WSRS Fall 2015 Newsletter

Fall 2015

President’s Viewbox

by Eric Stern, MD, WSRS President

Dear colleagues,

This past June, your WSRS leadership held a strategic planning retreat. This was the first time in recent memory that your leadership team has done so. The purpose of our retreat was to envision and set our organizational direction, which included reviewing the organization’s mission, setting the vision for the future, and establishing the organization’s values and ethical culture. As stewards for the organization, your board is responsible for setting major goals and developing strategies for achieving those goals. The board also approves operational and annual plans based on the direction set by the strategic plan.

Our meeting was facilitated by Donna Cameron, CAE, a consultant to organizations on preferred future planning/execution, board effectiveness, and organizational structure.

We also had the great fortune of having outside input and consultation from Dr. Paul Ellenbogen, of Dallas Texas, the past president of the Texas Radiology Society, and past president and past chairman of the board of chancellors of the ACR.

Some of our input for our strategic planning retreat was based upon a member survey which we conducted in April 2015. Your input was essential and extremely valuable in helping us set the direction for the future of our organization.

No good strategic planning session ever took place without visiting the organization's mission and vision statement. I will report to you in future communications the final form of our mission and vision statements. However, one tagline that we strongly supported is that “radiology matters". Maybe we should make some T-shirts to that effect?!

Some of the long term goals that I wish to share with you from our retreat are the following:

Governance and Fiscal Position – WSRS is fiscally healthy and has strong and effective governance processes—including leadership development, succession planning, effective meetings, active and productive committees, and staff support. 

Membership – Broaden membership and begin a pattern of growth that will result in achieving a goal of 1000 members by 2025, with at least 50% engaged at some level.

Advocacy – WSRS is recognized nationally and locally for its strength in advocacy and lobbying on behalf of the radiology profession

Alliances and Partnerships – WSRS expands its reach through partnerships and alliances and is a leader on both the state and national levels; having members in key positions within the ACR and WSMA.

Visibility – WSRS recognizes the value of investing in assuring that the radiology profession is recognized, respected and highly regarded within the health care community and general public.

While ensuring the articulation of the desired future is a primary responsibility of leadership, we can’t stop there.  Planning is the easy part.  Equal or greater focus and attention must be placed on execution.  Otherwise, we’re just making a laundry list of to do items with no follow-through.  Execution is a systematic process of carefully discussing the whys, hows and whats, steadfastly following through on decisions and directions, and ensuring accountability.  We intend to incorporate a culture of execution into all of our strategic discussions and decisions.

Radiology matters.

Yours truly,

Eric

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Eric Stern, MD, WSRS President, speaks before the ACR Council at the ACR Annual Meeting.  Eric was elected to a two year term on the Council Steering Committee, which oversees the activities of the Council.

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2015 Annual Meeting: November 7, 2015 — Register Today!

Douglas Green, MD, meeting chair

It is my great honor to be the Program Chair of the 2015 Washington State Radiological Society Meeting. This year’s program is focused on the issues relevant to all of our practices.

No issue is more relevant than what the value and role of radiology will be in the evolving health care delivery and payment system.  There is probably no radiologist in a better position to talk about this issue than Dr. Richard Duszak.  In his role as founding Chief Medical Officer of the Harvey L. Nieman Health Policy Institute, it is Dr. Duszak who is charged with showing us the way forward.

Dr. Anne Roberts, our ACR Chapter Visitation Speaker, will address questions about maintenance of certification (MOC).  What is the rationale for MOC?  What are the objections to MOC? What is being done to make the process less burdensome and more meaningful?  She will also talk about the new Interventional Radiology/ Diagnostic Radiology residency.  While it is too late for any of us to apply for a position in the match, this is an exciting development in which Dr. Roberts has been instrumental.

I would also like to highlight WSRS board member Dr. Gail Morgan’s talk on general diversity.  We all know that radiology needs to be more welcoming and inclusive for women and minorities, but many radiologists lack the understanding and skill to help achieve those goals.  As a member of the ACR’s Commission for Women and General Diversity and a coauthor of the Commission’s publications in the JACR, Dr. Morgan will provide information and guidance on ways we can all contribute  to a more diverse and vital profession.

There are other sessions in the afternoon diagnostic radiology track featuring UW speakers Jeffrey Robinson, Puneet Bhargava, Don “D.J.” Perry, and Anika McGrath. 

A special radiation oncology track during the afternoon will provide scientific updates from the Fall 2015 ASTRO conference thanks to support from Seattle Cancer Care Alliance.

