WAEPS

Winter 2016

President’s Viewbox

by Eric Stern, MD, WSRS President

Dear colleagues,

After a very successful annual meeting in November 2015, with our highest registration ever, we began the New Year on a terribly sad note. Our WSRS meeting program chair, Dr. Douglas Green, a UW radiologist, died tragically in an avalanche while skiing in Big Cottonwood Canyon, Utah. He was 49. Doug was in the initial stages of planning our 2016 meeting, which will be dedicated to his memory. As many of you know, Doug was a wonderfully thoughtful, intelligent, and forward thinking radiologist with a deep understanding of our specialty and how it related to the many aspects of day-to-day work, business, and a vision for our future. For the past several years, Doug had a regular column in the JACR called a “Reading Room with a View”. It was here that we were witness to the insights into his very clever mind. I urge you all to revisit these many editorials.

For more information about Doug and the tragic accident that took his life, click here


Dr. Doug Green, center-right, cuts an x-ray-decorated cake at the November 2015 meeting of the Washington State Radiological Society. (left to right, Ruben Krishnanathan, DJ Perry, Pooja Voria, Anne Roberts, Doug Green, Eric Stern)

On a brighter note, I want to bring to your attention the tremendous success of the American College of Radiology this past year and ask for your help in making 2016 even better.

I want to urge more radiologists to get involved in the ACR and WSRS. If you have colleagues who are not yet members, please invite them to join ACR. Why? Just look at the tremendous success from ACR advocacy just this past year alone, spearheading a rollback of the Multiple Procedure Payment Reduction (MPPR) to Medicare reimbursement for interpretation of advanced imaging scans performed on the same patient, in the same session, on the same day. Reducing the MPPR cut from 25% to 5% equals roughly $352 million over 10 years in reimbursements not cut. This equals $1,600 per radiologist for 10 years, or $16,000! In addition, the ACR spearheaded a two-year delay of recent U.S. Preventive Services Task Force draft mammography recommendations. This extends insurance coverage to millions of women.

These victories are possible because thousands of radiologists joined together to make them happen. ACR member dues pay for advocacy efforts. We could accomplish so much more if all of our colleagues join the College and work with us to advance our profession.

Together, we can do even greater things!

Radiology matters.
Yours truly,
Eric
Eric Stern, MD
WSRS President, 2014-2016

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RFS Report

As a resident, the WSRS offers many opportunities to acquire essential leadership skills, be mentored by leaders in our specialty, and prepare for our future careers.  Some of the areas where the WSRS provides unique experiences for residents include: 1) direct interactions with a diverse group of radiology leaders from throughout Washington state, 2) providing role models who demonstrate how to improve communication with legislators, 3) a better understanding of the nuances of political advocacy, for both our patients and our specialty, and 4) opportunities to actively participate in forward thinking committees that help shape the future of radiology.

At this year’s annual meeting, we had a wonderful opportunity to listen to ACR leaders Richard Duszak, MD  and Anne Roberts, MD share information about future changes in radiology culture and resident training.  By hearing about these potential changes earlier in our careers, residents became better prepared for these upcoming trends.  Our outstanding RFS Vice Presidents (Brandon Perry and Emily Johnson) also helped to organize a dedicated resident breakout session, where both young and experienced, practicing radiologists and radiation oncologists offered valuable insights about the current job market, application considerations, contract negotiation, and choosing your practice environment.  Participation in this and other similar events have offered residents a greater opportunity for career development.  Future employers will appreciate associates who are not only exceptional at interpreting advanced imaging and performing minimally invasive procedures for their patients, but who can also contribute to practice and hospital leadership, safety and quality improvement, practice building, and patient relations.

Over the past few years, participating in the ACR and WSRS Annual Meetings, the Olympia Day on the Hill, taking on active leadership responsibilities, and learning from organizational leaders have all provided growth and opportunities to develop leadership skills, build relationships, and acquire knowledge that would otherwise be difficult to obtain.

Radiology matters and so does the WSRS!  Thank you for supporting resident development and advocating for our future.

