Virginia Chapter, American College of Radiology

Virginia Chapter, American College of Radiology Volume 5 Number 1 BULLETIN Spring 2007 RICHARD A. SZUCS, MD President Commonwealth Radiology 3526 Crossings Way Midlothian, VA 23113 (804) 281-8237 phone (804) 285-0602 fax C. DOUGLAS PHILLIPS, MD President-elect UVA Department of Radiology PO Box 800170 Charlottesville, VA 22908 (804) 243-9312 phone (804) 924-8658 fax ADAM W. SPECHT, MD Secretary-Treasurer 3309 Chappell Place Virginia Beach, VA 23452 (757) 375-0707 phone (757) 962-5976 fax INside Becoming an ACR Fellow 2 A message from our 3 Lobbyist Legislative Committee 4 Update 2007 Annual Meeting 4 Update CMS Aborts IDTF 6 Enrollment Policy Pending Members 7 VA RBMA Update 8 Email requests 8 A MESSAGE FROM YOUR PRESIDENT Richard A. Szucs, MD President, Virginia Chapter ACR The Virginia Certificate of Public Need (COPN) law was again in the forefront during this year s Virginia legislative session. A bill sponsored by Delegate John O Bannon to streamline the COPN application process and exempt all imaging equipment under $500,000 from the COPN process was narrowly defeated in the House of Delegates Health, Welfare and Institutions Committee. This bill was supported by the Virginia Orthopedic Society and had support from other physicians interested in performing their own imaging in their offices. The $500,000 exemption was opposed by the Virginia Hospital Association and the American College of Radiology. Kevin McNally, our lobbyist, worked hard to make sure that our position was represented. A number of radiologists contacted their legislators. The bill was heard in committee on Tuesday, January 30, 2007 which was our scheduled capitol hill lobby day. A number of radiologists from both academic and private practice as well as residents from the Medical College of Virginia, University of Virginia, and Eastern Virginia Medical School attended the hearing. This provided a very visible show of support for the ACR position which was articulated by Dr. Karsten Konerding. The COPN process is very bureaucratic and cumbersome and can be improved. The arbitrary exemption of imaging equipment under $500,000 would have opened the door to widespread self referral and resulted in dramatic increases in utilization. We are fortunate that it did not pass. However, the ACR needs to work with the members of the Health, Welfare and Institutions Committee and the legislature to achieve comprehensive COPN reform. We need to have a network of radiologists around the state who have or are willing to develop relationships with their legislators so that when issues arise we can inform them of the issues and they can in turn discuss the concerns of radiologist with their legislators. Dr. Konerding will be working to develop such a network. If you are willing to be involved please let us know. Many thanks to those who contacted their legislators regarding the COPN issue. continued on page 2

continued from page 1 Increasing utilization of imaging services continues to be a major component of the rising cost of healthcare. Legislators as well as third party payors and employers all have an interest in preventing inappropriate utilization. United Healthcare recently announced that beginning March 1, 2008, it will adopt accreditation programs administered by medical societies for MRI, CT, PET, Nuclear Medicine and Echocardiography. The ACR has accreditation programs in place for these modalities. In Virginia, Anthem has recently contacted the Virginia Chapter ACR to ask us to be involved in developing accreditation programs for their members. We need every interested radiologist to stay informed and stay involved as we deal with the legislative and third party payers issues that affect all of us. If you would like to become more involved, particularly as part of our grass roots legislative network please let us know by contacting Jane Davis, Chapter Administrator at 804/622-8135. We will continue to work on your behalf and keep you informed. Sincerely, Richard A. Szucs, MD President Fellowship nominations are due to the ACR by MAY 1, 2007 for consideration in 2008. BECOMING A FELLOW IN THE ACR The degree of Fellowship in the ACR is a singular honor conferred by the ACR on the basis of outstanding contributions and service to radiology. The achievement of Fellowship is a result of nomination in accordance with the bylaws, meeting the qualifications of the Committee on Fellowship Credentials and election to Fellowship by the Board of Chancellors of the ACR. The process from time of nomination to awarding of the Degree of Fellowship takes approximately one year and culminates in the formal conference of the degree [with cap and gown] at an impressive ceremony held in connection with the annual meeting of the ACR. The awardee is eligible to place FACR after his or her name to indicate the new status after the convocation. In addition to the general qualification of outstanding contributions and service to radiology, more specific nomination guidelines include: service to organized medicine; significant scientific or clinical research in the field of radiology or significant contributions to its literature; performance of outstanding service as a teacher of radiology; or others including guidance regarding individuals with 20+ years of membership, service as a Chapter President, letters of reference, chapter activity. More specific details can be found in the ACR Fellowship Instructions & Guidelines for Candidates. Service and participation in the State Chapter is one of the major ways those interested in becoming a Fellow can enhance their application. The State Chapter is supportive of starting the application process for those who meet the qualifications and is interested in helping to guide those who aspire to obtain Fellowship Degree. To learn more about becoming a Fellow of the American College of Radiology, contact Jane Davis, Chapter Coordinator, at 804-622-8136 or jdavis@ramdocs.org. --2--

