February 2018

President’s Viewbox

by Pooja Voria, MD, MBA, President, WSRS

Dear Colleagues and Friends,

2018 is off to a great start! We are more than half way into the state legislative session, which is only eight weeks long this year. Although it is a short session, it has been packed with several bills that could affect us as radiologists, including balance billing, network adequacy, breast density, and tomosythesis coverage, just to name a few.

On February 1st, radiologists from around the state attended our 5th Annual Olympia Advocacy Day. Meeting with our legislators year after year gives us a voice and increases visibility for our profession. Thank you to our members, including residents and fellows, who participated in this important event.

We also kicked off the year with a Young and Early Career Professional Section (YPS) financial planning event on January 27th. We not only learned about planning our futures but also had a chance to network with other YPS members in the area.

On March 11th, we will co-host our first mentoring event for women residents and fellows. The WSRS Committee on Women and General Diversity has been working with the Women in Radiology group at the University of Washington to develop this program for women radiologists to mentor trainees. This is a wonderful opportunity for seasoned radiologists, radiation oncologists and medical physicists to share experiences and wisdom with the younger generation. I hope to see many of you there.

Registration for the 2018 Annual Meeting of the American College of Radiology (ACR) in May is open! Please let our office know if you will be attending (as soon as possible), as we would like to include you in our various activities that we will have in Washington DC, such as our board dinner meeting and visits to congressional offices during the Day on the Hill.

Finally, please save the date for our annual WSRS Meeting on Saturday, November 3, 2018 at the new Embassy Suites hotel near Century Link Stadium. More details will follow this year.

For those of you who are interested in improving your leadership skills, please remember that we offer scholarships to the Radiology Leadership Institute (RLI) programs. The RLI offers a variety of both in-person and distance-education courses to meet your needs. Additional course information can be found on their website: https://www.radiologyleaders.org/. If you are interested in applying for a scholarship, please contact Debra Alderman, the WSRS executive director, at debra@wsrs.org

Once again, thank you for your support. I look forward to seeing you at one of our events this year.

Warmest regards,

Pooja Voria, MD, MBA, President, WSRS

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Government Relations Report

Phil Lund, MD, Chair; Jim Hedrick, WSRS Lobbyist

Day of Advocacy in Olympia, 2018

February 1st was the WSRS’ Lobby Day in Olympia. Nearly 30 individuals participated including diagnostic radiologists, radiology oncologists, and practice administrators came together for a day of advocacy in our state capitol. Among the participants were nine residents from training programs at the UW, Virginia Mason and Madigan Army Medical Center. The group included quite a number of Seattle residents, but also people who traveled from Spokane, Prosser, Tacoma and Gig Harbor to participate. The goal was not only to inform lawmakers about our perspectives on current legislation, but also to build relationships with legislators. It’s a great experience getting to know how state-level government works and how you can make a difference. Please make the WSRS “Day in Olympia” next year a part of your plans. Information about the date and time for the 2019 Day in Olympia will be announced via email and on our website by summer 2018.

Members of the WSRS delegation stopped  for a quick photo in the state capitol rotunda between visits to legislators. This year the group included both diagnostic radiologists and radiation oncologists and trainees. 


Members of WSRS as well as leaders of Washington State's Radiology Business Manager's Association (RBMA) met with Jason McGill, (far end of table) of the Governor's healthcare policy staff. 


Shawn Call of the Virginia Mason residency program (center right), effectively utilized visual aids to help him explain imaging technology advances to a legislative aid.


Dr. Jeff Robinson, of the UW Medical School faculty (left) and Dr. Joshua Rosenbaum, a radiology resident at the UW, (center), provided  important perspectives to lawmakers on bills of interest to radiologists being considered in the legislature this session.


Radiologists from around the state used the lunch hour to develop strategies for effective advocacy. 


Key legislation this session:

While the group was in Olympia on February 1st, there was an opportunity for WSRS Vice-President Dr. Ruben Krishnananthan to testify before the Senate Health Care Committee asking the panel to support legislation concerning health care provider networks. Senate Bill 6470 would require the state Insurance Commissioner to approve the adequacy of a health plan's proposed provider network; including a determination of enough contracted providers at contracted facilities to ensure enrollees have in-network access to covered health services. The adequacy of provider networks has become a focus of legislative discussions this year in Olympia as legislators are contemplating a bill to end the practice of “balance billing” or a charge for services to patients when they are provided health services by an out-of-network provider.

