Journal of the American College of Radiology : JACR
-
When all patients are required to pay the same out-of-pocket amount for imaging services, which have varying degrees of benefit dependent on patient characteristics, there is potential for overuse and underuse. Rising costs of health care have stimulated efforts to redesign health care packages. ⋯ With value-based insurance design, cost sharing is still used, but a "clinically sensitive" approach is designed to mitigate the adverse health consequences of high out-of-pocket costs. The authors summarize the principles of value-based insurance design and review examples of its implementation in other areas of medicine.
-
The total number of procedures and their relative value units (RVUs) were used to measure the productivity of radiologists. Besides variations in productivity due to differences in the percentage of clinical effort, baseline productivity also varies among clinical subspecialty sections. The authors' previous research used the full-time equivalent (FTE) as the unit to adjust for differences in the percentage of clinical effort and a set of adjustment factors (or calibration constants) to modify the default work RVUs according to types of procedures. These adjustments led to comparable average productivity measurements across subspecialty sections. Since 2003, radiology practice has continued to change, including the introduction of positron emission tomography/computed tomography into clinical practice, suggesting a need to update the understanding of clinical productivity and refine the authors' adjustment procedure. In this study, the authors analyzed the most recent survey of academic departments and derived updated adjustment factors for differences in workload among subspecialty sections. The results can be used to determine faculty staffing requirements and evaluate radiologists' performance. ⋯ Clinical workload, as measured by RVUs per FTE and adjusted RVUs per FTE, is very useful for determining optimal staffing in subspecialty sections and in radiology departments in general. Workload continues to increase, both in examination complexity and in numbers of overall procedures. Adjustment factors make workload comparisons between subspecialty sections more valid and meaningful.
-
Meta Analysis
Turf wars in radiology: updated evidence on the relationship between self-referral and the overutilization of imaging.
In a previous article in this series, published in 2004, the authors reviewed the medical literature for evidence on the relationship between self-referral and the utilization of imaging. That evidence demonstrated that self-referral led to substantially higher levels of utilization with its attendant increases in cost and the exposure of patients to unnecessary radiation. ⋯ Once again, the evidence clearly indicates that self-referral results in the overutilization of imaging. Because radiologists have an important stake in the matter, it behooves them to be familiar with this recent evidence so they can bring it to the attention of policymakers in their areas.
-
To provide a snapshot of the demographics of radiologists providing coverage for emergency departments (EDs) and current imaging practices in EDs in the United States. ⋯ New imaging practices for the evaluation of entities such as chest pain, spine trauma, and abdominal pain and trauma are emerging in EDs. As one plans ED development, these trends should be considered.