November 2017

President’s Viewbox

By Pooja Voria, MD, MBA, President, WSRS

 

Dear Colleagues and Friends,

Thank you to all who attended our very first joint annual meeting with the WSMA on October 14th. Once again, I would like to thank Dr. Puneet Bhargava for a very successful program. This meeting also provided an opportunity to mingle with referring clinicians and put forth a “face of radiology” in the house of medicine. A special thank you to Dr. Diana Lam, Dr. Anika McGrath and Dr. Meghan Macomber for their efforts in developing the resident/fellow and medical student sessions.

In addition to our annual meeting, we have been very busy this fall hosting a variety of events across the state. We held our first networking event with the Young and Early Career Professional Section (YPS) at Puzzle Break, a local “escape room” experience. Unfortunately, we didn’t “escape,” but it was a fun opportunity to meet other YPS members in the radiology community. We will continue to host events for the YPS in the upcoming year. Our next event will be a dinner discussion regarding financial planning on January 27th  (more details on this event are included in this newsletter).

November 8th 2017 has been proclaimed as the Washington Day of Radiology by Washington State Governor Jay Inslee and  Spokane Day of Radiology by Spokane Mayor David Condon. This is also the day celebrated world-wide as International Day of Radiology (IDoR), commemorating the discovery of the X-Ray by Wilhelm Conrad Röntgen on November 8, 1895. This year IDoR celebrates the essential role radiologists play in the emergency room. The WSRS sponsored a networking event in Spokane where radiologists from Radia, Inland Imaging and other local practices gathered to celebrate IDoR as well as the International Day of Medical Physics (November 7th). 

The WSRS Committee on Women and General Diversity is working with the University of Washington Radiology Department to host a mentoring program for residents and fellows early next year. If you are interesting in being a part of this mentoring event, please let us know.  A survey asking female members of WSRS has been set up and invitations to participate in it went out earlier this month.

Finally, our annual Olympia Advocacy Day is set for February 1, 2018. Please join us and make the “Voice of Radiology” heard loud and clear in Olympia. It’s a fun and unique experience that I encourage all radiologists to participate in at least once in their career. Please contact our office to let us know if you can attend.

As always, the WSRS board is open to suggestions from our membership. So if you have an idea, want to help out at an event, or get involved, please do not hesitate to contact me at wsrspresident@gmail.com or Debra Alderman, our executive director, at debra@wsrs.org. Have a wonderful upcoming holiday season!

Warmest regards,

Pooja Voria, MD, MBA, President, WSRS

 

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WSRS Annual Meeting Highlights

On October 14, 2017, WSRS members, members-in-training and medical students participated in the WSRS Annual Meeting at the Hilton Airport and Conference Center. The meeting was held jointly with the WSMA’s annual meeting. Highlights included Dr. Tim Swan and Dr. Larry Muroff, representing ACR, providing valuable presentations on a variety of topics. 

The lunchtime career launch forum for radiology and radiation oncology residents and fellows and the special program for medical students were well attended and featured lively questions and answers. 

The Annual Business Meeting featured recognition of four 100% membership practices: TRA-MINW, Radia, Vantage Radiology and Via Radiology.  Dr. Charles Rohrmann was presented with the 2017 WSRS Gold Medal Award (see article about Dr. Rohrmann, below).  Officers and committee chairs provided updates on their areas of responsibility and elections were held.

Thanks to all who participated, particularly Dr. Puneet Bhargava who chaired the program and also presented the Doug Green Memorial Lecture for 2017.   See photos below and more will be  available to view by the end of November on our website

And save the date for the 2018 Annual Meeting:  November 3, 2018.

Many of the attendees at the annual meeting gathered for a photo with some of the special guests including Gold Medal Award winner Dr. Chuck Rohrmann, far left, and Dr. Larry Muroff and Dr. Tim Swan of the ACR, back row center.
 

The Annual Meeting was a great opportunity for friends and colleagues to reconnect.
 

