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How Independent Imaging Centers Contribute to Value-Based Medicine

 

 

As evidence-based medicine (EBM) evolved into value-based medicine (VBM) — the “practice of medicine based upon the patient-perceived value conferred by an intervention,” as Jong-Myon Bae defined it in the journal Epidemiology and Health — many referring physicians began to wonder about their choice of imaging providers.

 

Hospital-affiliated doctors can simply send a patient to the basement for an MRI or an ultrasound. But does this practice really contribute to a patient-centered model of care like VBM? Could physicians attain reliable diagnostic imaging at a reduced price for their patients, thereby balancing the outcome-to-cost ratio?

 

The answer is, resoundingly, yes. The reason? Independent imaging centers.

 

The price of an MRI at a freestanding clinic is often thousands of dollars less than the same scan, with the same outcomes, performed at a hospital. There are a few reasons for this — hospitals subsidize revenue-losing departments through radiology, and they’re less vulnerable to market-driven competition — but suffice it to say, freestanding imaging centers provide the same service as hospitals at a fraction of the price.

 

In August of 2016, the European Society of Radiology’s Working Group on Value-Based Imaging began its work investigating how radiology could better take part in the VBM model of patient care. Among the Working Group’s findings:

 

  • The VBM model, as currently practiced, leaves diagnostic imaging out of the equation. Practitioners measure the success of value-based outcomes starting with treatment — which, notably, cannot begin until the radiologist has completed her role in an accurate diagnosis.

 

  • In fact, a traditional VBM approach only factors in diagnosis when it is incorrect, or when it causes complications. This bias neglects the value a patient places in a correct diagnosis, which is, the first in a string of health outcomes that truly matters to the patient and his family.

 

  • In order to fold radiology the VBM paradigm, imaging providers should measure and improve five process steps in their work: Determining whether the referral is appropriate, protecting patients from radiation, producing radiology reports that are entirely accurate and easy to understand, maintaining excellent relationships between patients and the provider’s entire staff, and continuing education and innovation in the field.

 

Regarding that last point — arguably the Working Group’s greatest revelation — note that freestanding imaging providers are often at the forefront of these five process steps. In a marketplace glutted with competition, no imaging provider can afford to fall behind in the quality of care they offer patients. And, as previously noted, freestanding imaging centers offer this care at a much lower price-point than traditional hospital-based radiology departments. Often, they employ the exact same radiologists as the hospitals, and operate identical equipment.

 

A true reckoning of value-based medicine starts with making the right diagnosis, and that often depends on great radiology. Independent imaging centers offer that level of quality at a lower price. Therefore, they are valuable partners in value-based care.

 

If you’re a referring physician, the patient-centered approach is to talk to patients about their choice of diagnostic imaging providers. Often, the freestanding clinic leads to better outcome-to-cost ratios, which lie at the heart of value-based medicine.  

 

mri-biopsy

Precise Blog – How MRI Scans Can Reduce the Need for Biopsies

How MRI Scans Can Reduce the Need for Biopsies

 

Researchers at the Simmons Comprehensive Cancer Center have authored a study detailing a multiparametric magnetic resonance imaging (mpMRI) technique that predicts a malignant type of kidney cancer without performing a biopsy. The results of the method are impressive, but require more refinement to fully take the place of a biopsy.

 

Doctors frequently find kidney tumors accidentally while conducting CT scans for other reasons.

These scans alone do not yield the necessary information that tells doctors whether they are malignant or benign. Instead, a biopsy is usually performed. These procedures can save lives by correctly identifying the nature of the tumor, but they are also invasive and can cause complications.

 

“Using mpMRI, multiple types of images can be obtained from the renal mass and each one tells us something about the tissue,” Dr. Ivan Pedrosa, Professor of Radiology and Chief of Magnetic Resonance Imaging told the UT Southwestern Newsroom.

 

Identifying malignant masses in the kidney is extremely important because treatment is highly effective before the tumor metastasizes. However, once it spreads to other parts of the body, survival rates are low. Clear cell kidney carcinoma is an aggressive subtype of malignant masses that the researchers.

 

Seven radiologists studied the records of 110 patients with cT1a masses.

 

These patients had all undergone an MRI as well as a partial or radical nephrectomy. The observing radiologists did not know the final pathology findings, but instead relied on an algorithm to judge whether tumors were metastatic.

 

The researchers had 78 percent accuracy when rating that the mass was “probably” or “definitely” clear cell kidney carcinoma. When rating that the mass was possibly carcinoma, they had a 95 percent success rate.

 

The promising results show that biopsies may not be necessary for identifying certain cancers.

 

Because some patients are reluctant to consent to biopsies, this new technique is potentially lifesaving. As it stands, patients who do not want a biopsy may learn important information if an MRI shows that their kidney mass has a high probability of becoming metastatic. This new information could convince them that the pain of a biopsy is worth going through.

 

Using these methods to identify clear cell histology is still a work in progress. The doctors at Simmons Comprehensive Cancer Center will have to achieve a higher degree of accuracy in predicting malignant kidney masses for the method to become mainstream.

 

However, as standardization of imaging protocols and reporting criteria are refined, accurate results should increase. When MRI scans alone are sufficient to identify clear cell kidney carcinoma, doctors will have another powerful tool in the fight against cancer.