Our featured lunchtime speaker will be Washington State Representative from the 43rd District, Brady Piñero Walkinshaw.  Walkinshaw serves on the House Appropriations, Judiciary, and Early Learning & Human Services Committees, where he's championed issues housing, mental health, and criminal justice. In 2015, he was named Legislator of the Year by Washington's Housing Alliance. Prior to his election to the legislature, Walkinshaw spent several years at the Bill & Melinda Gates Foundation leading work on strategic partnerships with foreign governments and agencies of the United Nations focused on food and agriculture.

We have an appealing venue in downtown Seattle, have kept costs as low as possible, and have commissioned a chocolate cake to be decorated with the image of Frau Roentgen’s hand in celebration of the International Day of Radiology.  We hope that you are able to join us for a great day of learning and networking.

Looking forward to seeing you on November 7.

Please register today on the WSRS website’s Annual Meeting page.

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Three WSRS members to become ACR Fellows in 2016

The ACR has recently announced that three WSRS members will join an elite circle of radiologists as ACR Fellows in 2016.  Dr. Felix Chew, of University of Washington Physicians; Dr. Drew Deutsch, of Tacoma Radiological Associates; and Dr. Jonathan Medverd, of the University of Washington Medical School (and immediate past president of the WSRS), will be inducted into the Fellowship at the ACR’s 2016 Convocation.  WSRS is extremely proud of these three dedicated physicians and their career accomplishments to date.  If you or someone you know is interested in applying for Fellowship, information on the process is available on the WSRS website.

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RLI Scholarship Application Deadline: October 15, 2015!

WSRS awards up to two $1000 scholarships annually to support two members participating in the ACR's Radiology Leadership Institute program. The deadline for applications for 2016 scholarships is October 15, 2015 and the scholarship(s) will be presented to the recipients at the annual meeting on November 7.  Jason Stoane, MD, 2015 WSRS RLI Scholarship recipient from Bellingham,  shared some of his RLI experiences:

I used the scholarship to attend the RLI bootcamp in Dallas, TX. The course was truly excellent. There was a mixture of radiational learning, but we also did several interesting projects. However, the highlight was a 24-hour simulation. We were told that our radiology group was going to be replaced by a national group for various reasons. We were tasked to come up with a plan to present to the hospital board the next morning to save our jobs. They utilized actors to test our mettle and distract us. It was quite an experience.

I got so invigorated by the experience, I went on to do the rest of the coursework for the RLI and recently became the fourth person to finish all four levels. Even though I already have an MBA, I found there were many important lessons specific to radiology for me to learn. I really enjoyed defending my RLI practicum, as well. Overall, a great experience, which I highly recommend to all, no matter what stage in your career.

The WSRS Leadership Scholarship has been created to promote and support the development of radiology leaders in Washington State. Any interested member is encouraged to apply. Note that these scholarships are not available to members in training.  For more information and to fill out the online application form, visit the WSRS website’s RLI Scholarship page.

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Off-label Use of Medications and Devices: What Does This Have to Do with Us?

Jeffrey Robinson, MD, MBA, Assistant Professor, Department of Radiology, University of Washington

As we all know, any new medical product subject to FDA regulation must be shown to be safe and efficacious in a particular situation. When satisfied of these conditions, the FDA approves the use of that product for that indication. Once approved for one indication, licensed physicians may use approved devices in any way we see fit. Very often, manufacturers will strategically choose the indication for a particular product that will more easily receive FDA approval than a more general application. Sometimes, off-label use of a product dwarfs its approved use. In recent years, the US Department of Justice has subjected medical device manufacturers and drug makers to increasing scrutiny for actively marketing off-label use of their products.

In 2013, Johnson and Johnson agreed to a $2.2 billion settlement for promoting off-label use of its drug Risperdal and for paying kickbacks to physicians and at least one pharmacy provider. The drug was approved to treat schizophrenia, but J&J promoted its use to treat symptoms of dementia such as anxiety, agitation, depression, hostility, and confusion.  In another example, Medtronic agreed in 2012 to a $40 million settlement with the FDA for promoting off-label use of its Infuse Bone Graft product—a combination implant and osteoblast-stimulating protein. Hundreds of individual lawsuits against Medtronic are still pending in many jurisdictions across the country.

So what does this have to with radiology? Why should we care?

Off-label use of devices or drugs occurs in several areas of radiology, primarily in the interventional realm. Innovative devices are approved for one indication, and creative interventionalists find other uses for them. The use of expandable metallic stents to maintain the intrahepatic tract of TIPSS procedures represents such an innovation. While TIPSS was first reported in 1987, it was not until 2004 that the FDA approved Gore’s VIATORR stent for TIPSS. Stents placed before then, and any non-Gore stent placed since (as far as I know), represents off-label use. Ultrasound contrast material has been used in some centers in the US for years but was only approved by the FDA in 2014.