The 2018 legislature is contemplating two pieces of legislation concerning mammography. Senate Bill 5912 is supported by WSRS and overwhelmingly approved by the state Senate. The measure directs the state to ensure the existing mandate to provide mammography services, at no cost to the patient, includeing coverage for tomosynthesis (3D mammography) under the same terms and conditions currently allowed for mammography under health plans for all disability, HMOs, and public employee health plans.

Another bill concerning mammography has been considered by state lawmakers for several years now. Senate Bill 5084 would require, after a mammogram, a health care facility to send the patient a notification that identifies the patient's individual breast density classification. Versions of this bill have been introduced over the past several years and WSRS has a long history in these discussions. In order to better manage this conversation, WSRS participated in the drafting of the current version of the bill by providing suggested patient notification language acceptable to the WSRS Breast Imaging Task Force that also is strongly supportive of our core interest in optimal patient care. SB5084 passed the state senate during this year’s legislative session on a unanimous 48-0 vote. The bill is expected to have a much tougher time garnering passage in the House where the bill has languished in years past due to concerns of the bill possibly resulting in unnecessary testing, interfering in the physician-patient relationship, and liability risks for facilities that fail to notify. WSRS has taken a neutral position on the bill as many WSRS members have strong feelings on both sides of the issue.

Additionally, WSRS is concerned with other bills in play this session. If you would like to receive Jim Hedrick’s weekly legislative updates, let Debra Alderman in the WSRS office know and she’ll be happy to forward them to you.

Updates as of 2-27-18:

Please be advised Senate Bill 5912, regarding tomosynthesis as a mandated coverage, just passed the House on a 95-2 vote. No House amendments, thus it has passed the legislature. The governor could sign this legislation into law as early as next week.  We are hoping some members of WSRS will be able to be present at the signing ceremony as we have been supporting this bill throughout the session and are very pleased at its success. 

In addition, the breast health notification bill, SB 5084 is on the House floor calendar and eligible for a floor vote at any time. 

Regulatory issues:

Gold Carding:

The Washington State Office of the Insurance Commissioner (OIC) started a rulemaking process in September 2017 concerning “Gold Carding” programs whereby insurance carriers grant some providers a distinct status allowing a waiver of prior authorization for procedures. OIC became concerned that these arrangements may not be regulated sufficiently to assure fairness and protect patients and stakeholders were asked for comments on proposed rules in October 2017. After the initial discussions, in November 2017 OIC decided to withdraw the rule-making on gold-carding.

In a statement, OIC said it remains very interested in the development of this practice, with a focus on keeping it transparent for providers and consumers and making sure consumers can access services appropriately.

Extremity Ultrasound:

The Health Technology Assessment (HTA) program within the Washington State Health Care Authority (HCA) began a preliminary literature review in anticipation of assessing the efficacy and cost effectiveness of extremity ultrasound in fall of 2017. Dr. Ruben Krishnananthan, on behalf of WSRS, submitted medical literature at the request of HTA in September 2017. Since that time, the HTA has indefinitely delayed further assessment of extremity ultrasound.

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Preparing for mass casualty imaging scenarios

Jeff Robinson, MD, WSRS board member

As little as we like to think of it, a major disaster could occur in any of our locales at any time. Be it extreme weather, a mass shooting or a transit collision our emergency departments have the potential to be overwhelmed at any time.

A mass casualty incident is defined as an occurrence where the available resources are exceeded by demand. As the physicians managing imaging resources, it is the radiologists’ job to work with the ED providers to ensure that essential imaging is done.

There are more facets of a disaster plan than can be addressed in one column, but I would like to start with an idea and some suggestions.

The idea is triage. We are all familiar with the concept, in which victims are divided into groups by the severity of their condition. One group consists of those expected to die no matter what is done; another group includes patients expected to survive and a final group includes patients for whom intervention has the greatest likelihood of improving survival. When imprecisely done, “overtriage” results in overutilization of scarce resources, which may deprive seriously injured patients of needed care. “Undertriage,” in which insufficient attention is paid to seriously injured patients, is less of an issue once patients arrive at the hospital. In a disaster situation, our role as radiologists should be to consult with the ED providers to ensure that they are not overscanning: imaging mildly injured patients at the expense of severely injured ones.