 

References:

 

Anderson, Avery. “State-of-the-Art MRI Technology Bypasses Need for Biopsy.” UT Southwestern Medical Center, 2 Jan. 2018. Accessed March 14, 2018.

Canvasser, N. et al. “Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Identify Clear Cell Renal Cell Carcinoma in cT1a Renal Masses.” The Journal of Urology, volume 198, no. 4, Oct. 2017, pp. 780-786. Accessed March 14, 2018.

National Cancer Institute. “Kidney Cancer.” Kidney (Renal Cell) Cancer—Health Professional Version. Accessed March 14, 2018.

 

National Institute of Health. “Clear Cell Kidney Carcinoma.” The Cancer Genome Atlas, National Institute of Health. Accessed March 14, 2018.

The MRI Procedure in 10 Steps: Managing Patient Anxiety Through Information

10 Jan 2018 Health Care, Medical, MRI

 

A first-time MRI procedure can make patients nervous, even to the point of ending the scan. That can lead to higher costs for imaging centers, and even affect patient outcomes if the anxiety interferes with the quality of the radiology report. Research shows one simple way to help nervous patients get through their scans without interruption: Communication.

 

A 2015 study in the journal Magnetic Resonance Imaging tested an intervention in which imaging staff explained the MRI process to one group of patients. They took blood samples during the scans, later testing them for the stress hormones prolactin and cortisol. Additionally, they took both the experimental and control groups through the 40-questions State-Trait Anxiety Inventory to measure patient nervousness.

 

The patients who had the intervention in which staff verbally shared information about the scan showed a 6-percent drop in cortisol after the scan. The control group’s cortisol levels increased by 18 percent. The authors of the study conclude that “MRI anxiety can be reduced by information and communication. This combined method is shown to be effective and should be used during daily radiology routine.”

 

So what can physicians do to prepare their patients for a first MRI scan in advance? It’s never too early to start educating patients about what they can expect during a health procedure. And the MRI process can be boiled down into 10, easy-to-grasp steps. Share these steps with patients to help limit anxiety during an MRI scan:

 

  1. First, radiology staff will walk the patient through a detailed screening process. Because of the strong magnetic field generated during an MRI, patients must report any medical implants or metal particles in their bodies. These may preclude the use of MRI imaging. 
  2. Once the patient clears the screening, staff will lead them into the MRI suite. Some imaging facilities offer hospital robes, to ensure there’s no metal in the patient’s clothing. Others allow patients to wear their own metal-free clothes, such as sweat pants and a T-shirt. The technologist will proceed to position the patient on the table; most commonly, patients lie on their backs. If the scan requires an additional radiofrequency coil, the technologist will place that on the patient’s body at this time.

  3. The patient enters the bore. Meanwhile, technologists cycle through a list of pre-programmed settings called “protocols.” They’ll choose the protocol that corresponds with the body part they are imaging; this will tell the MRI machine which angles, targets, and pulse sequences to use in this particular procedure.

  4. Before the scan proper begins, technologists run a “scout” or “localizer” scan. This is a low-quality image, and it won’t be used in reporting. However, localizer scans obtain visual and placement information that the computer will used to plan the angles of its imaging later in the process.

  5. Parallel imaging is a process designed to speed up scan time. It collects less raw data during the scan, and patches missing information using special algorithms to generate the final image. Parallel imaging requires specifically calibrated coils, and may call for a calibration scan at this point.

  6. One of the great strengths of MRI scans is that they create 3D images that can be viewed from any angle. The next step is to program in the angle of images for the radiologist. Technologists can change the “thickness” of the image at this point, as well.

  7. Before the scanner can begin collecting valuable images, it must calibrate all systems through the use of a prescan. This shouldn’t take much more than 10 or 20 seconds.

  8. It is only at this relatively late stage in the process that the technologist actually runs the scan. They will make necessary adjustments and continue scanning according to the chosen protocol. In the end, they’ll have clear, accurate images that radiologists will use in their reporting.

  9. Some types of images require extra work in post-production, but this can be done after the patient has left the MRI suite.

  10. Scanning complete, the technologist pulls the patient from the bore. Different types of scans take varying lengths of time, but most range between 20 and 60 minutes.      

 

When patients understand more about their medical procedures, and know what to expect, they’re less likely to experience significant anxiety. That’s both a value in itself — as patient-centered caregivers, staff at Precise Imaging works to keep patients comfortable, both physically and emotionally — and an element of better diagnoses, which lead to better patient outcomes.

 

To learn more about an MRI procedure from Precise Imaging, or to refer a patient, call us at 800-558-2223.  

 

References:

 

Deshmane A, Gulani V, Griswold MA, Seiberlich N. Parallel MR imaging. Journal of Magnetic Resonance Imaging: JMRI. 2012;36(1):55-72. doi:10.1002/jmri.23639

 

Elster AD. “Performing an MR Scan.” MRIQuestions.com. 2017. Web. Jan. 8 2018.

 

Tazegul G, Etcioglu E, Yildiz F, Tuney D. Can MRI related patient anxiety be prevented? Magnetic Resonance Imaging. 2015;33(1):180-3. doi:10.1016/j.mri.2014.08.024

 

Insurers Demand Independent Imaging Centers: What Physicians Should Tell Patients

Independent imaging centers are moving to the forefront of diagnostic care in the United States. Recently, at least one major health insurer dropped coverage for CT and MRI scans at hospital radiology facilities. The insurance company will only pay for these scans when patients visit providers who specialize in diagnostic imaging, and imaging alone.