This year the Annual Meeting was well attended by medical students from the University of Washington (Seattle) and the Pacific Northwest University of Health Sciences (Yakima). 
 

Dr. Puneet Bhargava, program chair of the meeting, delivered the Doug Green Memorial Lecture. His topic was, “Diversity in collaborative behaviors: Giving, taking, and matching.”
 

Dr. Pooja Voria, President of WSRS, chaired the annual business meeting of the WSRS which included presentation of awards, committee reports and elections.

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Gold Medal Award

Charles “Chuck” A. Rohrmann, Jr., MD, FACR honored with WSRS 2017 Gold Medal Award

Dr. Pooja Voria presented Dr. Chuck Rohrmann with the prestigious Gold Medal Award on behalf of the WSRS at our annual meeting on October 14, 2017.  The presentation included two of the radiologists who trained with and were mentored by Dr. Rohrmann and a slide show with highlights of his career. 

After serving in the US Air Force and completing his medical training and residency, Dr. Rohrmann began his career on the faculty of the University of Washington in 1975.  He served as Director of GI Radiology from 1975-2000, Director of the UW Radiology Residency Program from 1978-1999, associate director of the program from 2000-2007, and Vice Chair of UW Radiology from 1985-2000.

Dr. Rohrmann is as respected by his colleagues as he is beloved by his residents and fellows. Dr. Rohrmann, who has been on faculty at UW Medicine since 1975, has served the Department of Radiology's residency program for almost 30 years, and is responsible for establishing and upholding the high standards the program maintains today.

Dr. Rohrmann has been an exceptional role model to many of the northwest’s radiology professionals who had the opportunity to learn with Dr. Rohrmann during his long career at the University of Washington. Among those is Dr. Mary Kellly, who provided a touching testimonial to Dr. Rohrmann’s influence at the ceremony at which he received his award.  Here is an excerpt of her remarks:

“At the heart of every residency is the individual whose integrity and energy inspires the trainees and holds them accountable to achieve the highest level of performance. Within the University of Washington diagnostic radiology residency, Chuck Rohrmann was that person.”

“Chuck’s expertise in GI radiology gave him enormous credibility. Patient care and teaching came to the fore in his interactions with the residents and fellows. That penetrating, amused gleam in his eye pinned you … he knew you, and he expected you to do the right thing. And for that, what better role model?

Chuck was our gateway to an incredible profession within medicine. If I had to indicate the single individual most important in my development as a radiologist, it would be Charles A. Rohrmann, Jr. Thank you, Chuck!”  --MARY KELLY, M.D. ’80, RES. ’84

The Rohrmann Endowment for UW Radiology Resident Educational Excellence was established to help support radiology residents' opportunities to extend their learning beyond the classroom with attendance at conferences, participation in research and community service.  To learn more about the Endowment and how you can make a contribution in honor of Dr. Rohrmann, visit this website.

 

Dr. Pooja Voria presented Dr. Chuck Rohrmann with the prestigious WSRS Gold Medal Award for 2017.

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IDoR 2017

State and city-level Day of Radiology celebrations and proclamations

In order to elicit more recognition of the important role of diagnostic and therapeutic radiology to the health and wellbeing of our state’s residents, WSRS requested that Governor Jay Inslee make an official proclamation of Washington Day of Radiology, November 8, 2017.  His office confirmed that he has granted our request and sent us a copy of the proclamation

We also reached out to select cities around the state, requesting their mayors and city councils make similar, city-wide Day of Radiology proclamations in conjunction with International Day of Radiology, November 8, 2017 – the anniversary of the discovery of the X-Ray.

The Mayor and City Council of  Spokane proclaimed Spokane Day of Radiology and council member Amber Waldref read the proclamation at the November 6th Spokane City Council meeting.  WSRS board member Som Prabhu, MD was on hand to provide a few remarks about the role of radiology in healthcare.
 

Dr. Som Prabhu made brief remarks to the Spokane City Council and fellow citizens at the council’s November 6, 2017 meeting.  Spokane has proclaimed November 8, 2017, “Spokane Day of Radiology.” 

 

Spokane City council member Amber Waldref, far right, read the “Spokane Day of Radiology”  proclamation and stopped for a photo with representatives of the radiology community (left to right): Dr. William Keys and Dr. Terri Lewis of Inland Imaging, and WSRS board member, Dr. Som Prabhu, of Radia, Inc.  (holding the proclamation).

WSRS sponsored a networking event in celebration of the Spokane Day of Radiology/International Day of Radiology on Wednesday, November 8th at the Steel Barrell in downtown Spokane. 

Vancouver, Washington’s Mayor and City Council have also proclaimed a day of radiology in their city for 2017.  We hope to hold a social event for Vancouver and Portland area radiologists in early 2018.

If you’d like WSRS’ help submitting a proclamation request to your city council and mayor for Day of Radiology 2018, please contact our office and we’d love to assist.

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Government Relations Update

By Jim Hedrick, WSRS Lobbyist

The Big Picture:
This week's election results from the 45th Legislative District  showed that Democrat Manka Dhingra, a King County Prosecutor defeated her Republican opponent, Jinyoung Lee Englund, a former congressional staffer. This victory means that the Democratic party will have a majority in the State Senate in the coming term. Pundits are now predicting what impact that shift in power may mean for the legislative agendas of various constituencies in the coming year.

Legislative negotiations are on-going on how or if the legislature will address the water rights issue created by the state Supreme Court’s Hirst decision a year ago. The ruling places a much higher legal threshold to drill wells in rural areas of the state. Politically the issue has been tied to passage of the state capital budget, which for the first time in state history, was not enacted by the legislature in 2017. There is conjecture the legislature may convene in an end of year session, prior to January to address both the Hirst and capital budget issues. Regardless both issues are expected to dominate the 2018 legislative session.

State Revenue / Economic Update:
The latest state quarterly economic and revenue forecast was released on September 20. State revenue collections are forecasted to increase over $270 million in the current 2017-19 biennium. The state revenue forecast council says the U. S. economic forecast is similar to June and personal income and employment in Washington state are slightly higher. As has been the case for some time, Washington’s economy is continuing to outperform the nation. State general fund revenues grew 13.8% between the 2013-15 and 2015-17 biennia and are now expected to grow 12.9% between the 2015-17 and 2017-19 biennia.

Balance Billing:
WSMA has recently conducted on survey of its members regarding the approach to the balance billing issue in the upcoming 2018 legislative session. Below is a WSMA summary of the survey results by issue.

  • Reimbursement:
    • Throughout negotiations, we have focused most closely on provisions related to reimbursement. As with other areas of the survey, responses here were mixed. On the question of whether benchmarking to less than the 80th percentile of physician charges, most won’t go lower, though several said 70th percentile would be acceptable.
    • Most respondents said that Medicare is not an acceptable benchmark. Of those who identified an acceptable percentage, it ranged from 133 to 400 percent. Similarly, most said that Medicaid is not an acceptable benchmark. Those who identified a percentage were between 200 and 300 percent.
    • Some were open to OON reimbursement tied to a carrier’s median contracted rate, depending on details of how the rate would be applied.
       
  • Dispute resolution:
    The vast majority of respondents didn’t have direct experience with either mediation or arbitration of claims. Among those who had a preference between arbitration and mediation, opinion was evenly split. In either event, most favored a dispute resolution system where the arbitrator/mediator could split the difference between the parties’ final offer (rather than a “winner take all” system).
     
  • ERISA/Self-funded:
    ERISA poses a major problem as state law generally cannot compel self-insured plans to comply with balance billing legislation. Most respondents felt it was reasonable to require insurance companies to identify the nature of their plan (so physicians would know whether balance billing is permissible), and felt that insurers, rather than physicians, should bear the burden of solving the ERISA problem.
     