While we have not yet been prominent targets of off-label-use lawsuits, physicians may be subject to allegations of (a) failing to meet the standard of care or negligence per se because the off-label use was not approved or (b) a violation of informed consent if the patient was not told of the off-label use.

This should not dissuade any physician from practicing in whatever manner we see fit. However, we should consider the necessity for using a device or drug in a manner other than that for which it was approved. If we do, we should inform our patients and consider including that fact in consent forms.

Dr. Jeffrey Robinson is an Assistant Professor of Radiology at the University of Washington.  He has practiced in the private setting for 17 years, and has been consulted as an expert witness for over 15 years. In 2012, he started ClearReview to address the problem of expert witness bias in radiology litigation.  Dr. Robinson is scheduled to speak at the WSRS Annual Meeting on Nov. 7 on the topic of “Diagnostic Errors in Radiology.”

The United States Department of Justice. “Johnson & Johnson to Pay More Than $2.2 Billion to Resolve Criminal and Civil Investigations.” Department of Justice: Office of Public Affairs, last modified October 22, 2014, accessed September 23, 2015, http://www.justice.gov/opa/pr/johnson-johnson-pay-more-22-billion-resolve-criminal-and-civil-investigations

  “Infuse Bone Graft Lawsuit.” Druwatch.com, last modified March 26, 2015, accessed
September 23, 2015, http://www.drugwatch.com/infuse/lawsuit/

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ACR Annual Meeting and Day on the Hill, Washington DC, May 2015

WSRS representatives stopped to enjoy the spring sunshine on Capitol Hill between legislative visits.   (Left to right):  Eric Stern,  MD; Leila Bender, MD; Marie Lee, MD; Linda Chen, MD; Jonathan Medverd, MD; Whitney Shofner-Michalsky MD;   Elliot Rapp MD;  and Ed Kim MD.


Members of the WSRS delegation explained  some of their top priorities to Senator Maria Cantwell’s staff member Nico Janssen who specializes in healthcare legislation.  The fast-pace of Hill Day demands teamwork--with some of the group engaging in dialogue with legislators or their aides, some taking notes while others are busy checking their text messages for last minute schedule changes. (Left to right):  Ruben Krishnananthan, MD;  Kathy Choi-Chinn, MD; Gail Morgan, MD; Nathan Cross, MD; Marie Lee, MD, Erik Kilgore, MD, Nico Janssen, and Leila Bender, MD.


Representatives and Senators from Washington State enjoy visits from their constituents.  Rep. Derek Kilmer, second from right, has been especially cordial in making time to meet with members of the WSRS delegation to hear their concerns.  (Left to right):  Ruben Krishnananthan, MD;  Anika McGrath, MD;  Emily Johnson, MD;   Phil Lund, MD; Rep. Derek Kilmer and Kathy Choi-Chinn, MD.

Rep. Adam Smith met with several WSRS delegates who live in his district which includes parts of Seattle as well as Eastside suburbs.  (Left to right): Anika McGrath, MD;  Nathan Cross, MD; Gail Morgan, MD; Rep. Smith;  Ruben Krishnananthan, MD and Emily Johnson, MD.

Spokane area Congresswoman Cathy McMorris Rodgers (second from left), the fourth highest ranking member in the House Republican Caucus, takes a few minutes out of her busy schedule to visit with members of the WSRS during their Day on the Hill in Washington DC on May 20, 2015.

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WSRS Residents Make the Most of DC Experience

Radiology residents from Washington State were again active in May, as several flew out to Washington DC to attend the ACR Annual Meeting.  They joined residents in radiology, nuclear medicine, and radiation oncology from throughout the country to discuss and help set ACR policy.  While there was dedicated programming for the residents and fellows to learn about leadership, quality & safety, and the business side of radiology, it was the advocacy efforts of the ACR that struck the loudest chord with the Washington State residents.  Dr. Whitney Shofner-Michalsky from the University of Washington wrote:

Attending the ACR conference in Washington D.C this year was a great experience! I enjoyed meeting residents from other programs and learning about the mission of the ACR. However, my favorite part of the conference was attending Capitol Hill Day where we had a chance to lobby congress regarding three main issues in healthcare affecting radiologists. I felt inspired by the community of radiologists at the ACR conference and left the meeting feeling excited about the future of radiology as a whole.

Dr. Linda Chen, also from the UW, reflected on the day ACR members visited their senators and representatives on Capitol Hill as follows:

I was very grateful for sponsorship from WSRS to attend this year’s ACR annual meeting. The Day on the Hill was an invaluable opportunity to observe the legislative process in action on the national level, and experience the importance of advocating for our patients and future practice.