 

How will this change the conversation between referring physicians and their patients? In order to explain the changes — why insurers would make a rule like this, and why it’s not at all a bad change for patient care — physicians need only look at two key metrics of today’s health care system: price and quality.

 

The Price Difference Between Hospitals and Independent Imaging Centers

 

When an insurance company makes a move like this, it’s a clear indication that there’s a wide price differential that’s not necessarily associated with a difference in quality of care. Research from the Healthcare Financial Management Association — a professional organization for people who work on the financial side of the health care industry — shows that prices at hospitals are, in fact, dramatically higher than those at the average free-standing imaging provider. Among other differences, the HFMA found:

 

  • MRI scans cost an average of 70 percent more at hospitals than at independent imaging centers.
  • When those MRI scans covered the head and/or neck, they were an average of 80 percent more expensive in hospital-owned facilities.
  • The differences were even more stark for CT scans. Imaging of the body using CT cost 135 percent more at hospitals.
  • For CT scans of the head and/or neck, patients paid an average of 149 percent more at hospitals than at free-standing imaging facilities.

 

This research was published in 2017, though most of its data came from 2014. Either way, price gaps remains.

 

Measuring the Quality of Diagnostic Imaging Providers

 

Patients are used to associating higher prices with better service. In health care, however, quality and cost are independent of one another. The United States has the most expensive health care in the world.

 

In 2014, U.S. health care spending per capita was $9,237. That year the United Kingdom spent $3,749 per person while Japan’s figure stood at $3,816. Still, among the 12 wealthiest industrialized nations — including Japan and the UK — the United States lands dead last in terms of life expectancy.

 

Clearly, spending more does not buy better care in this country. In fact, independent imaging centers offer measures of quality, in terms of better patient experience, that most hospitals cannot boast. At Precise Imaging, these include:

 

  • Evening and weekend hours to work around the patient’s schedule, not the other way around.
  • Excellent, board-certified radiologists and technicians, often the same ones hospitals use, at a drastically reduced cost.
  • Quick reporting with HIPAA-compliant online sharing with referring physicians. Most doctors are reading radiology reports within 24 hours of the scan.
  • Same-day scheduling.  
  • Transparent pricing.

 

There have been plenty of good reasons to refer patients to a free-standing imaging facility for years. Now that insurers are refusing to support the arbitrary and inflated costs that hospitals charge, more and more patients will be able to experience the care that Precise Imaging provides.

 

HIPAA Compliance for Online Radiology Reports

Patients and referring physicians increasingly enjoy the benefits of digital access to radiology reports, but the online environment raises new concerns about HIPAA compliance.  

 

It is, of course, entirely appropriate for doctors to be concerned about patient privacy online. In May of 2017, at least 7,000 medical records were leaked at a New York City hospital. In November of that year, hackers took hostage the protected health information of 7,000 patients at a Massachusetts sports medicine provider, demanding a ransom with the threat of releasing the data. The following month, news broke that an ex-employee of a San Antonio mental health provider left the job with more than 28,000 patient records downloaded to a personal computer.  

 

Data breaches happen, and when they do, health care providers could find themselves in violation of HIPAA. So how can physicians be sure that their radiology providers are adequately protecting their practices and their patients?

 

Here, we describe some of the ways that the Precise Imaging web portal does it. By following these recommended protocols, our IT systems keep out intruders, ensuring compliance with HIPAA to keep protected patient information safe and secure. First, though, we’ll take a look at the letter of the law itself. What exactly does it mean for an online data-sharing system to be “HIPAA-compliant?”  

 

The Health Insurance Portability and Accountability Act of 1996 and Patient Privacy

 

According to the HIPAA Security Rule, which governs the storage and transmission of electronic protected health information (EPHI), requires covered health care providers to meet four major goals:

 

  1. The provider must keep EPHI in their possession — whether they create the information, hold it, or simply pass it along — completely private and confidential. It cannot become available to any non-approved parties.

 

  1. Within reason it is the provider’s responsibility to anticipate potential threats to secure information. If they identify a threat, they must act to protect EPHI from it.

 

  1. Similarly, providers have a duty to shield EPHI within their control from “unauthorized uses or disclosures.”

 

  1. Finally, these requirements extend from top administrators to the very bottom of the pay scale. Every health care provider must make sure that all employees comply with the above rules.

 

Note that the Security Rule does not dictate specific technical steps companies must take to keep EPHI safe and secure. These things are up to the providers. And the entities covered under HIPAA have strong incentives for investing in ironclad digital protections for their patients’ health information: They can face fines of up to $50,000 per compromised health record, with an annual maximum limit of $1.5 million.

 

But there’s an even more important reason why responsible health care providers invest heavily in protecting patient information. Organizations that devote themselves to patient-centered care don’t just treat a single injury or illness and forget their patients. They concern themselves with every aspect of the patient experience, from physical and emotional comfort to mental well-being between visits, as much that’s possible. Finding out that your personal information has been leaked is a stressful experience, and no self-respecting health care provider wants to bring anxiety into a patient’s life. In short, we invest heavily in privacy because that’s what’s best for the patient.

 

HIPAA Compliance in the Radiology Web Portal

 

Precise Imaging offers a series of user-specific web portals, for patients, referring physicians, and even personal injury attorneys who may need access to diagnostic images to win a case. Each of these web portals provides best-in-class security features, clearing HIPAA requirements and protecting our users’ priceless data.