  • Network adequacy:
    The vast majority of respondents felt that network adequacy is an important issue, and most feel that a requirement for carriers to contract with physician groups operating within a facility (rather than in a region) would be useful if enforced. Most were open to other network adequacy requirements as well.
     
  • Transparency:
    With regard to transparency requirements, sentiment was mixed. Respondents were split on whether it is reasonable to require physician groups to list carriers they’re contracted with on a website, as well as requiring them to notify hospitals when they terminate a contract with a carrier. A requirement for scheduling entities to notify patients of the potential for balance billing similarly drew mixed reviews. Several respondents said they felt it was reasonable to require standard disclosures to patients warning of the potential for balance billing.

Gold Card Programs / Alternative to Prior Authorization:
Our lobbyist Jim Hedrick attended the Office of Insurance Commissioner (OIC) stakeholder meeting on proposed rule 2017-07 concerning gold card programs / alternative to prior authorization in October. The OIC became concerned about arrangements in contracts (found on audit) concerning relationships between plans and carriers that were alternative to prior authorization. The OIC has concerns about prior authorization being waived. The OIC says it needs “ground rules” to ensure fairness, protect patients, ensure a level-playing field. OIC does not like the name “gold card program” and is exploring a “better name” including: provider recognition program, provider utilization management, alternative authorization process.

OIC cannot answer how prevalent gold card programs are currently. WSMA and WSHA asked that the OIC delay the rulemaking process and get a baseline of data. OIC wants a rule – expedited. OIC is seeing gold carding programs in contracts but also done through “verbal agreement.” OIC wants to mandate written agreements.
 

Save the Date for the 2018 WSRS Day of Advocacy in Olympia:  February 1, 2018.  For details as they are firmed up, visit the Annual Olympia Day page of the WSRS website.

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YPS

Young members escape from routine at first YPS event

WSRS’ newest initiative is a Young and Early Career Professionals Section (YPS). The board has appointed two YPS co-chairs of this new ad hoc board committee that is charged with serving the needs of professionals under 40 or within their first eight years after training. Dr. Diana Lam, of the University of Washington, and Dr. Brad Fehrenbach, of TRA-MINW, are the co-chairs.  In addition, Dr. Som Prabhu, our YPS representative to the ACR and other young physicians on the board, are helping to reach their colleagues and encourage their participation.

The first WSRS Young and Early Career Professional Section (YPS) event was a success, with our members working together to solve hidden puzzles during an escape room event. Although they were not able to escape, they had a lot of fun trying to accomplish the task as a team.

The next YPS event will be a dinner and program at Wild Ginger in downtown Seattle on Saturday evening, January 27, 2018. Arrival 6:30 – 7 p.m.  Dinner and program at 7 p.m.  The guest speaker will be Brian Torgerson, a certified financial planner offering tips on financial planning for young physicians. 

There is no cost to attend and a complimentary dinner is included.  Members under 40 or within their first 8 years after training are encouraged to attend.  Please RSVP by 1/22/18 via email:  debra@wsrs.org and mention any dietary restrictions.

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RFS

Residents and Fellows gained valuable insights and experiences at WSRS Annual Meeting
By Joshua Rosenbaum MD, UW Diagnostic Radiology PGY-5, Chief Resident of Research

The WSRS annual meeting this year proved to be an excellent opportunity to promote diversity and career development for trainees within the field of radiology.

This year’s meeting combined with the Washington State Medical Association was a good opportunity to network and expand our own perspective on the medical field. Dr. Lucy Kalanithi’s presentation about her journey through her husband's illness, documented in the book When Breath Becomes Air, was an important reminder of why we serve as physicians. As radiologists, we sometimes lose perspective on the humanistic aspect of medical care. Remaining in tune with challenging health care situations can certainly help us all be more compassionate radiologists. Additionally, Dr. Bhargava's talk on "Giving, Taking and Matching" was an important reminder that there is great diversity in personality types and that developing greater understanding of these can significantly improve how we work with one another.