Don J. Perry, MD
UW Radiology Chief Resident, PGY5
WSRS RFS President

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Annual Meeting 2015

Attending the annual WSRS meeting for the first time was an outstanding experience for so many reasons. The first, and most important to me, was the overwhelming sense of welcome and camaraderie I enjoyed throughout the day. From Debra’s warm greeting at sign-in to the nonchalant encouragement from the ever pleasant Dr. Stern to chat with the vendors, and the countless conversations with fellow residents, I quickly recognized this meeting would help build long term relationships beneficial to any radiologist in the state of Washington.

But the WSRS annual meeting wasn’t just rubbing elbows with residents and bigwigs!  The presentations from an array of esteemed radiologists were both enjoyable and practical. Dr. Richard Duszak from Emory University and The Harvey Neiman Health Policy Institute somehow clarified healthcare payment models in a logical concise way...and made it fun and interesting! Dr. Douglas Green illustrated some surprisingly appropriate parallels between the commoditization of radiology and Uber. Dr. Anika McGrath assuaged my fears about the dreaded corporatization of radiology while the career panel intensified them about the (thankfully improving) highly competitive job market.

One of the most readily implementable teaching points came from Dr. D.J. Perry’s presentation, which exemplified how radiologists can maximize value in day-to-day practice by taking a proactive role in patient management. The practice of radiology goes far beyond skilled interpretation of images and generating concise reports. The value of taking the time to contact referring physicians about important findings, such as a bladder mass, and the effort of expediting necessary further workup, such as a PET-CT, to get the patient to appropriate therapy not only saves lives in a very literal sense, it reminds our referring physicians and patients of our truly indispensable contribution to patient care.

By the end of the day I found myself thinking about the true meaning of the word value, defined by Merriam Webster as “relative worth, utility, or importance”--the value radiology brings to healthcare, the value of keeping current on various trends in imaging, and the value of developing relationships with colleagues and mentors. In my opinion, it is a term that needs to be associated with radiology much more frequently, and the WSRS provides an outstanding platform to collectively discuss creative alternatives to continually improve the practice of radiology, and ultimately optimize every patient’s experience in healthcare."

Jason Vergnani, MD
Resident, Sacred Heart Medical Center
Spokane, WA

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Day of Advocacy in Olympia—February 23, 2016

It’s not too late to sign up for our annual day-long visit to our state capitol!

Join colleagues from around the state to visit lawmakers in Olympia, advocate for important legislation and develop relationships with your state senator and representatives. 

The day includes continental breakfast, transportation from Seattle to Olympia and back, coaching on how to be an effective advocate, lunch, and group meetings at our state capitol with legislators and healthcare policy specialists.

If you are coming from other parts of the state, please contact us so we can help coordinate transportation. Don’t miss this exciting program!

In order to get appointments set up, we need WSRS members and members in training to RSVP early and provide us with the address at which you vote.

Please RSVP with your home address and your cell phone number to Debra Alderman, WSRS Executive Director, as soon as possible.  debra@wsrs.org  or phone: 206-956-3650.

To read about the 2015 Day of Advocacy, visit our website’s government relations page.

Participants in the WSRS 2015 Day of Advocacy in Olympia paused for a photo between meetings with legislators.  Left to right are WSRS board members:  Pooja Voria, MD, President-Elect; Jonathan Medverd, MD, Immediate Past President; Vickie Nguyen, MD, RFS President; Sammy Chu, MD, Secretary, and Eric Stern, MD, President.

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Legislative Update as of 2-3-16

Brad Boswell  brad@boswellconsulting.org  206 300 6270

The 2016 Washington State Legislature is scheduled for 60 days and we are currently going in to the 3rd week of session.  Legislative leaders in both the House and Senate have made it clear that they do not expect it to go beyond the 60 days.  The Democrats currently control the House of Representatives by 1 vote and the Senate is controlled by a 1 vote majority for the Republicans.  Jay Inslee, a Democrat, is the Governor.  With the election scheduled for next November, both the House and Senate are lowering expectations for any major legislative efforts in either the budget or policy this session.  Some kind of a plan to deal with the McCleary court decision and the significant increase in education spending associated with it will be given to the court but there is no expectation that they will actually move forward on legislation until 2017.  The only major changes to the state budget this year are expected in the area of forest fire funding and mental health.  Their will be significant effort made to create a funding fix for Charter Schools stemming from the Supreme Court ruling that they can not use common school funding for them.  In total, despite significant political rhetoric and campaign posturing, it is not expected to be a very productive session this year.