 

The following is far from an exhaustive list of the security tools that protect radiology reports and other EPHI within Precise Imaging web portals. But it should make clear that these systems are robustly protected from data loss that could put patient information at risk. Here are a few of the tools that our IT systems have in place to protect EPHI and comply fully with HIPAA requirements:

 

  • All transfers of EPHI through the Precise Imaging web portals are fully protected by SSL/TLS encryption. Transport Layer Security (TLS) is the industry standard for protecting data in transit from clients to servers and back again. This is an updated version of Secure Sockets Layer encryption (SSL), but we refer to the technology as “SSL/TLS” because people still tend to use the terms interchangeably. In fact, TLS is more advanced than SSL encryption, and that’s what our web portals use to encrypt data in transit.

 

 

  • Data remains secure even in a computer’s local cache through AES, the Advanced Encryption Standard. This block cipher algorithm is one of only two encryption tools used by the U.S. government, and it remains a powerful lock on data. To further protect data within the local cache, these web portals purge the cache of EPHI after each session. That is, after the user logs out, there’s no patient information stored locally at all.

 

 

 

  • Site administrators set strict user identifiers. Each user must have a unique login ID and password, and our systems don’t allow weak passwords. We may even ask for periodic password replacements; all of these systems are designed to keep EPHI as secure as possible.

 

 

 

  • Audit trail tools track each user’s activities (without storing EPHI). If, somehow, an unauthorized user gained access to one of our web portals, integrated reporting tools would flag any suspicious activity.

 

 

 

  • After a period of inactivity, sessions will logout automatically. This reduces the chances of an unauthorized viewer gaining access to EPHI when users simply forget to log off.

 

 

The servers that Precise Imaging web portals use are configured specifically to comply with HIPAA. When it comes to patient data, we don’t take chance. Server rooms that host patient data are even equipped with comprehensive physical security, greatly reducing the risk of intrusion.

 

There’s no reason that compliance with HIPAA should reduce the web-based functionality that so many radiologists, referring physicians, and patients rely on to create better health outcomes. At Precise Imaging, we follow advanced security protocols to protect patient information. We’re able to share online radiology reports with full HIPAA compliance, which tends to reassure even the most security-conscious referring physician we work with.

 

References:

 

7,000 Patients Impacted by Extortion Attempt on Sports Medicine Provider. HIPAA Journal. 28 Nov. 2017. https://www.hipaajournal.com/7000-patients-extortion-attempt-sports-medicine-provider/

 

Gefen R, Bruno M, Abunedeh H. Online portals: Gateway to patient-centered radiology. American Journal of Roentgenology. 2017 209:5, 987-991. doi.org/10.2214/AJR.17.18291

 

HIPAA Violations & Enforcement. American Medical Association. N.d. https://www.ama-assn.org/practice-management/hipaa-violations-enforcement

 

Lee, CI, Langlotz CP, Elmore JG. Implications of Direct Patient Online Access to Radiology Reports Through Patient Web Portals. Journal of the American College of Radiology. 2016 13:12PB, 1608-1614. doi.org/10.1016/j.jacr.2016.09.007

 

PHI of 28,000 Mental Health Patients Allegedly Stolen by Healthcare Employee. HIPAA Journal. 5 Dec. 2017. https://www.hipaajournal.com/phi-28000-mental-health-patients-stolen-by-healthcare-employee/

 

The Security Rule. U.S. Department of Health & Human Services Office for Civil Rights. 12 May, 2017. https://www.hhs.gov/hipaa/for-professionals/security/index.html

 

United States. (2004). The Health Insurance Portability and Accountability Act (HIPAA). Washington, D.C.: U.S. Dept. of Labor, Employee Benefits Security Administration. https://www.gpo.gov/fdsys/pkg/PLAW-104publ191/pdf/PLAW-104publ191.pdf

 

breast-mri

Rethinking Breast MRI Cancer Screening

Breast MRI is not a first-line breast cancer screening tool for most women. The American Cancer Society recommends annual MRI screening only for women with a lifetime risk of breast cancer that’s greater than 20-25 percent, and only as an adjunct to mammography. The problem is that MR images are too clear, leading to too many false positives, the ACS explains.  

 

“While the high rate of biopsies and further investigations is acceptable in women with a high risk of breast cancer, the number of such investigations in women at lower risk will be much higher than would be appropriate, leading to the need to counsel women in lower risk categories that MRI screening is not advisable and that the harms are believed to outweigh the benefits,” wrote researchers for the American Cancer Society Breast Cancer Advisory Group in the ACS guidelines in 2007.

 

However, a study published in the May 2017 issue of the journal Radiology suggests that it could be time to rethink these recommendations. Researchers from the University of Aachen studied 2120 women, aged 40 to 70, with lifetime breast cancer risk factors of less than 15 percent. The women received screening via MRI, ultrasound, and mammography between 2005 and 2013.

 

Of the 60 cancers discovered in the study, 59 were observed using MRI scans. None were uncovered by ultrasound or mammography alone. Meanwhile, the positive predictive value of the MRI screening was high, hinting that concerns over false positives may be exaggerated given current MR technology and advances in radiology practice.

 

“In women at average risk for breast cancer, MR imaging screening improves early diagnosis of prognostically relevant breast cancer,” the authors concluded.