The Residents and Fellows lunchtime career launch program was particularly helpful for trainees preparing to search for their first jobs.  RLI representative Dr. Larry Muroff's talk about "What They Didn't Teach You But Really Need To Know," provided extremely valuable information and insight about varying job opportunities.  It was helpful to learn about recent survey data of the radiology job market and what kinds of questions to ask at a job interview.

The RFS' career panel which included by four young professionals sharing their own career launch stories, was invaluable in providing a confidential and informative question and answer section along with fruitful opportunities to network.

RFS members participated in a portion of the medical student program. This was a nice opportunity to practice mentorship skills and gain some additional perspective about our own practice of radiology.  Lastly, the privilege of presenting my own talk at this year’s annual meeting allowed me to develop and gain comfort with presentation skills at a statewide level. These opportunities to develop, grow, learn and network are perfect examples of the added value WSRS can provide to members in training. 

The residents and fellows program at this year’s annual meeting featured both a talk from RLI speaker Dr. Larry Muroff and a panel discussion with practical tips on their career launch.  Members in training who attended included residents from the UW, Madigan, and as far away as Colorado.
 

Panelists at this year’s residents and fellows lunchtime career launch session included, left to right, Tom Mullen, MD, of Asante – Three Rivers Medical Center, Grants Pass, OR; George Wang, MD, TRA-MINW, Tacoma; Leila Bender, MD, Radia, Seattle; and Udo Schmiedl, MD, University of Washington, Seattle.

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Spotlight on Diversity

Insights from ISC on inclusion and unconscious bias
By Peter R Eby, MD, FACR, FSBI, Chair, WSRS Breast Imaging Task Force

Jay Baker, MD, FACR, FSBI, Yasmeen Fields, CAE and I represented the Society of Breast Imaging (SBI) at the annual ACR Intersociety Summer Conference (ISC) in Annapolis, Maryland in early August. The lively and serious meeting, subtitled “Diversity, Inclusion and Unconscious Bias,” was chaired by Jonathan B. Kruskal, MB, ChB, PhD, FACR. It was my first invitation to the ISC meeting and I was very excited by the topic. I know what you are thinking because the same thought crossed my mind. Why did the SBI send two straight white guys to a meeting on diversity? Dr. Baker represented us as the Vice President of our society and I provided coverage for our newsletter. Together with Ms. Fields we returned from the meeting inspired and full of ideas.

The keynote speaker, Brenda J. Allen, PhD, Professor of Communication and Vice Chancellor for Diversity and Inclusion from the University of Colorado, and author of “Difference Matters: Communicating Social Identity,” opened the meeting with a discussion of bias that engaged our collective desire to include representatives from all backgrounds and walks of life in our profession. She shared a quote that helped me acknowledge my own assumptions about people: “If you’ve got a brain, you’ve got a bias.” No one is immune. Nor is bias necessarily malicious. But we cannot remain silent.

We must acknowledge our biases openly as individuals and in groups because radiology and medicine have a problem. We do not attract physicians that equitably represent a cross section of our population. Certainly, we have no shortage of intelligent, ambitious, caring, curious and devoted doctors as the SBI embodies. But in many medical centers, hospitals and group practices we lack physicians who share some obvious characteristics with the patients they serve. For example, approximately 13% of the US population is African-American. Visit this link for the data. However, in 1975-76 of the 15,295 first year medical students, only 1,036 (6.8%) were African-American. And the decades have yielded no change in that fraction. Of the 20,627 first year medical students in 2015-2016, only 1349 (6.5%) were African-American. Visit this link for the data. The attendees at the ISC meeting were charged with developing strategies and tools to address these problems for our specialty and our patients.

Disparities, like those described above, negatively impact all of us in physical, moral and economical ways. Social identity is based on the perception of a group and being a member of that group. It provides comfort through a reflection of oneself. Patients who do not feel comfortable or respected may delay seeking medical care or withhold critical information to their detriment and, in turn, the detriment of society. Patients who seek timely treatment may go out of their way to receive care at facilities with physician representation they identify with.

Data also show that teams with diverse membership are more productive, creative, innovative and economically successful than homogenous teams.3  Multiple thoughtful articles from the Journal of the ACR, covering additional aspects of diversity, were recently curated by Kristina E. Hoque, MS, MD, PhD, and Elizabeth K. Arleo, MD in an online collection. Radiology and medicine need diverse teams to meet the ongoing challenges of health care for the sake of our patients.

While quotas for race, ethnicity, religion, gender and sexual orientation cannot be our sole focus, they do illustrate how distant we are from the destinations of diversity and inclusion. The US census provides data on our general population. Regional, state, county and neighborhood variations can significantly impact the relative ingredients in our melting pot. But what does radiology look like? And what does the SBI look like? We don’t exactly know.  Despite our evidence-based culture, we have never collected demographic data from our members so we don’t know how many men, women or under-represented minority members form the fabric of the SBI. For additional information on this topic, click here.

The SBI would like to know how closely our membership represents the US population so that we can actively engage our current and future providers for the benefit of our patients. To that end the SBI will offer you the opportunity to add demographic information, including gender, race and ethnicity, to your profile during the next billing cycle. It will not be a requirement; any such information will be confidential. Ultimately, we must create an environment of safety within the SBI and radiology that will attract all members of our human family. The SBI has committees for advocacy, international education and quality but no committee for diversity or inclusion yet.

The Washington State Radiological Society, however, is leading the way. Gail N. Morgan, MD, FACR, under the directive of then WSRS President Eric Stern, MD, FACR spearheaded WSRS as the first ACR state chapter to establish a Committee on Women and Diversity in 2015.  She presented this inaugural work on behalf of WSRS at the Chapter Leaders Workshop at the ACR Annual meeting in May 2016.  At the request of the ACR Commission on Women and Diversity, she developed a primer for implementation that is now being used as a model at the ACR for other state chapters.

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Spine imaging in trauma

By Jeff Robinson, MD, FACR, Harborview Medical Center

Harborview receives about 15 emergency transfers per day, accompanied by about 20 CT’s between them. We recently completed a review of over 600 CT’s of transfer patients, and found considerable variation in scanning techniques. While not surprising, this does have implications for diagnostic accuracy.

We all focus considerable attention to the cervical spine in trauma imaging, but often the thoracic and lumbar spine get cursory evaluations. At Harborview, the trauma surgery and spine services require explicit clearance of the spine before removing spinal precautions. In the trauma setting, we routinely reconstruct lumbar and thoracic spines retrospectively out of torso CT scans and report them separately. We believe the smaller field of view and thinner slices, both axial and MPR, result in higher sensitivity to nondisplaced fractures. If you do not do explicit spine reconstructions, we would encourage you to use a 3mm sagittal and coronal MPR slice thickness for your chest, abdomen and pelvis CT scans, at least in trauma and to include a section in your structured report specific to the spine.

The table below reflects Harborview Emergency Radiology scan parameters:

  Dedicated Spine Imaging General Torso Imaging
Slice thickness 2mm axial, sagittal,      coronal 3mm axial, sagittal, coronal
Reconstruction algorithm bone Soft tissue
RFOV 18cm variable

 

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Focus on Communication

By Katherine Choi-Chinn, WSRS Secretary

WSRS recently launched WA ACR state chapter Engage social platform. You are automatically enrolled if you are in the ACR database with the email that ACR has in their database.  You should had already receive the introductory email about a month ago. If you haven’t, please feel free to contact me  and we’ll get that rectified for you.

There are over 500 current members from diverse backgrounds. Whether you are solo, in a large private practice, military,  academic setting or employed this is the platform for you to network, communicate, or even problem solve. Members can be of all different stages of careers, from residents to retired radiologists, physicists or radiation oncologists. Questions, advice or commentary can be public or private, it’s your choice.