In a mass casualty situation, you must adjust your scanning techniques to speed throughput. Your standard protocols which may have arterial and venous phase, delayed scans, or sophisticated post-processing built into the scanner’s protocol book, need to be set aside. Streamlined protocols with minimal acquisitions (non-contrast head and venous phase pan scan, for example) and minimal post-processing (sagittal and coronal MPR only) should be to be used during a disaster. It is too late if you have to program the scan when you need it. Be prepared to read at the scanner console and issue provisional reports to the ED and surgeons with pen and paper which you can clean up later with more complete and careful dictations.

Hopefully your preparations will never be needed, but we have to assume that, unfortunately, a major disaster of some sort will occur.

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PAC Report

Jonathan Medverd, MD, Chair

Do you have a relationship with your local legislators? Do they know who you are (and vice versa)? A long-term goal of WSRS PAC is for our state legislators to know the radiologists, radiology oncologists and medical physicists in their districts and to look to them as a resource of trusted information regarding any and all health care issues in our state.

Challenge yourself to making this vision a reality. The benefits to your practice, the House of Medicine, as well as your individual professional satisfaction will be substantial. This is an election year. Endeavor to establish three contacts between yourself or your practice and your local legislators between now and November. “Contacts” can be letters or phone calls or, ideally, in-person activities such as your attendance at an event where your legislators are present. These might be events hosted/visited by your legislator or other groups. But you can also create an opportunity to get to know your district lawmakers by inviting them for a tour of your practice facilities. The specifics of what makes most sense will vary by situation. What is important, however, is to begin establishing a mutual familiarity that will lead to a relationship. WSRS PAC and the WSRS government relations committee are available to help and support you and your colleagues.

In our representative government, presence, visibility and voice are imperative. Please let us assist you. Contact Debra Alderman in the WSRS office at debra@wsrs.org or call 206-956-3650 and she’ll connect you with the PAC and government relations committees.

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Payer Relations Report

Sammy Chu, MD, FRCPC (Chair of CAC/Payer Relations Committee)

Washington State All-Payer Claims Database (WA-APCD)

In 2014, the Washington State Legislature passed a law establishing an all-payer claims database. This is an attempt by the state to create more price transparency in the complex health care arena. Already established in 13 other states, the all-payer claims database will collect claims data directly from the payers, whether they be the Medicaid program, health insurance carriers operating in the state, third-party administrators paying claims on behalf of health plans, or Labor & Industries. These entities are mandated to supply the information; there are very few exceptions. The information collected will include billed amounts, allowed amounts, and paid amounts, for select procedures. Provider data will also be collected (though I don’t believe that this will be at the individual physician level at this time). The ultimate objective of the WA-APCD is to provide the citizens of Washington State a resource to determine what a medical procedure should be expected to cost in their city.

Since 2014, the state Office of Financial Management (OFM) has been tasked to write rules to get the database off the ground. The OFM has contracted out management of the database to the Center for Health Systems Effectiveness at Oregon Health Sciences University. The project is ready to be launched, and WA-APCD would like to allow providers an opportunity to review the information collected and request corrections to any errors found. This Review and Reconsideration (R&R) process just launched last month, and it is not too late to register. More information can be found at the following website:

More Information

Those radiologists with ownership in “outpatient diagnostic centers” (i.e. outpatient clinics) will want to take note that several imaging exams will be reported on the public website, such as mammography, OB ultrasounds, pelvic ultrasounds, and lumbar spine MRIs. It will likely be worth your while to engage in the R&R process. Further details are available at the above website.

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Residents & Fellows Section (RFS) Report

Anika McGrath, MD; PGY-5, WSRS RFS President, UW Chief Radiology Resident

This past year has been exciting and productive for the WSRS Resident and Fellow Section (RFS). At the WSRS Annual Meeting, senior UW radiology resident Dr. Joshua Rosenbaum was selected to give a presentation entitled, “Why patients no-show for their radiology appointment and what we can do about it.” Dr. Meghan Macomber, UW chief resident in radiation oncology, assisted Dr. Diana Lam in organizing the first medical student break-out session at the annual meeting which had a great turn-out! The RFS Career Lunch panel was also a great success. We want to once again thank our panelists, Drs. Udo Schmiedl, Leila Bender, George Wang, and Tom Mullen for the invaluable career advice and mentoring opportunities.