 

Other Factors Limiting the Use of Breast MRI Screening

 

Even if further studies show that false positives are no longer as prevalent in MRI breast screening as they once were, other barriers continue to limit patient access to the procedure.

 

There are two major reasons physicians don’t order more breast screening via MRI, reports Radiology Today magazine: Insurance companies won’t cover breast MRI for women unless they show high risk, citing excessive costs for the procedure; and there simply aren’t enough MRI providers across the nation.

 

These are concerns that patients and physicians in many parts of California, Nevada, and Arizona needn’t worry about. Precise Imaging operates a growing network of more than 70 free-standing imaging centers in communities across these states — with more on the way.

 

Precise Imaging Expands Access to Breast MRI Scans

 

By providing access to MRI scans within many communities, Precise Imaging allows patients to schedule appointments when and where they please. This greatly expands the total MRI capacity in areas where Precise Imaging operates.

 

As for the issue of cost, Precise Imaging provides a streamlined, flexible billing system, allowing patients to pay through as many avenues as possible. That includes Medicaid/Medicare, PPO insurance, personal injury liens, letters of protection, and low cash prices.

 

And because Precise Imaging providers aren’t attached to a broader hospital system, they don’t have to balloon prices to cover high-loss areas, such as emergency services. Together, these factors allow Precise Imaging to offer more diagnostic imaging procedures — including breast MRI — to more patients at a lower cost.   

 

Some day soon, breast MRI might becomes a standard screening procedure for all women, with life-saving results.

 

References:

 

Kanal K, Butler P, Sengupta D, Bhargavan-Chatfield M, Coombs L, Morin R. U.S. Diagnostic Reference Levels and Achievable Doses for 10 Adult CT Examinations. Radiology. 2017 284:1, 120-133. doi:10.1148/radiol.2017161911

 

Saslow D, Boetes C, Burke W, et al. for the American Cancer Society Breast Cancer Advisory Group. American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography. CA: A Cancer Journal for Clinicians. 2007 57: 75–89. doi:10.3322/canjclin.57.2.75

 

Yeager, D. MRI Monitor: Brevity is the Soul of It. Radiology Today. 2017 18:10, 28. http://www.radiologytoday.net/archive/rt1017p28.shtml

 

Precise Imaging to Open New Anaheim Location

Precise Imaging to Open New Anaheim Location, Expanding Availability of Patient-Centered Diagnostic Care with Unparalleled Access for Physicians

 

November 10, 2017 — Anaheim, California —  Precise Imaging, a private corporation owned by Jaklin Benji, Matt Benji and Mike Rashidi, will open a new facility at 3174 West Lincoln Ave., in Southwest Anaheim, on the 13th day of November 2017. As a leading independent provider of diagnostic imaging services across California, Nevada, and Arizona this latest location will feature a state-of-the-art open MRI scanner.  The opening of an Anaheim location will create even more flexibility for those in need of imaging services while expanding access for referring physicians and their patients.

 

“Access to quality care is our highest priority,” said Danny Rackow, director of technology and operations at Precise Imaging. “The new Anaheim location gives doctors and patients yet another quality source for MRI procedures while bringing the  benefits of an open MRI to a whole new community.”

 

The Anaheim location adds to Precise Imaging’s growing network of over 100 locations, many of which offer evening and weekend hours, same-day referrals, and 24-hour turnaround on radiology reports—even less for STAT cases.

 

Patient-Centered Care with Physician-Preferred Workflow

 

In keeping with Precise Imaging’s mission to build dependable relationships with referring physicians in every medical specialty, the new location will offer a powerful suite of digital resources for health care providers. Physicians can make referrals at any time through a free online form. Following the procedure, they can view radiology reports and images 24 hours a day through a simple, HIPAA-compliant web portal. Experienced IT staff is available at every hour of the day and night to assist physicians with all digital tools.

 

“Doctors should be able to focus on care and not get bogged down on the simplest interactions such as scheduling, availability and ease of use with a provider,” Mike Rashidi said. “We built our physician access tools to make the entire process hassle-free, from referral to reporting to interacting with insurance providers, because we want what the doctors want: better health outcomes for patients.”

 

Precise Imaging has a proven track record of patient satisfaction, and the new location will continue this tradition. The inclusion of a comfortable open MRI scanner in the latest facility is just one example of the compassionate care that sets Precise Imaging apart. Friendly, experienced staff and board-certified radiologists take the time to provide support for the whole patient—body and mind—and that can lead to better, more actionable reports.

 

Continued Partnerships with Personal Injury and Workers’ Compensation Attorneys

 

*Legal professionals who serve clients in Anaheim will benefit from the establishment of the new Precise Imaging location. The company has a long history working with injured clients, and has developed a streamlined and efficient work flow that can provide case-winning medical evidence right on schedule.

 

*Physicians can refer a client online with the click of a button and reach out for support any time through a dedicated web portal. All Precise Imaging locations accept personal injury liens, letters of protection, and workers’ compensation liens.

 

“We’ve helped thousands of attorneys seek justice for their clients, and that mission continues with our new facility,” says Matt Benji.

 

To learn more about Precise Imaging’s new location, or to schedule an appointment anywhere in the network, call 800-558-2223.

