Digital Radiography’s big payoff
Digital Radiography (DR) enables the near-immediate rendering of high-quality medical images, right at the point of care. Quick acquisition and instantaneous availability of clinical images has made DR the gold standard for X-raying patients.
With new government legislation that encourages practices to go fully digital, many are making the transition from Computed Radiography (CR) and film to DR to optimize workflow and provide state-of-the-art care delivery. Patients, physicians and technologists reap myriad benefits of DR implementation, demonstrating the resultant substantial value of a significant initial investment.
The time is Now
In December 2015, the Consolidated Appropriations Act of 2016, or Omnibus Spending Bill, was enacted with a provision that caught many in the medical imaging community by surprise.
The federal legislation mandated that Medicare payments for exams performed on analog X-ray systems be reduced starting in 2017 and for CR equipment the following year. The technical reimbursement for a film X-ray will see a 20-percent cut; CR will be reduced by 7 percent from 2018 to 2022 and by 10 percent after that.
Ideally, these payment reductions will incentivize digital radiology holdouts to upgrade their X-ray technology for the more efficient delivery of care. As with other reimbursement cuts, it is expected that private payers will follow suit.
Like it or not, the analog X-ray transition to DR is imminent. It’s estimated over 8,500 CR systems are in use, with up to an additional 1,200 film systems still in the market. Some specialist and radiology groups are crying foul, asserting that their film or CR technology is suitable for the volume they do or type of image they need to acquire.
Eventually, however, replacement parts will be hard to come by. And, as reimbursement cuts continue—from those imposed by the Omnibus Spending Bill to other reductions across the board—practices need to maximize efficiency by quickening exam time and making image acquisition as smooth and safe as possible for patients. Time is money and most of us need more of both. The human cost of analog technology is perhaps most significant—from the mounds of paperwork for front desk staff to the loading of cassettes by RTs, practices must consider the economic incentives of transitioning into a fully digital center.
Better Decisions, Sooner
Film is incredibly inefficient and now holds an extremely small share in the X-ray market. CR, on the other hand, when introduced, offered film users many significant benefits over traditional cassettes. Still, the changing of cassettes for digital formatting is slow—having to remove it from the bucky tray, read it, replace it—with no image validation at the point of care. These cassettes also require replacing since they degrade, an added expense. The digital workflow that DR provides, on the other hand, is incredibly fast and efficient. Once the DR is ready in the bucky for the patient, the images are acquired in mere seconds.
With current DR technology, the technologist can also pre-program the anatomy information so the machine is ready to go before the patient enters the exam room; then, the patient only needs basic positioning. The RT simply makes sure the anatomy is accurate, and without having to change cassettes, can take all the images needed. Less time and attention is spent on the equipment, and more time and attention engaged with the patient. This one-on-one time and connection from more human contact and less machine tinkering can make all the difference about how the patient perceives his care experience. The facility offers top of the line technology, but more importantly, demonstrates a true interest in the patient’s overall experience.
Today’s DR technology is both forgiving and dynamic. The image can be reprocessed and tweaked right at the patient bedside. As today’s technology is designed to do more at the point of care, less is required of the patient in terms of waiting and repositioning. Both the patient and technologist know almost immediately if they got the images that are needed, and if minor adjustments can be made for even better visualization. DR functionality enables system programming for the image acquisition order, as well. Thanks to advanced post-processing capabilities, the technologist is able to present to the physician images that are in a familiar and preferred format for faster interpretations. Read time is maximized for efficiency, which makes the whole operation run smoother.
With the speedy acquisition, patients won’t wait for long periods of time between exposures. Typically, when movement is down, image quality goes up and fewer retakes are required. In a fully digital environment, the physician can weigh in quickly on whether the images facilitate a certain diagnosis, as well. DR significantly reduces the time between exposure and image availability, leading to better decisions sooner. If the physician is unsure about a certain diagnosis, he is more likely to request additional images from different positions knowing he can get them on the spot. This often results in more accurate care decisions, and sometimes even prevents the patient from going in for a more advanced modality scan such as Computed Tomography (CT).
Overall, the patient is able to have a positive care experience that not only shows value for his concerns, but also his time. Prove to the patient that this exam was executed with efficiency and clinical quality in mind, and he will return—perhaps recommending the facility to others.
One of the primary benefits of using DR X-ray technology is the substantial productivity boost. By acquiring images in seconds, the technologist is able to attain about twice the number of images—and therefore patient exams—in the same amount of time with DR vs. CR equipment. Practices that formerly used CR technology in two X-ray rooms can do the entire volume in one room, leaving the extra room for back-up, overflow, or perhaps other services or modalities to achieve new revenue streams. Consider the opportunity of adding ultrasound to a musculoskeletal (MSK) practice to visualize soft tissue tears or tendon injuries. Physicians can give a more thorough, accurate diagnosis while increasing productivity and revenue.
Executing X-ray exams in nearly half the time as CR means much less waiting for patients. A full waiting room is bad for business. And represents valuable real estate for other potential patients and the delivery of additional services. Waiting time costs everyone money, so as care providers, it’s critical to minimize delays and inefficiencies as much as possible.
Outpatient centers and non-hospital settings are prime candidates for maximizing patient throughput. In today’s healthcare climate where patient beds are at a premium, hospitals are seeking out a model that focuses on caring for the system’s most critical patients.
Hospitals want and need to send more patients to outpatient and specialty care centers. These facilities must make this as easy as possible for them, leveraging their tools and technologies to take the load off the most taxed institutions.
Investing in fully digital technologies, from DR to the electronic health record, makes full economic sense in the fulfillment of this role. Even a small practice of five doctors may have 10 or more front desk employees knee-deep in paperwork; reducing non-clinical work enables huge workflow gains, and often reduces compliance risk and the related HIPAA repercussions.
As we’ve seen, single physician or smaller practices are commonly being acquired by larger hospitals, or proactively seeking to align with them to maximize profitability. Joining a group of practices or banding together with a group of independent centers often makes good financial sense. Connecting electronically makes total integration a game-changer for all parties involved. From the sharing of medical imaging exam results to billing and scheduling, digital technology integration enables growth and efficiency.
Consider the Ultimate Payoff
The passage of the Omnibus Spending Bill simply affirms what many analog practices already knew: digital X-ray technology is the most efficient way to deliver this service to patients. As of 2017, they are financially incentivized to do so. Productivity is the focus of the future as reimbursement continues to decrease.
The cost of healthcare simply must be reduced. The pressure is all around, and practices, in turn, feel price pressure regarding capital outlays and large technology investments. While a significant capital outlay may seem like a deterrent, administrators managing equipment dollars must consider the ultimate payoff and their needs for successful growth: automation, accuracy, uptime, speed, workflow, success. If you’re not where you need to be today, consider how the investment in technology will take you where you want to go tomorrow.