A MESSAGE FROM OUR LOBBYIST Kevin R. McNally Reed Smith LLP the $500,000 exemption from his bill. As a result, VCACR lobbied HWI Committee members heavily in opposition to HB 2155. Late last summer the House Health, Welfare, and Institutions Committee empanelled a special task force to review the current state of the COPN process. In four meetings between September and December, Task Force members heard a great deal of testimony from hospitals, the Department of Health, and regional Health Planning Agencies regarding both the problems that COPN can cause, and the problems such review prevents. There was little doubt that at the end of these hearings there would be a major legislative initiative to reform what was perceived as a lengthy and costly process. It was not a surprise, therefore, when four COPN reform bills were introduced by members of the HWI Committee. Two of the bills sought to remove the regional Health Planning Agencies from the COPN review process. Another bill sought to do away with COPN entirely and institute a process for the licensing and accreditation of equipment and service providers. The last bill, HB 2155, proposed many reforms to the review process, but also provided an exemption from COPN review for any new or replacement equipment valued at $500,000 or less. In the view of the Chapter s Gold Legislative Contributors: Committee, HB 2155 would AGFA have HEALTHCARE thrown open the door to a proliferation of extremity magnets, increased selfreferrals, and that the resulting cherry-picking PER-SE TECHNOLOGIES, INC. OUTPATIENT IMAGING AFFILIATES THANK YOU TO ALL CONTRIBUTORS FOR YOUR CONTINUED SUPPORT! of insured patients would severely impact the revenue streams of Virginia s hospitals, thus reducing the hospitals ability to provide services to the indigent and Silver Contributors: uninsured. FUJIFILM MEDICAL SYSTEMS GE HEALTHCARE SIEMENS MEDICAL SOLUTIONS HB 2155 also proposed useful reforms that the VCACR would have supported, but despite numerous attempts by the VCACR and the Virginia Hospital and Healthcare Association, HB 2155 s patron could not be moved to strike As luck would have it, all of the COPN bills were scheduled to be heard by the HWI Committee on the same day VCACR had scheduled its lobbying day at the Capitol. The Chapter membership was, therefore, very visible at the hearing a fact that was not lost on the Committee s members. After an amendment to HB 2155 that would have struck the $500,000 exemption was approved by the Committee on a close vote, the patron asked that his bill be struck from the roll, or killed. Shortly thereafter, the remaining three COPN reform bills were either defeated by Committee vote or struck by the patron. There was an attempt a few days later to resurrect HB 2155 s provisions by amending a completely unrelated COPN bill. In the face of strong and united opposition, however, the proposed amendment was withdrawn before it could be put to a Committee vote or struck by the patron. Recognizing that some reform of the COPN process is needed, and that COPN reform will be an ongoing topic for the legislature in 2008 and beyond, VCACR will continue to work with legislators and other interested groups to fashion legislation that will promote improved access to quality healthcare for all Virginians, but Bronze do so without Contributors: crippling the Commonwealth s APS Medical Billing hospitals or providing an uncompetitive Bracco Diagnostics, advantage Inc. to any particular practice MAG regime. Mutual Insurance Company Medical Practice Managgement, Inc. Many Quantum thanks Medical to all the Business VCACR Service members who Zonare Medical Systems called, wrote, or visited their legislators regarding this important matter. It was your voices that informed your state representatives. And in the end, it was your voices that counted. --3--