King County Superior Court has ruled that Initiative 1336, the measure approved by voters in November that would have cut the sales tax by one percentage point unless the Legislature allows a public vote on a constitutional amendment requiring a two-thirds supermajority vote for future tax increases, is unconstitutional and thrown it out. Although this ruling will be appealed to the State Supreme Court, for the time being it takes away the threat of a $1Billion hole in the budget posed by the Initiative.

February 5th is the committee cut off date that marks the last day to read in committee reports and pass bills out of committee in the house of origin.  This means that any bill that has not passed out of its original committee will be considered dead for 2017.  Any legislation that has fiscal impacts has a longer time period to move through the process.  Conventional wisdom is that if bills have not had a hearing by the first cut off they will not move any further though the process.  Legislators are all hoping to see their pet projects moved along, but as is normally the case in a short session, it is highly unlikely that a number of them will pass. 

WSRS Issues:

Breast Density: Senate Bill 6146 has been introduced by Senator Rolfes and would require breast density information be provided on the lay letter directly to patients.  WSRS has created alternative language for this legislation and provided this preferred language to Senator Rolfes.  She appreciated the WSRS willingness to work with her and indicated that if the bill gets a hearing she would work with us to get our preferred language in the bill.  At this point 6146 has not been scheduled for a hearing and with only a short time left it is unclear if this legislation will even get a hearing.
http://app.leg.wa.gov/DLR/billsummary/default.aspx?Bill=6146&year=2015

Balance Billing:  House Bill 2447
Would ban the ability for a practice group to balance bill patients in an emergency room setting when the practice group is not on contract with the insurance carrier.  A new system of binding arbitration would be created to make payment decisions in disputes between providers and carriers.  WSRS is opposed to this legislation and believes that it would remove the incentive for insurance companies to contract with providers and would in essence create a default reimbursement rate in statute.  A public hearing has been held for this legislation and Insurance Commissioner Kriedler testified in support of this legislation.  The entire provider community, including WSRS, is opposed to this legislation and is working to prevent it moving forward.  The insurance lobby has also testified in opposition to this legislation and is actively working to stop it.  This bill has been scheduled for a committee vote, however it is unclear if that will actually happen.
http://app.leg.wa.gov/billinfo/summary.aspx?bill=2447&year=2015

Third Party Administrators (RBMs): House Bill 2445
Has been introduced and has had a hearing.  This legislation would provide a modest regulatory structure over third party administrator companies such as Radiology Benefit Managers (RBMs).  The regulatory structure would be housed in the Office of the Insurance Commissioner and would allow them to have some oversight of the activities that RBMs engage in.  The provider community universally supported the legislation and WSRS signed in support.  The insurance carriers and the Union Health Trusts testified in opposition believing the OIC already has the authority to regulate these entities through the health carriers themselves.  Additional work and changes to this legislation are expected, and at this point it is scheduled to be voted out of committee soon.  http://app.leg.wa.gov/billinfo/summary.aspx?bill=2445&year=2015

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ACR Annual Meeting 2016

Once again, there will be a large contingent of WSRS members attending the upcoming ACR meeting in Washington DC this May.  If you plan to attend the “Hill Day” visits to legislators on Wednesday, May 18, be aware that Debra Alderman, WSRS Executive Director, is coordinating the schedule of visits for our delegates. So please contact her to let her know your plans. She will need your home address and cell phone number in order to schedule meetings with your congressional representative and senators.  You can reach Debra via email: debra@wsrs.org  or by phone: 206-956-3650.

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RLI Scholarship

Congratulations to Dr. Puneet Bhargava, recipient of a $1000 WSRS leadership scholarship to attend RLI programs in 2016!  WSRS awards up to two $1000 scholarships annually to support two members participating in the ACR's Radiology Leadership Institute program. Deadline for applications for 2017 scholarships: October 15, 2016.  The nomination form is available on our website.

Dr. Puneet Bhargava (second from left) was among the panelists that shared their first-hand career launch experiences for the Residents and Fellows Section lunchtime session at the 2015 WSRS annual meeting.  Dr. Bhargava was recognized for his leadership potential with a $1000 leadership scholarship which he is using to attend ACR’s Radiology Leadership Institute Programs in 2016.

Dr. Bhargava provided this update on how the RLI program is benefitting him already this year:

I used the scholarship funds to get access to several modules from the ACR RLI Program Catalog. I had specific learning needs to prepare myself better for potential leadership opportunities within the realm of academic radiology. For example, I wanted to learn more about developing a business plan, negotiation, etc. The curriculum advisory services team at the ACR interviewed me to assess my needs and constructed a well-suited curriculum.

I have been through many of the modules already and they are extremely well done. I am planning on getting an executive MBA degree for more advanced learning and feel that these modules are a great start.

Overall, the scholarship is a great opportunity from WSRS. I highly recommend to those members with leadership interests.

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Gold Medal Award

Each year the WSRS board honors a Washington State radiologist, radiation oncologist or clinical medical physicist with a Gold Medal Award recognizing outstanding service to our profession demonstrated throughout the recipient’s career.   Congratulations to the 2015 Gold Medal Award honoree, Dr.  Fred Mann, MD!

WSRS President, Dr. Eric Stern (left) congratulates Dr. Fred A. Mann, 2015 WSRS Gold Medal Award recipient.

Nominations for the 2016 Gold Medal Award will be accepted between now and July 31, 2016.   Click here to download the nomination form.

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WSRS Members Urged to Apply for ACR Fellowship

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 below.ACR is now accepting applications for Fellowship for the 2017 Convocation Year. The ACR's website has all the details about requirements and an easy, online nomination form. To visit the ACR's Fellowship page, click here.

It takes some time to gather the required supporting materials and recommendations and for the WSRS Fellowship chair and other leaders to sign off on each application.  For this reason, you are urged to begin working on your application early.  To provide enough time for the process, WSRS has set May 31, 2016 as its deadline for members to submit their applications for the coming cycle.

If you need assistance with your application, please contact Debra Alderman, WSRS Executive Director: debra@wsrs.org and she can put you in touch with the appropriate WSRS leaders.

If you have questions about your eligibility, the online application process or anything else, feel free to contact the ACR Fellowship office staff via email : facradmin@acr.org

A list of WSRS members who have already been honored as ACR Fellows is on our Fellowship page of our website.

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CAC Report

Sammy Chu, MD, Chair

Happy New Year!  I hope 2016 brings the best to all of you.  As the New Year begins, we can celebrate some good news that the ACR had a large part in.  As you may know, CMS applies a discount to the Technical Component (TC) and Professional Component (PC) of the Medicare fees it pays to imaging providers when a patient undergoes two or more advanced imaging studies performed during the same “session” by the same group practice (otherwise known as the Multiple Procedure Payment Reduction, or MPPR).  There is a 50% discount on the TC, and a 25% discount on the PC, for 2nd and subsequent studies.  The ACR did not see the reasoning behind the discount for the PC, and fought hard to get it reversed.  (I don’t spend 25% less time when interpreting a combination MR of the brain and c-spine, compared to the two separate exams; do you?)  As a result of the ACR’s efforts, in the Consolidated Appropriations Act passed in December, the MPPR for professional fees will be reduced from 25% to 5% starting on January 1, 2017.  WSRS would like to thank our national organization for all the energy it spent on this effort.

For those of you that are involved in the operation of outpatient CT scanners, you should already be aware of the National Electrical Manufacturers Association (NEMA) XR-29 Standard Attributes on CT Equipment (also known as MITA Smart Dose).  This standard was established in an effort to optimize and reduce radiation dose from CT scanners.  Starting at the beginning of this year, CT exams performed on a scanner that is not compliant with all four attributes of the XR-29 Standard face a 5% reduction on the TC.  This reduction increases to 15% as of January 1 next year, if exams continue to be performed on a non-compliant scanner.  For more information, the ACR has prepared an FAQ document that is available at the following link.

I continue to hear sporadic reports of various audits (or euphemistically termed “Medical Reviews”) by CMS and other payors on radiology practices and individual radiologists.  These have included requests for further documentation such as ordering providers’ notes.  If you or your practice has been subjected to these requests (or if you have any other payment concerns), please contact me (e-mail:  samchu.rad@gmail.com ) so we can track how widespread this issue is, and see how to address your concerns.

Finally, you should be well into your ICD-10 transition.  CMS reported at the end of last year that there was no increase in the claim rejection rate after the transition.  If you have noted otherwise, please e-mail me with the details.  So far, I have only heard of a few issues with Noridian (our state’s Medicare contractor) not “translating” all of their ICD-9 codes to ICD-10, but these have since been corrected.  However, I urge you to continue to be vigilant with your ICD-10 conversion.  An agreement was reached to ease the transition on October 1 last year, whereby the Medicare contractors accepted code families (i.e. the first 3 digits of the ICD-10 code) rather than the entire specific code for payment (unless there was a specific Local Coverage Determination (LCD) or National Coverage Determination (NCD) for a specific procedure/exam).  This agreement expires on October 1 of THIS year, and you and your practice will need to be accurate with the ENTIRE code as of this date to receive payment.  No rest for the weary!

If you have any questions or concerns on the above, please don’t hesitate to contact me. samchu.rad@gmail.com

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Suicide Prevention Training Required for All Washington Physicians

As a result of legislation passed in 2015 (and opposed by the WSMA), this year all active Washington state physicians, physician assistants and those physicians and PAs holding a retired active license must complete a one-time six-hour training in suicide assessment, treatment and management.

To meet this new requirement, the Washington State Psychiatric Association is offering WSMA members a discounted registration fee to attend one of their new one-day, six-hour workshops on suicide care training.

The workshops, instructed by WSMA member and WSPA President-Elect Jeffrey Sung, MD, will be held on Feb. 20, Apr. 16, and May 21 from 8:30 a.m.–4 p.m. at the Swedish Medical Center First Hill Campus in Seattle. The workshops will use lecture, video-based educational tools and writing exercises to address approaches, formulation and clinical responses to suicide risk. The training is approved for six CME credit hours.

Visit the WSPA website for details and to register. The WSMA will continue to keep members informed of opportunities to meet this new requirement.

*Physicians and PAs must complete the training by the end of the first full continuing education reporting period after Jan. 1, 2016, or during the first full continuing education reporting period after initial licensure, whichever is later. Suicide prevention training meeting the criteria established by the legislation taken between June 12, 2014 and Jan. 1, 2016 can be counted toward the required six hours. See this model list of training programs that will be accepted

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Avoiding Errors with Better Inter-provider Communication

By Amelia Ramstead for Physicians Insurance

You might think that you’ve been doing a great job of communicating with other providers and specialists and you’re ready to close this page and read something else. But before you do that, consider this:

A study published in the Journal of the American Medical Association (JAMA) found that there’s a big discrepancy between in reports of successful communication between primary care physicians and specialists. While 69.3% of primary care providers report that they “always” or “most of the time” pass along crucial patient information to specialists, only 34.8% of specialists say that they “always” or “most of the time” receive the information. Additionally, although 80.6% of specialists say that they “always” or “most of the time” send the results of a consult back to the primary care provider, only 62.6% of providers report receiving the results. (1)

Clearly, there’s a problem here.

Do you know how many other providers each of your patients currently sees? Are any of them specialists? More importantly, how many of them have you had the opportunity to speak with yourself? Do you ever feel your missing important information?

There’s a lot of discussion around care coordination, but unfortunately, in the fast-paced medical environment, care coordination tends to be one of the first things to fall through the cracks. On the surface, this seems understandable. You’re busy. Your colleagues are busy. You’d rather not disturb them if at all possible, and you’d prefer not to be disturbed yourself.

But what if another provider holds the key to improving your patient’s outcome? Without the information from the other provider, you might be trying to solve a jigsaw puzzle with several missing pieces. This doesn’t do your patients any favors, and it increases the likelihood of missing a crucial diagnosis, resulting in patient harm. Good communication with other providers also sends a clear signal to patients that you are invested in their health, which improves patient satisfaction. Studies have shown that satisfied, happy patients who feel that their provider cares are less likely to sue in the event that something does go wrong.