I’ve enjoyed the ACR Engage Forum and reached out to former colleagues, even made plans to meet one at RSNA last year! What a terrific platform. Engage is what you make of it. If you are involved in research and would like to collaborate with others- this is your opportunity to reach others likeminded.  Exploring job opportunities? This could a potential way to connect and ask questions. One opportunity that we will soon launch is standardizing trauma protocols so that when a patient goes to Harborview, repeat advance imaging would not be necessary improving care and decreasing radiation exposure. The possibilities are endless. It’s up to you to make the most of it and I look forward to hearing from you on Engage!

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Payer Relations

By Sammy Chu, MD, Payer Relations Chair and CAC Liaison

Your Payer Relations Committee continues to be hard at work.  Approximately one year ago, Noridian, the Medicare contractor for Washington State, proposed a policy for payment of chest x-rays.  It listed over 100 pages of ICD-10 codes that Noridian felt were appropriate indications for a chest radiograph. However, after teaming up with the California Radiological Society and taking a closer look at the list, we found large numbers of omissions.  During the comment period, we pleaded with Noridian to eliminate the list, as every other Medicare contractor in the country had done.  Barring that, we asked for more time to go through the list.

I am happy to report that Noridian revised their proposal, and instead of 100+ pages of codes to weed through, they have provided a “negative list” of codes they would NOT cover.  (In other words, Noridian will pay for everything else.)  The length of that list?  LESS than ONE page!  I greatly appreciate Drs. Mark Yeh and Mark Alson from California for their collaboration on this effort.

Just over a year ago, through the efforts of both your society and the Washington State Medical Association, the Washington State Legislature passed a bill requiring Radiology Benefit Managers (RBMs) in the state to register with the Office of the Insurance Commissioner (OIC).  In follow-up to the legislation, the OIC has now passed an administrative rule outlining the transparency needed for the pre-authorization process, the need to utilize “clinical review criteria based on reasonable medical evidence”, and deadlines for the insurance carriers to provide a determination (5 calendar days for a routine request).  For details, click here.   

This doesn’t solve the steerage issue, but it does show that the OIC is aware of the barriers that the insurance carriers are putting up to limit patient access.  If you are interested in further details, the WSMA is hosting a webinar at noon on Nov. 15.  To register and for more information, click here.

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Curbside Consults

Avoiding Pitfalls and Planning for the Future 
By Miranda Aye, JD, and John Graffe, JD

This article excerpt was provided by Physicians Insurance, A Mutual Company. To read the full, original version, visit the"Curbside Consult" link on the resources page of the WSRS website.

Most physicians are familiar with “curbside consults.” A physician approaches a colleague in the same field or a specialist in another, provides a very brief history of a real patient’s issue, and asks the colleague’s opinion on how to proceed. Generally speaking, few records, if any, are reviewed. The patient is not identified, and the consulting physician does not document or bill for services. These informal consultations used to occur mostly in hospital halls or lunchrooms or even by phone. Today the consultations can also take place via email or text message.

Curbside consults have likely been occurring ever since the practice of medicine first began, long before we even had curbs. They are a common and often valuable tool in the collegial field of medicine. Just as with any other aspect of medicine, if providers don’t act within the standard of care, liability can arise. However, because the degree of information shared and the questions asked of the consultant vary a great deal, the standards of how to act appropriately in these interactions are not always clear.

When Does Liability Arise?
Typically, for a medical malpractice claim against a physician to be successful, a physician-patient relationship must have been established first so that the physician owes the patient duty of care.

A true curbside consult usually doesn’t create such a relationship and duty. That’s why it should not create the potential for liability. However, the curbside consult should be informal and the advice given should be general in nature. When specific advice is sought or when a consulting physician’s advice will be relied upon for making treatment decisions, a formal consult may be more appropriate. Key to this interaction is clear communication between the consulting and attending physicians and clarification about the nature of the consult.