LEGISLATIVE COMMITTEE UPDATE Karsten Konerding, MD Chair, Legislative Committee The 2007 General Assembly has thankfully recessed without doing major harm to the interests of Virginia s radiologists. We were almost blind-sided by those who would have exempted low-cost imaging equipment in physicians offices from COPN requirement, but managed to have HB 2155 withdrawn by its sponsor after a key hostile amendment passed. In the process we got a much better idea of which House members understood the importance of COPN in preventing overutilization and self-referral, with some real surprises. We hope to make good use of this knowledge in the Virginia Radiology PAC S support of candidates in the 2007 State election cycle. We also learned that we must be much better prepared in the future for such stealth maneuvers by legislators and those of our fellow physicians who will undoubtedly continue to assault the COPN process as it currently exists. We must develop a grassroots network of radiologists who are constituents of the members of the key legislative committees and who can respond on short notice with calls to these members explaining just how bills before them will affect radiologists and patients in their districts. Your legislative committee members and our lobbyists just can t contact all these members quickly enough to educate them in time when these bills suddenly appear on the agenda. It was obvious to those of us who attended the HWI committee hearing on the COPN bills on VCACR Legislative Day in January that many of these members were clueless about just what the COPN process means, and they need education if we are to continue to defend radiologists interests successfully. In the next Newsletter we ll include a way for you to let us know who YOUR Senator/Delegate is. In the meantime, please be sure you know this information yourself; find out from your local authorities NOW if you can t identify YOUR legislators. One significant bill which passed almost unnoticed was HB 1623 (Del. Landes), which repealed part of the several-years-old comprehensive COPN deregulation bill, never implemented by subsequent General Assemblies due to the high cost estimates for its requirements to link deregulation to assurances that indigent care and academic medical centers be protected and that quality standards (specifically, ACR accreditation) be a requirement for imaging and oncology facilities. I fear that our opponents will see this abandonment as an opportunity to push through all kinds of ill-conceived COPN deregulation measures, whether comprehensive or of the cherry picking variety we ve had to deal with each year recently. In addition to maintaining our vigilance toward such legislation, we may need to be pro-active and seek out key legislators who will work with us to craft and sponsor legislation protective of our interests and those of the Commonwealth s citizens and their health-care costs. More about this in future newsletters! MARK YOUR CALENDARS! 2007 ACMLC ANNUAL MEETING MAY 19-23, 2007 HILTON WASHINGTON WASHINGTON, D.C. 2007 VCACR ANNUAL MEETING AUGUST 11, 2007 Boar s Head Inn Charlottesville, Virginia --4--

2007 Radiology Lobby Day Kevin McNally, Chapter Lobbyist held a short VCACR members and residents line up to attend briefing before going to General Assembly. hearings and meetings with legislators. THANK YOU TO ALL CONTRIBUTORS FOR Dr. Keith Thompson and other members waitdrs. Adam Specht, Mark Vaughn and resident YOUR CONTINUED SUPPORT! ing to hear if other COPN bills will be heard Scott Conrad prepare to attend hearings. Please complete this form and return it Dr. Karsten Konerding, PAC Chairman, reviews the key points of his testimony with residents. Drs. Richard Szucs and Douglas Phillips discuss HB 2155 which was struck from the roll. --5--

CMS ABORTS IDTF ENROLLMENT POLICY Thomas W. Greeson Reed Smith LLP On January 26, 2007, CMS issued Medicare Program Integrity Manual Transmittal 187, which would have made significant changes to Medicare s Independent Diagnostic Testing Facility (IDTF) enrollment rules. The transmittal which included several significant policy changes that were not included in the 2007 Medicare Physician Fee Schedule final rule would have had a dramatic impact on the ownership and operations of diagnostic imaging centers and other types of IDTFs. CMS, however, rescinded the transmittal prior to its implementation date of February 26, 2007. The following were some of the issues with the new IDTF enrollment requirements: 1. There was a prohibition against IDTFs sharing space and equipment with other IDTFs and suppliers. This may actually be welcomed by many IDTFs, but the scope of the requirement is quite unclear and raises the question regarding what to do with such agreements in place after February 26. 2. CMS would deny payments to enrolled IDTFs for services performed prior to enrollment date. This would have been a major departure from existing practices and a requirement not imposed on any other supplier type. 3. IDTFs would have been required to use only technologists who are full-time W-2 employees of the IDTF. At issue is why must they be employed, and why full time. CMS appears to be rethinking this restriction. 4. All enrollment requirements must have been met by a physician before an interpreting physician can be permitted to provide services for the IDTF. Thus, it appears an IDTF could not receive interpretation services from a radiologist who is going through a carrier/ contractor s individual physician enrollment process. 5. The Medicare carrier/contractor must independently verify insurance coverage of the IDTF seeking enrollment. 6. There was 30 day reporting period requirement for changes to any of the structure or physician or non-physician (technologist) staffing. IDTFs would appear to have a tighter deadline than any other Medicare supplier type. And it undoubtedly will add to the already large burden imposed on carrier/contractor provider enrollment staffs, exacerbating the delays in the enrollment process that could make the punitive features of this transmittal even more painful to IDTFs going through the enrollment process. 7. The supervising physician would be responsible for the overall operation and administration of the IDTF, including the employment of personnel who are competent to perform test procedures, record and report test results promptly, accurately and proficiently, and for assuring compliance with the applicable regulations. This language appears to shift the overall responsibilities of the supervising physician from exclusively professional to include management services. While it is certainly true that a physician providing general supervision should be responsible for the direction of the overall quality of the technical (clinical) services in the facility, this provision seems to convert the supervising physician into an administrative manager rather than medical director. Finally, of particular concern to radiologists was the deletion of the criteria that distinguishes a radiologist s office from an IDTF, creating concern that Medicare carriers could try to force even radiologist-owned offices (or radiology group-hospital joint ventured imaging centers) into IDTF status. continued on page 7 --6--