So, what can you do to improve inter-provider communication and patient outcomes?

1. Adopt appropriate health information technology (HIT). If you don’t have up-to-date HIT, you are missing out, and even worse, so are your patients. HIT makes it easy to update patient charts quickly as well as deliver reports and results and send messages to colleagues. If you already have HIT in place, take a look at it. If it’s an obscure brand, you may want to consider replacing it with a more commonly used program that will connect you with more specialists.

2. Standardize note formats. When you send written communication, are you using a standard format, or one of your own devising? Regardless of how simple you may consider your own format to be, if it isn’t in common use, it’s an error waiting to happen. Whether you’re based in an inpatient facility or in private practice, you will need to communicate with other medical professionals, and it’s essential that they understand what you are trying to tell them. HIT may resolve formatting issues, but if you are delivering an email or hard-copy orders, use a standard format with recognizable abbreviations (or, better yet, no abbreviations at all) and codes.

3. Pick up the telephone and call. How quickly should communication take place? If you need results from a specialist right away, it makes no sense to send an e-mail or other electronic note and then sit back and wait. You don’t know if the message was received or if it’s stuck in some kind of limbo.

Call.

Need a response right away?

Call.

Aren’t sure you understand what the specialist is saying?

Call.

Have further questions about the results?

Call.

In an urgent situation, a phone conversation or face-to-face meeting can save a life – or at least prevent serious injury. Yes, it takes more time, but the information you gather from an actual conversation with a colleague could save you a great deal of time further down the road, improve patient outcomes, and ultimately help prevent a costly error. 

You can achieve better inter-provider communication by adopting appropriate HIT, standardizing note formats, and using the phone to communicate with specialists. The improved communication you experience will benefit you and your patients in many ways.

_________________

1. Ann S. O’Malley and James P. Reschovsky, “Referral and Consultation
Communication Between Primary Care and Specialist Physicians: Finding Common Ground”, Archives of Internal Medicine, January 1, 2011, Vol.171, No. 1 :56–65, doi:10.1001/archinternmed.2010.480.

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Emergency Radiology Course, Seattle, August 14-17, 2016

Dear Colleague,

I am the new course director for the annual Emergency Radiology course sponsored by the University of Washington.  I am pleased to share that we will be offering the course again this summer at the Grand Hyatt Hotel.  The dates are Sunday, August 14 through Wednesday, August 17, with sessions beginning at 7:30 AM and ending at 1:00 PM.

This course is designed for any radiologist who covers the Emergency Department. We will provide comprehensive presentations and interactive discussions covering the broad range of emergency imaging, as well as some not-so-basic findings specific to trauma radiology.

We will have a variety of registration discounts and options available, so please save the date, and check www.uwcme.org for more details.

If you have any comments or questions, please don’t hesitate to contact me directly and I look forward to seeing you this summer in Seattle!

Jeffrey Robinson, MD MBA
Assistant Professor, Department of Radiology, University of Washington
Phone (206) 744 3561. Cell (206) 799 1657
jeff8rob@uw.edu

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Important Dates

WSRS Day of Advocacy in Olympia, February 23, 2016. If you plan to attend, please contact Debra Alderman, WSRS executive director:  debra@wsrs.org   206-956-3650.  She will need your home address and cell phone number.

ACR 2016, May 15-19, 2016.  If you plan to participate in the Hill Day program on Wednesday, May 18, please contact Debra Alderman, WSRS executive director, who is coordinating visits to congressional offices for all Washington State attendees:  debra@wsrs.org   206-956-3650.  She will need your home address and cell phone number.

For more information on the conference, visit their website.

WSRS Annual Meeting 2016. 
Save the Date:  Saturday, November 5, 2016. More details will be sent out and posted on our website soon.

Note that additional conferences and CME opportunities are on the calendar page of our website.

Deadlines:
Nominations for WSRS RLI Scholarships for 2017:  October 15, 2016

Nominations for ACR Fellowship: We recommend strongly that you submit all of your materials by May 31, 2016. 

Nominations for WSRS Gold Medal Award for 2016:  August 15, 2016

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