Journal of the American College of Radiology : JACR
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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.
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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.
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The Medicare Fee-for-Service Program is in the midst of numerous administrative and regulatory changes that may affect the way local Medicare payment policy is implemented. These changes involve redefining the contractors' jurisdictions, competitive bidding for the contractor selection process, combining the administration of Part A and Part B services, and error rate auditing. In addition, the roles of the Contractor Medical Directors and Contractor Advisory Committees are yet to be defined, and the future of the existing advisory process, while currently unchanged, remains uncertain. ⋯ The American College of Radiology (ACR) monitors the activity of the local contractors and assists local physicians through the ACR Carrier Advisory Committee Network. The ACR has used a combination of clinical and economic experts to develop model Local Coverage Determinations for use by the local contractors, and some of these model policies have been developed in conjunction with other specialty societies, which bolsters their effectiveness. The changing administrative environment presents challenges and opportunities for specialty societies to influence local CMS payment policy.
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To study recent trends in the utilization of abdominal imaging in the Medicare population. ⋯ In recent years, the increase in the utilization rate of abdominal imaging among the Medicare population was relatively moderate (25% over 9 years). There was a substantial increase in the use of computed tomography and computed tomographic angiography and a smaller increase in the use of ultrasound. The use of plain radiography and gastrointestinal fluoroscopy declined. Radiologists strongly predominate in abdominal imaging, and this may be one reason why growth has been modest.
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As medical education and continuous professional development shift toward an outcomes-based model, there is increasing focus on the documentation of physician self-assessment and a commitment to lifelong learning. The Accreditation Council for Graduate Medical Education is helping prepare trainees for these changes by increasing the focus of graduate medical education on outcomes through the development of the 6 competencies. As part of this process, the learning portfolio is a new component of the Accreditation Council for Graduate Medical Education radiology residency program requirements. The purpose of this article is to familiarize the reader with the role of portfolios in medical education and to discuss strategies for the implementation of learning portfolios in a residency education program.