We also had strong resident participation at the annual WSRS Day of Advocacy in Olympia. Residents who attended included UW trainees: Joshua Rosenbaum, MD; Patty Ojeda, MD; Tanner Clark, MD; Keegan Hovis, MD; Meghan Macomber, MD and Anika McGrath, MD. The Virginia Mason trainees were Shawn Call and Carolyn Clark. And representing the radiology residency program at Madigan Army Medical Center was Hannah Chen, MD. It was fun to advocate for radiology-related issues such as mandatory insurance coverage for tomosynthesis and strengthening oversight of insurance network adequacy. We left the day inspired by how political advocacy impacts our field, how our state legislators can benefit from our expertise, and how important it is to become an invested member in our field at an early age.

We are looking forward to the upcoming ACR meeting in May. We want to once again thank all the committee and board members who helped serve as mentors on residents abstracts for the upcoming meeting. We really appreciate your thoughtfulness and generosity with your time. We look forward to seeing everyone in DC!

Radiology and radiation oncology residents from three of the training programs in Washington State participated in the Day of Advocacy in Olympia on a rainy  Feb. 1, 2018. UW, Virginia Mason and Madigan Army Medical Center residents enjoyed working together and networking and learning about the political process in our state capitol. 


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Young and Early Career Professionals Section (YPS)

Diana Lam, MD, chair

The WSRS Young and Early Career Professionals Section (YPS) had a successful winter dinner event focusing on the topic of financial planning for young physicians. The speaker was certified financial planner Brian Torgerson. Topics ranged from wealth planning and saving to disability and longer-term health insurance to estate planning. Thank you for those that were able to attend - it was great to meet and to catch up with other early-career radiologists! Be on the look out for our future events. Upcoming activities will be posted to the events page of the WSRS website: https://wsrs.org/events-calendar/

Gathering for the second WSRS YPS event since the group was established last year, young radiologists from the Puget Sound area met on a Saturday evening in late January to learn about financial planning from an expert, Brian Torgerson, CFP. 


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Mentoring event for women March 11th

The WSRS Committee on Women and General Diversity and UW's Women in Radiology are co-sponsoring our first Women's Mentoring Event on Sunday, March 11, 2018 from 1-4 p.m.

The Washington State Radiological Society and the UW Women in Radiology group are pleased to jointly host an afternoon of mentorship and networking for women radiologists, radiation oncologists and medical physicists along with residents and fellows.

This will be a casual afternoon including a mentoring panel and round table discussions — with a diverse array of women professionals. We will have representatives from various practice settings, such as private practice, academia, and teleradiology.

Highly requested topics such as job hunting, offer negotiations, career advancement, work life balance, and burnout will be covered. There will also be plenty of time for trainees and young professionals to get their questions answered and to connect with fantastic mentors and mentees. There is no charge to attend but space is limited, so register now!

The event will be held at the UW’s Waterfront Activities Center, located behind Husky Stadium, just a few steps away from the UW light rail station.

A light lunch will be served. There is no charge to attend but space is limited. Please RSVP by emailing sauer@uw.edu Please include your full name, location of your practice or training program, and any dietary restrictions or requests for accommodations we should be aware of.

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Save the Dates

ACR Annual Meeting in Washington DC, May 19-23, 2018. Registration is now open on the ACR website. If you plan to attend, please contact Debra Alderman in the WSRS office so we can include you in the WSRS activities in DC including a dinner for our group at a restaurant on Monday evening, May 21 and the day of advocacy on Capitol Hill on Wednesday, May 23. Debra will be making the appointments with members of Congress and their staffs for all of our WSRS members, so please let her know if you’ll participate. Please provide her with your home (voting) address and your cell phone number. She can be reached at: debra@wsrs.org or call 206-956-3650

WSRS Annual Meeting- November 3, 2018, at the brand new Embassy Suites hotel near Century Link Stadium in Seattle. Details will be posted on this page of our website soon.

FACR nominations for the 2019 convocation year should be submitted between April 30 and May 31, 2018. For more information, visit this page of our website.

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