We discussed with legislators H.R. 1151, the USPSTF Transparency and Accountability Act of 2015, regarding the recently released mammography screening recommendations from the USPSTF. We communicated our belief that these changes are critical, since they affect citizens’ access to preventive healthcare services, and our hope that these decisions will be made with greater transparency in the future. We advocated for oncologists and radiologists to be on decision panels, so patients’ wishes and medical reality can be better represented.

I had the privilege to witness how these personal conversations with legislators could inform them on the bills they debate, and how these bills in turn can impact our patients' care. I hope our continued efforts can foster opportunities for open communication that help deliver patient care more effectively back in the reading room.

Residents and Fellows who are interested in attending the ACR’s 2016 meeting and participating in the Day on the Hill with the WSRS delegation should contact their RFS leaders as soon as possible.  The 2016 meeting will be held May 15-19 at the Marriott Wardman Park Hotel in Washington, DC.  More information is available on the ACR website.

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WSRS Teams with WSMA for Successful Certificate of Need Decision

On July 9, 2015, the Washington State Supreme Court unanimously decided that the Department of Health had exceeded its scope of authority when it promulgated a 2013 rule that would have dramatically expanded the purview of the certificate of need (CON) program in Washington State.  WSRS financially supported the amicus curiae brief in this case (initiated by WSMA) which highlighted the potential adverse implications of the now-invalid rule.

Background: DOH had adopted the rule following a directive from Governor Inslee in June 2013 for the department to modify the CON process to take into account transactions other than “sale, purchase, or lease” by which hospitals and hospital systems change control, including “affiliations, corporate restructuring, mergers, and other arrangements.” While the intent of the new rule was to protect the delivery of reproductive services following changes in control of hospitals, the language DOH used in the rule was exceedingly broad.

The WSRS, WSMA and other parties expressed concern that the rule might require a CON review for arrangements such as new alignments between physicians and medical practices with hospitals, exclusive contracts between physician specialty groups and hospitals, and any other type of joint services agreements with hospitals. The amicus curiae brief argued that this could impede the development of Accountable Care Organizations and other integrated forms of health care delivery, and could result in significant financial and administrative burdens on physicians, their practices, as well as hospitals. The Supreme Court decision leaves it up to the legislature to determine when a business transaction between hospitals will trigger the need for the CON process, rather than allowing the department to unilaterally expand the CON process through rule changes.

Thanks to the WSMA for providing material for this article.  For further information on this case, please contact WSMA staff members: Denny Maher, JD, MD at denny@wsma.org or Tierney Edwards, JD at tee@wsma.org.

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Calendar

RADToberfest
October 1-Nov. 4, 2015
RADPAC is currently promoting Radtoberfest—an opportunity to support the national Political Action Committee that represents the interests of radiologists.  For more information on how to get involved, visit the RADPAC website.

Make a Change, Have an Impact: Put Your Ideals Into Practice with Doctors Without Borders
You can change your life by attending an upcoming Doctors Without Borders recruitment information session for medical and non-medical professionals in Seattle.
Seattle Info Session
Thursday, October 15, 2015 at 7:00 PM
Belltown Community Center
415 Bell Street
Seattle, Washington 98121
Click here to attend the Seattle session.

Choosing Wisely Summit
Friday, Oct. 30, 2015, 9 a.m. to 4 p.m.
Seattle Airport Marriott
3201 South 176th Street, Seattle, WA 98188
Join health care leaders, stakeholders and national Choosing Wisely representatives on Friday, Oct. 30 for Improving Value in Health Care: The Choosing Wisely Summit, a day-long, in-depth look at how the Choosing Wisely initiative in Washington state is moving from education to implementation.
If your practice or clinic is working to integrate Choosing Wisely recommendations into daily operations, this conference will give you the tools and inspiration to implement change within your care setting.
This activity has been approved for AMA PRA Category 1 Credit ™
For more information and to register online, please visit the website for the event.

WSRS Annual Meeting
Saturday, November 7, 2015
Venue:  W Seattle Hotel
For more details and to register, visit the WSRS Annual Meeting page

Fusion of Imaging in the PNW
Bellevue, Washington, March 19-20, 2016
The Pacific Northwest Chapter of the Society of Nuclear Medicine and the Pacific Northwest Radiological Society will hold their annual meetings jointly at the Hyatt Regency in Bellevue, Washington, March 19-20, 2016. Please save the date for this exciting program that will feature parallel tracks with relevant, educational topics in both anatomical and functional imaging. For more information, visit the PNWRS website.

ACR 2016 | The Crossroads of Radiology®
May 15–19, 2016
Marriott Wardman Park Hotel
Washington, DC
Resident & Fellow Section
May 14–15, 2016
Registration opens Oct. 15
Abstract submission open Oct. 5–Jan. 8
To view testimonials of those who attended the 2015 ACR Annual Meeting, click here.

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