 

About Precise Imaging

 

Precise Imaging is a leading provider of MRI, X-ray, PET, and other diagnostic services with locations across California, Arizona, and Nevada. The company offers industry-leading support for physicians and attorneys with best-in-class patient care. Flexible billing options include Medicaid/Medicare, PPO insurance, personal injury liens, cash prices, and more. To learn more about Precise Imaging, please visit www.precisemri.com.    

5 Ways Radiology Technologists Reduce Patient Claustrophobia During MRI Scans

5 Ways Radiology Technologists Reduce Patient Claustrophobia During MRI Scans

 

Physicians strive to prevent distress in patients at every turn, but between 4 and 30 percent of patients who undergo MRI scans still report some level of anxiety. This isn’t just a problem for patients; claustrophobic reactions can add considerable time to MRI scans, and can even adversely affect clinical findings through lower-quality images.

 

Even worse, according to a 2007 article published in the Journal of Magnetic Resonance Imaging, claustrophobic patients abort around 2 million MRI scans around the world every year. That deprives physicians of much-needed diagnostic images.  

 

The good news is that radiologists and technologists have developed interventions that can help to reduce claustrophobic reactions leading up to and during the procedure. As the first point of contact with patients, referring physicians can help lay the groundwork for a comfortable, anxiety-free patient experience by explaining how technologists can help alleviate their fears as soon as a patient expresses trepidation about the upcoming imaging exam.

 

To that effect, here are some of the latest techniques and strategies physicians can explain to nervous patients when they refer them for an MRI scan:

 

  1. The first step to treating anxiety is to recognize that it is occurring, and technologists are trained to look for signs of discomfort throughout the entire patient interaction.

 

A 2013 study published in the International Journal of Behavioral Medicine used both subjective self-reports before and after the procedure to gauge patient anxiety. The researchers also measured electro-physiological reactions during the entirety of the study scan. Their findings suggest that patients tend to be most anxious at the beginning of the scan, as they enter the MRI bore. Then their distress usually diminishes throughout the course of the procedure.

 

Physicians can explain that patients might feel nervous or unable to complete the MRI scan at the beginning, but that once they’re through that portion of the scan, they’ll likely begin to feel more calm.

 

However, patients should know that technologists are aware of the patient’s experience, and are committed to keeping them comfortable. Imaging staff listen for verbal cues of patient anxiety — from an explicit admission of fear to a tremor in the voice — and will move quickly to help a patient through a moment of panic.

 

Technologists also watch their patients’ eyes; people with claustrophobia might glance nervously at the scanner’s bore or else avoid looking at the machinery altogether. Other indications of anxiety that technologists watch for include blanching or flushing in the patient’s face; reluctance to follow simple instructions; sweating; or reports of tachycardia.

 

Physicians can help to prepare nervous patients for a better experience at the imaging center by assuring them that the imaging staff is aware of, and responsive to, any discomfort they might feel, and that they will pause the procedure at the patient’s request.  

 

  1. Patients should know that the choice to go through with an MRI scan is entirely within their power; technologists will never try to coerce them to go through with a procedure they decide to delay.

 

Ultimately, health care choices belong to the patient. If patients express anxiety about an upcoming MRI scan, physicians can assure them of this fact. They can explain that the patient can choose to forego a scan at any point during the treatment process.

 

By including this comforting information in an explanation of the health benefits of the MR images, physicians both place the nexus of control within the patient while also gently encouraging them to undergo the procedure for the sake of their health.   

 

  1. Technologists provide detailed, thorough explanations to patients before entering the examination room.

 

Patients who know what to expect are less likely to become anxious. But technologists also use their pre-scan conversations to build healthy clinical relationships with patients. It’s important for patients to know that their technologists are friendly, understanding, competent, and utterly trustworthy. Early conversations help to create this welcoming atmosphere.

 

Physicians can lay the groundwork for a successful imaging procedure by assuring their patients of the technologist’s positive attributes. That’s why it’s so valuable for physicians to work with preferred imaging providers, building relationships and trust that they use to help reassure patients who might be uncomfortable with the procedure. It’s all part of the patient-centered approach that Precise Imaging practices.

 

  1. There are multiple distraction-based interventions that have documented history of helping patients through their anxiety when they enter the scanner bore.

 

The authors of Pinpointing Moments of High Anxiety During an MRI Examination, the study from the International Journal of Behavioral Medicine, seem hopeful about in-bore audiovisual systems that could distract patients during moments of anxiety — perhaps by allowing them to experience favorite TV shows or movies during the exam. The researchers also point to the use of prism glasses, which provide mirrors that allow patients to see outside of the bore, even as they lay flat for the procedure.

 

However, even something as simple as placing a soft cloth over the patient’s eyes can help alleviate claustrophobia, writes technologist Thomas Rotunda, BSMI, BSHA, R.T.(R)(MR)(QM), in a recent edition of the journal Radiologic Technology.

 

This practice “is a basic way to combat claustrophobia because it helps patients ignore how close the inside of the scanner is to their faces, which likely makes them feel less confined,” Rotunda writes.

 

  1. Newer scanning technology can be incredibly effective in reducing claustrophobia among patients.

 

One of the most powerful changes that imaging centers can make is to update their equipment, and that’s been true for a decade. A seminal 2007 study in the Journal of Magnetic Resonance Imaging found that the latest MRI scanners, which reduced noise in-bore noise by 97 percent while also featuring a shorter bore than previous models, could reduce the incidence rate of claustrophobia by three times.

 

Physicians can reduce the expectation of anxiety in their patients by explaining the changes that have taken place since the old days of narrow bores and loud machines. Managing patient expectation will go a long way toward reducing claustrophobia and anxiety, which will lead to greater outcomes for patients.

 

Call Precise Imaging at 800-558-2223 to discuss advanced imaging equipment available and anxiety-reduction options, or to make a referral.

 

References:

 

Dewey M, Schink T, Dewey C. Claustrophobia During Magnetic Resonance Imaging: Cohort Study in Over 55,000 Patients. Journal of Magnetic Resonance Imaging. November 2007; 26(5):1322-1327. Available from: Wiley Online Library. Accessed November 2, 2017.

 

Melendez J, McCrank E. Anxiety-related reactions associated with magnetic resonance imaging examinations. JAMA, The Journal Of The American Medical Association [serial online]. 1993;(6):745. Available from: General OneFile, Ipswich, MA. Accessed November 2, 2017.

 

Minde D, Klaming L, Weda H. Pinpointing Moments of High Anxiety During an MRI Examination. International Journal Of Behavioral Medicine [serial online]. June 2014;21(3):487-495. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed November 2, 2017.

 

Rotunda T. Reducing Occurrences of MR-related Claustrophobia in Patients With PTSD. Radiologic Technology [serial online]. September 2017;89(1):97-99. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed November 2, 2017.

 

sports medicine diagnostic imaging

Diagnostic Imaging for Sport and Exercise Medicine (SEM) Specialists

Diagnostic Imaging for Sport and Exercise Medicine (SEM) Specialists

 

Sports physicians and radiologists work together to quickly diagnose and treat the musculoskeletal injuries associated with frequent physical exertion. Still, sport and exercise medicine (SEM) remains a young specialty — it wasn’t until 2005 that the United Kingdom’s Department of Health granted SEM official specialty status.

 

So it’s a good time to ask the question, both of sports physicians and radiologists themselves: How can this close working relationship improve as both specialties develop? What exactly do sports physicians need from their diagnostic imaging providers, and how can those providers tweak their processes to work better with SEM specialists and their patients?

 

Here are a few thoughts, culled from the extant literature:

  1. Help provide actionable images to help decide when it’s safe for athletes to return to the field
  2. Assist with screening efforts and pre-play assessments;
  3. And they can provide “technical assistance with certain procedures.

 

Diagnostic imaging providers have much more to offer SEM physicians than confirmation of a given diagnosis.

 

 

According to I. McCurdie, FRCP, FFSEM(UK), writing in the British Journal of Radiology in 2012, “confirmation of accurate diagnosis” is only the first area in which radiologists can support sports physicians. They can also:

 

Sports physicians, in other words, need access to imaging providers who can respond to a wide range of needs. It makes sense for an SEM specialist to create relationships with established, trustworthy networks of imaging providers like Precise Imaging. With the range of expertise, simple systems for billing and referral, and an online portal just for physicians, Precise Imaging can respond to the immediate needs of SEM specialists and their patients.

 

Elite athletes often need incredibly quick turnaround on radiology reports.

 

When high-level athletes get injured, their managers want them back on the field as soon as it’s safe. Team physicians typically don’t have time to wait for a several-day turnaround to get their radiology reports.

 

Radiologists must be physically present, at imaging facilities or even on the field, in order to produce accurate reports a quickly as possible. Precise Imaging radiologists always work on-site at their facilities, and they average a turnaround of 24 hours, with available same-day referral service.

 

 

Sports physicians require access to multiple imaging modalities from the same provider.

 

 

“The range of pathologies and different tissues injured during sport and exercise determine the imaging modalities used,” writes McCurdie. “With soft-tissue injuries being common, the opportunity to image with ultrasound during functional movements (often as an extension of the clinical examination) and avoid any exposure to irradiation makes this a very useful tool.”

 

At the same time, MRI scans reveal soft-tissue injuries and have been successfully used to diagnose muscle damage accurately. Still, many physicians prefer to begin diagnostic imaging efforts with radiography.

 

“Plain X-ray should still generally be the first imaging technique,” wrote John Orchard et. al in the Medical Journal of Australia in 2005. In that article, “The use of diagnostic imaging in sports medicine,” Orchard and the other authors pointed out a few exceptions to the guideline of defaulting to X-ray.

 

“Exceptions include some forms of superficial tendinopathy, in which ultrasound may be more appropriate, and situations where radiation exposure is contraindicated, such as in a pregnant patient,” they wrote.

 

Precise Imaging locations offer multiple imaging modalities, often with a full range of options for each. So patients with musculoskeletal injuries associated with sports and exercise can visit a single outpatient clinic for ultrasound, X-ray, MRI, and/or CT scans, all with simple, convenient scheduling.

 

 

While all imaging modalities have their uses in sports medicine, MRI scans are sometimes crucial for the diagnosis of one of the most common knee injuries in sports: the ACL tear.

 

 

Klass et al. point out that MRI scans are a central component to care for patients with chronic knee conditions. In their literature review, though, the authors found that MRI was increasingly paying dividends in cases of acute injury, particularly a tear in the anterior cruciate ligament (ACL).  

Of course, physicians can often diagnose ACL injuries without the use of MRI technology. However, Klass and colleagues conclude, “It should be realised that significant advances are being made, and that there may be an increasing use of MRI in the management of the acutely injured knee which will include rupture of the ACL.”

 

Precise Imaging for Patients of SEM Specialists

 

SEM physicians and their patients benefit from diagnostic imaging facilities that:   

 

  1. Are capable of multiple imaging modalities;
  2. Remain available for expanded hours, including weekends and evenings;
  3. Offer quick, simple scheduling, including same-day service and ride assistance;
  4. Employ radiologists with experience in musculoskeletal injuries associated with sports and exercise, who carry full board certification, and who work on-site at the place of testing;
  5. Are able to handle a variety of payment types, including insurance, Medicaid and Medicare, personal injury liens, and even low cash options for uninsured patients;
  6. Operate large networks of outpatient clinics, ensuring availability and flexible scheduling.

 

Patients under the care of an SEM specialist will benefit from the friendly and efficient service of the Precise Imaging team. If you’re a referring physician and you’re looking for a new imaging partner to help with a sports and exercise medicine practice, contact Precise Imaging at 800-558-2223 today.

 

References:

 

Cullen M, Batt M. Sport and exercise medicine in the United Kingdom comes of age. British Journal of Sports Medicine. 2005;39(5):250-251. doi:10.1136/bjsm.2005.019307

 

Gibbs NJ, Cross T, Cameron M, Houang MT. The accuracy of MRI in predicting recovery and recurrence of acute grade one hamstring muscle strains within the same season in Australian Rules football players. Journal of Science and Medicine in Sport. 2004;7(2):248-258. [PubMed]  

 

Klass, D et al. MR imaging of acute anterior cruciate ligament injuries. The Knee. 2007;14(5):339-347. doi:10.1016/j.knee.2007.04.008

 

McCrory P. What is sports and exercise medicine? British Journal of Sports Medicine. 2006;40(12):955-957. [PubMed]

 

McCurdie I. Imaging in sport and exercise medicine: “a sports physician’s outlook and needs.” The British Journal of Radiology. 2012;85(1016):1198-1200. doi:10.1259/bjr/14729770

 

Orchard, J, Read J, Anderson I(J)F. The use of diagnostic imaging in sports medicine. The Medical Journal of Australia. 2005;183(9):482-486. Available from: https://www.mja.com.au/journal/2005/183/9/2-use-diagnostic-imaging-sports-medicine

No health Insurance

Diagnostic Imaging Referrals for Uninsured Patients

What should physicians do when they suspect a patient needs an expensive diagnostic imaging procedure, but they also know that patient lacks health insurance, or has an inadequate plan? How do they weigh financial considerations against crucial diagnostic information?

 

As physicians, you balance a huge number of variables in deciding which diagnostic imaging procedures to order for your patients. You must weigh radiation exposure versus probability of actionable images, for instance, or decide whether a patient needs an X-ray, an MRI, or both.

 

And like it or not, every decision a referring physician makes will have an impact on the patient’s final bill — which becomes problematic, both ethically and medically, given the role financial stress plays in negative health outcomes such as depression.

 

Lack of Health Insurance and Frequency of Diagnostic Imaging

 

Here’s what we do know, at least as of the 2012 publication of this study from the Journal of the American College of Radiology: Uninsured Americans received fewer imaging procedures in emergency departments than insured patients. In a sense, this is unsurprising; Americans without health insurance generally receive less health care overall.

 

What we don’t know is what to do about it. Should we order less imaging for insured patients, or more for uninsured patients? We won’t really know until we can measure the outcomes of uninsured patients who receive equal care. To do that, we must find a way to provide truly affordable diagnostic imaging for all patients. That’s where Precise Imaging can help.  

 

How Physicians Can Reduce the Financial Impact of Imaging on Patients

 

The ideal situation would be for physicians to have access to imaging centers that offer a full and flexible range of payment options along with the highest-quality service, simple scheduling, and fast results. That’s exactly the combination that Precise Imaging offers to referring physicians.

 

Precise Imaging operates 70+ locations with evening and weekend hours, so your patients can always find a time and a place that suits them. If transportation is a problem, Precise Imaging can send a car for free. And with same-day scheduling and a 24-hour average turnaround on reports, you’ll have the information you need without delay.

 

But the real issue for uninsured patients is the financial burden. That’s why Precise Imaging’s experienced billing team is trained and authorized to handle an incredible variety of payment options. For personal injury cases, they can accept liens. If workers’ compensation is involved, that’s no problem.

 

Precise Imaging even offers special cash prices for uninsured or underinsured patients. Friendly billing staff can also work with payors to establish structured payment plans. These options can create powerful discounts for patients in need, and might be just the assurance that you need to order a procedure you’re on the fence about.

 

Financial considerations shouldn’t have any place in patient care, but, unfortunately, they are real, and must be considered. Next time you’re weighing the options for an uninsured patient, remember that Precise Imaging can help. Call Precise Imaging at 800-558-2223 to learn more about cash prices for uninsured patients.    

 

References:

 

Moser, James and Kimberly Applegate. “Imaging and Insurance: Do the Uninsured Get Less Imaging in Emergency Departments?JACR. Journal of the American College of Radiology, Jan. 2012. Web. 29 Sept. 2017.

 

Galea, Sandro et. al. “Urban Neighborhood Poverty and the Incidence of Depression in a Population-Based Cohort Study.” ScienceDirect. Annals of Epidemiology, Mar. 2007. Web. 29 Sept. 2017.

 

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