continued from page 6 CMS was under intense pressure to not implement these new rules and responded to the concerns of the IDTF industry. The fact that CMS rescinded the transmittal gives hope that the any future substantive changes to the IDTF rules will come via notice and comment through formal rulemaking. PENDING MEMBERS Adam W. Specht, MD Secretary-Treasurer The following persons have made application for membership in the Virginia Chapter of the American College of Radiology and their names are currently in processing with the Membership Committee: Kathy Byun, MD Charles D. Grant, MD David E. Grayson, MD Agnes E. Holland, MD Kenneth C. Hite, MD Luisa P. Marsteller, MD Pradnya Y. Mhatre, MD Igor Sirotkin, MD Daniel W. Schepens, MD Jennifer S. Weaver, MD Norfolk Roanoke Harrisonburg Norfolk Lynchburg Williamsburg Christiansburg Manassas Lynchburg Virginia Beach Chapter members who have negative comments have (30) days from March 22, 2007 to submit, in writing, these comments to the Secretary-Treasurer. If no negative comments are generated, an applicant may become a member by resolution of the Board of Directors. Any written comments should be submitted to: ADAM W. SPECHT, MD Secretary/Treasurer c/o Jane B. Davis Virginia Chapter, ACR 2201 West Broad Street, Suite 205 Richmond, VA 23220 or via email to: jdavis@ramdocs.org Pledge Card VIRGINIA RADIOLOGY PAC 2007 LEGISLATIVE ADVOCACY CAMPAIGN Name: Address: City: State: Zip: Phone: Fax: Email: Pledge amount: $1,000 $250 $500 $100 Other: Payment Method: Enclosed is Check: # in the amount of: $ ( Payable to Virginia Radiology PAC) Charge my Credit Card VISA Mastercard Number: Amount: Name on card: Please complete this form and return it with your payment to: VIRGINIA RADIOLOGY PAC 2201 WEST BROAD STREET, SUITE 205 RICHMOND, VIRGINIA 23220 or send by fax to Jane Davis at 804-788-9987 --7--

Mark Canada President, RBMA Virginia RBMA Update With the Deficit Reduction Act upon us, a host of new CPT codes, Medicare fee reductions, and new technologies entering the market, Virginia-based radiology administrators have had more than their share of management challenges the first quarter of this year. Below is a summary of RBMA activity covering both current and upcoming events: Owners of freestanding imaging centers have had to carefully scrutinize operating expenses with less reimbursement for the technical component of many high-end exams. The RBMA has offered guidance to expense management through contributors to the RBMA Bulletin ( Jan-Feb 2007). The 2006 RBMA Accounts Receivable Survey was published and made available to RBMA members. This valuable tool enables us to benchmark our performance measures with other radiology groups of similar size and demographic makeup. Radiology managers throughout the country have worked together to address reimbursement issues associated with the introduction of new CPT codes. The new mammography codes in particular have been problematic for some carriers. PACS technology has changed the way we staff our facilities and the dynamics of our relationship with the hospital and referring physicians. The RBMA has kept this issue on the forefront and advises groups on how to capitalize on this exciting trend. Finally, the RBMA National Summit is scheduled for May 6-9 in St. Louis, MO. The meeting will unite managers from all over the country to promote the sharing of ideas and offer professional growth opportunities through educational seminars. Please support your radiology managers and encourage their attendance of this valuable meeting! REMEMBER TO UPDATE OR SUPPLY THE VCACR WITH YOUR EMAIL ADDRESS! Your Name: Group Name: Preferred Address: City: State: Zip: Phone: E-MAIL: Fax: