Tuesday, June 19, 2012

Thank You For Funding Imaging Advantage

You may remember the string of articles published here on DoctorDalai.com concerning Imaging Advantage.

In brief, Imaging Advantage insinuates itself between radiologists and hospital administrations, promising the latter huge benefits and screwing the former. Think Enron and the energy market, and you have the idea. IA's most famous take-over and subsequent flop in Toledo is well documented here and elsewhere.

The model is one only a doctor-hating administrator could love. IA claims that they are usually able to successfully hire on the group they are displacing from the hospital, and ultimately that group loses a good chunk of its salary, which goes back to IA, and probably is kicked back in some subtle form to the hospital. Administrators seem to be buying into the platitudes, as IA claims "hospitals and partners across 14 states."

Since I've declared my love for capitalism on numerous occasions, the Socialists out there are probably just drooling (more than usual) over the opportunity to point out that IA represents the "free" market in action, so how could I possibly object? Basically, this is anything but a free market scenario. C-Suite types, who make these decisions, are NOT the end-consumer of my product. They are choosing IA and their ilk in theory to "improve care" which somehow never seems to happen. Perhaps they think they will save some money on those horribly expensive rads, although how this happens when most hospitals don't directly pay rads is a mystery to me. My personal theory is that these interlopers take over the interpretive revenue stream from the rads, and somehow promise, maybe surreptitiously, to return some of that to the hospitals. No, this is about as much of a free market operation as the collection of protection money.

But only greedy capitalistic administrators would fall for this greedy capitalistic scheme? Wrong, borscht-breath. Your very own United States of America is buying into the inflated egos of Mr. Hashim and company. I assume our pal Naseer still runs this thing...the IA website isn't very informative these days.

Read this and weep:

Health Care Innovation Awards: Illinois

Notes and Disclaimers: 
  • Projects shown may also be operating in other states (see the Geographic Reach)
  • Descriptions and project data (e.g. gross savings estimates, population served, etc.) are 3 year estimates provided by each organization and are based on budget submissions required by the Health Care Innovation Awards application process.
  • While all projects are expected to produce cost savings beyond the 3 year grant award, some may not achieve net cost savings until after the initial 3-year period due to start-up-costs, change in care patterns and intervention effect on health status.


Project Title: “The right exam, at the right time, read by the right radiologist"
Geographic Reach: Illinois
Funding Amount: $5,977,805
Estimated 3-Year Savings: $14,935,320
Summary: Imaging Advantage LLC, in partnership with Vanguard Health Systems and other hospital systems in the Chicago metropolitan area, is receiving an award to re-engineer the end-to-end workflow process for hospital-based imaging services, including by leveraging technology to integrate immediate consultations with radiologists and other decision-support tools into the “front-end” of the patient-care continuum, where imaging exams are ordered and critical care decisions are made. A key objective of the program will be to reduce duplicative and/or clinically unnecessary advanced imaging exams. The program also will (1) deploy a unique disruptive innovation — RealTime QA® — which applies “double-blind” interpretations to high-difficulty exams in advance of patient treatment, (2) eliminate preliminary (or “wet”) reads after-hours and (3) materially improve exam turn-around times.  As a result, the program will reduce inappropriate advanced imaging utilization, improve quality assurance and, ultimately, improve patient safety and experience. A 30% decrease in CT use and decreased utilization of other imaging modalities is expected. CMS will also be evaluating planned centers in Detroit, San Antonio, and Boston.
Over a three-year period, Imaging Advantage LLC will train 495 workers in health care-related jobs. The new workforce will include clinical staff as well as IT development and operational staff.
Yes, folks, that would be about SIX MILLION DOLLARS out of YOUR pocket and mine, to fund this "experiment". There's a sucker born every minute, and most go to work for the government or become hospital administrators, it seems.

IA is doing nothing more than slapping a few buzz-words on its anything-but-clever "Real Time QA", labeling it a cost saving measure, (which is like wrapping a turd in fancy paper) and selling it to the morons civil servants at CMS.
Imaging Advantage is committed to advancing patient care and optimizing radiology services healthcare by introducing our RealTime QA Program. Imaging Advantage is the first in the healthcare industry to create a program specifically designed to address issues and resolve discrepancies while the patient is still present in the hospital, clinic or imaging center.

How it Works
Using our double blind parallel reading and review process, targeted high-risk cases are selected and interpreted simultaneously by two radiologists. If the results differ materially, the interpreting physicians review and resolve discrepancies, and correct any reported results prior to the patient being discharged. Simply put, higher quality of patient care is provided if discrepancies are resolved prior to the patient leaving the facility.

Why it’s Important
Catching mistakes before they are made, our RealTime QA Program adds value to healthcare facilities by:

--Reducing errors in high-risk exams lowering malpractice claim potential
--Reducing the need for patient call-back or report addenda
--Improving operational efficiency
Anyone who buys into this should be committed, in my humble opinion. What is a "targeted high-risk case"? Where are the most errors made? Probably mammo, but I don't see them applying this in that venue. How many of these double reads will be forced on the already overworked and underpaid rads? And I suppose cutting imaging utilization is the primary goal of a company that makes money from imaging utilization? Sure it is. Actually, utilization was cut at the IA flagship in Toledo, according to one of the displaced rads there, as clinicians took their business elsewhere.

If you aren't happy about your tax dollars supporting this, let your Congressman know. As an aside, and this is my PERSONAL OPINION, not reflective of anyone or anything else...any rad who signs on with IA had better have one incredible collection of extenuating circumstances which forced him to do so...otherwise don't ever come to me looking for work. Favorable consideration will be given, however, to those displaced by this operation.


Anonymous said...

I completely agree with you. What a farce of resource allocation. Oh Dr. Dalai, what has our system come to? $6 million to IA? We all want to improve the delivery of healthcare but not by giving taxpayer $ to unscrupulous crooks who have commoditized radiology.

Anonymous said...

Hey Dalai-Do you publish your quality metrics or are you like most others with a God complex that don't think they should be held to a quality standard? Keep fighting technology and process improvement and pray you are able to retire before we shine a light on mediocre and subpar performance. It's usually those that scream the loudest that have the most to hide!

Anonymous said...

Hey, Naseer! Long time no see! Hope you're proud of your little scam to bilk the government. I guess they aren't too much smarter (or more foolish) than your favorite hospital administrators...

Anonymous said...

This is not Naseer and I don't work for IA. Instead of trying to be the TMZ of Radiology, perhaps you and your staff should pick up some of the recent independently published industry literature from Advisory Board and other organizations that clearly state the benefits being delivered by the top national groups. Maybe in your next post you can explain how "peer review" works in a typical Rad Group that is an equal financial partnership. You can follow that up with insight on what processes local Rad Groups have in place to drive appropriate utilization when they are paid based on the number of studies they read and not the quality of their work.
While I believe most local groups have the best interest of their patients and clinicians at heart, it is impossible to argue that the traditional radiology delivery model is structurally flawed when it comes to accountability and quality. I'm quite certain there is a lot more "bilking" going on in the area of overutilization.

Anonymous said...

OK...dmarkup? Hegemonrad? Again, long time, no see.

You have indeed piqued my curiosity. If you would be so kind as to educate me and my readers (both of them) in the methods your (not IA) Top National Group accomplishes this lofty goal, I would be glad to publish the information here. Keep in mind that the clinicians are the drivers of utilization in just about every "classic" model, although that may change with the ACO concept.

I'm anxiously awaiting your response...