Be aware that the differences between a formal and an informal consultation can become blurred. If an on-call physician or a physician who is contracted to provide hospital coverage is sought for consultation, a seemingly informal meeting could be considered as the formation of a physician-patient relationship. The same goes in the setting of a supervisory role between the consulting and attending physician.

General Guidelines for Radiologists to Consider
When a radiologist is asked to provide an informal consultation, the first question he or she should ask is whether a formal consultation is necessary. Curbside consults are typically appropriate for general questions and low-acuity clinical questions. If the question is specific and/or complex, or when a radiologist knows that his or her interpretation will be relied upon in making treatment decisions, a formal consultation and a corresponding report may be more appropriate and safer for the patient.

Sometimes radiologists should document curbside consults. For example, if you’re asked to log in to a patient’s electronic medical record (EMR) for an informal review, you should be aware that the review becomes part of the EMR’s audit trail, and in litigation, audit trails are often requested and produced. You could find yourself involved in litigation for an informal consult that took place so long ago you no longer have any memory of it. Also be aware that someone else might create an electronic paper trail of an informal consultation. If that happens, it may be wise for you to document the consultation in the form of a letter to the requesting physician or whatever form is most appropriate. 

When providing a curbside consult, remember that any communications including confidential patient information must be in compliance with HIPAA and other health-care privacy laws. This applies even in nontraditional communications, such as text messaging or voicemail, as well as unique situations involving requests for consultations regarding mammograms.

Conclusions

  • Informal curbside consultations by radiologists can be a valuable tool, but they are not appropriate in every setting.
  • Legal responsibility is decided on a case-by-case basis. Two key steps to help mitigate the legal risks are (1) clear communication with the requesting provider and (2) documentation. Logging onto the EMR can have unique consequences.
  • If a secondary review results in a new or different interpretation, the consulting radiologist is responsible for ensuring that new or changed findings are documented and communicated appropriately.
  • Embracing changes in technology and formalizing curbside consults may help drive better patient care.
  • Above all, always acting in the best interest of the patient and taking steps to provide good care will be the best guiding principles.
  • For more information, visit this page of the ACR website  and this article in Imaging 3.0.

Editor’s note: this article was shortened due to newsletter space limitations and several key topics were not included in this version.  Please visit the WSRS website for the full text of this article, in pdf format, on the resources page of the WSRS website.

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Save these Dates

January 27, 2018 – YPS event at Wild Ginger, Seattle
Program will feature financial planning expert Brian Torgerson. Free to members under 40 and within first eight years after training.  See YPS article, above, for details. RSVP by 1/22/18 to Debra in the WSRS office:  debra@wsrs.org

February 1, 2018 - WSRS Day of Advocacy in Olympia.
For details as they are firmed up, visit the Annual Olympia Day page of the WSRS website. Please RSVP as soon as possible to Debra in the WSRS office:  debra@wsrs.org

May 19-23, 2018 – ACR Annual Meeting in Washington DC. 
Join WSRS members for a short meeting and dinner near the conference hotel on Monday evening, May 21 and join our delegation for visits to the Washington State congressional delegation on Wednesday, May 23. If you plan to attend, please contact Debra Alderman in the WSRS office by early April so she can schedule legislative appointments and plan the Monday evening dinner.   debra@wsrs.org

May 31, 2018 – WSRS members’ deadline to apply for ACR Fellowship for the 2019 convocation year. See the fellowship page of our website for details.

July 31, 2018 – Deadline for nominations for WSRS Gold Medal Award 2018.
See the Gold Medal Award page of the WSRS website for details.

August 31, 2018 – Deadline to apply for a WSRS Leadership Scholarship to be used for RLI programs in 2019. See the RLI Scholarship page of the WSRS website for details.

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WSRS

2001 Sixth Avenue
Suite 2700
Seattle, WA 98121


Phone:
(206) 956-3650

Website:
wsrs.org


Email:
wsrs@wsrs.org

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