifying patient eligibility for health insurance, standardizing
healthcare patient identification cards, and improving coordination of
prior authorization processes for radiology and pharmacy services.
From "HASC Describes How Billions Wasted on Administration of
Healthcare"
Healthcare Administrative Simplification Coalition
(07/20/09)
New Organization Challenges Perks Policy for Doctors
A new organization of doctors, called the Association of Clinical
Researchers and Educators, is seeking to roll back policies curbing
interactions between doctors and drug company representatives, saying
restrictive rules ultimately will hurt patients. The group is promoting
“productive collaboration’’ between industry and physicians, which they
say leads to better medicines and treatments. Long-term goals include
reversing restrictive new conflict-of-interest policies and
establishing chapters at universities and within medical specialty
societies.
From "Perks Policy for Doctors Challenged"
Boston Globe (07/23/09) Kowalczyk, Liz
Clinical Practice
ASTRO Issues Consensus Statement on Using APBI to
Treat Breast Cancer
A consensus statement outlining patient selection criteria and best
practices for the use of accelerated partial breast irradiation (APBI)
outside of clinical trials has been published by the American Society
for Radiation Oncology (ASTRO). Benefits of the APBI procedure include
a decreased overall treatment time and a lessening of the radiation
dosage delivered to healthy tissue and adjacent organs, but APBI's
long-term safety and effectiveness in comparison to whole-breast
irradiation (WBI) remain unknown and results of randomized trials
comparing the two procedures will be unavailable for many years. The
ASTRO consensus statement lists which patients may be considered for
APBI, what comprises appropriate informed consent for patients treated
with APBI, which diagnostic imaging tests are necessary for patients
treated with APBI, how to combine APBI with surgical and chemotherapy
treatment, and how the various APBI methods compare with one another.
"ASTRO's Accelerated Partial Breast Irradiation Consensus Statement
Task Force developed these recommendations to serve as a framework for
promoting more clinical investigations into the role of APBI in
treating breast cancer," said lead study author Maj. Benjamin Smith,
MD. "It is unlikely that APBI will replace WBI for most patients
treated with breast-conserving surgery, but further study may establish
APBI as an appropriate and desirable treatment for certain selected
patient groups."
From "Accelerated Partial Breast Irradiation Consensus Statement From
the American Society for Radiation Oncology (ASTRO)"
International Journal of Radiation Oncology, Biology,
Physics (07/09) Vol. 74, No. 4, P. 987; Smith, Benjamin D.; Arthur,
Douglas W.; Buchholz, Thomas A.; et al.
Saying `Sorry' Pays Off for U. of Michigan Doctors
The estimated $5.8 billion annual cost of malpractice claims nationwide
has drawn scrutiny in the debate on healthcare reform. The University
of Michigan Health System is trying to reduce such costs by admitting
mistakes up front and offering compensation before being sued.
According to a study by Richard Boothman, chief risk officer for the
University of Michigan Health System, malpractice claims against the
health system decreased from 121 in 2001 to 61 in 2006, while the
backlog of open claims went from 262 in 2001 to 106 in 2006 and 83 in
2007. Between 2001 and 2007, the average time to process a claim fell
from 20 months to eight months, costs per claim were reduced by 50
percent, and insurance reserves dropped by two-thirds.
From "Saying `Sorry' Pays Off for U. of Michigan Doctors"
Associated Press (07/20/09)
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