LABOR SHORTAGE STABILIZES, STUDY INDICATES

Is the escalating job-market shortage for diagnostic radiologists starting to stabilize? According to a study in the October issue of the American Journal of Roentgenology (AJR), that is indeed proving to be the case, although the labor shortage continues.

The study, led by Daniel D. Saketkhoo, PhD, Yale University School of Medicine, looked at all diagnostic radiology jobs advertised in both AJR and Radiology between January 2000 and December 2001. Those jobs were coded by practice type, geographic location, and subspecialty, and were compared with the previously published results from 1991 to 1999.

The research showed that from January 1999 to December 2001, 15,205 positions were advertised for diagnostic radiologists, representing a 284% average per-month increase as compared with the previous 4-year period. The 12-month average of job advertisements peaked in June 2001 at 476. A statistically significant increase in advertised jobs was noted in the Midwest, with relative decreases in the Northeast, Northwest, Southwest, and California. Significant decreases were seen in the number of general radiology, vascular and interventional, and emergency radiology positions. In addition, demand for mammographers, pediatric radiologists, neuroradiologists, abdominal imagers, and chest radiologists increased significantly.

Figure. Graph illustrates the number of help wanted advertisements by year in AJR and Radiology for diagnostic radiologists sorted by practice type, from January 1991 through December 2001. Reprinted with permission from the American Journal of Roentgenology.

The authors of the study conclude that the demand for both private and academic radiologists continues, but the pace of increase has slowed dramatically in the past 12 months, particularly in the western United States. In addition, the study noted that the gap between private and academic job openings has been widening since 1995. The latest figures reported more than 3,500 want ads for academic positions, vs less than 2,500 for private positions. By contrast, the ratio was almost equal in 1995 (see Figure).

ATLANTA INSURER LINKS QUALITY TO PAY FOR RADIOLOGY GROUPS

Report turnaround time and the number of false-negative mammograms could be among the measurement criteria in a newly developed quality incentive program that will affect at least five radiology groups in Georgia.

PROMINA Health System, an Atlanta-based group consisting of eight hospitals and more than 4,000 physicians, has joined insurer CIGNA HealthCare of Georgia to form the "Reward for Quality" program, which contains many features recommended by practice managers and consultants for physician financial incentives, aimed at production, cost control, or quality. The plan could result in higher compensation for physicians who meet mutually defined quality benchmarks in comparison to their peers through the analysis of data from CIGNA patients treated at PROMINA facilities.

"This will include all specialists, and of course that includes radiologists," says Andy Morley, MD, senior vice president of clinical operations for PROMINA. The program's criteria to measure quality will be based on the Health Plan Employer Data and Information Set (HEDIS), a set of standardized performance measures made up of various tests and rating systems.

But Morley says meetings with radiology groups are still ongoing to determine "how to develop quality indicators specific to radiology," and that the criteria employed will be more clinical than operational. "A few are operational, such as report turnaround time and patient waiting times. Those are big areas of concern," he says. "But radiology certainly has the toughest challenge in this program, as much of the criteria will be clinical. For example, we'll likely implement some tests for film-reading accuracy for mammogram readings."

The program will affect PROMINA's five affiliated radiology groups, in addition to more than 50 individual radiologists. Consisting of three separate payment tiers based on points, the program allows physicians to garner points to earn the reimbursement. If a practice achieves a certain performance level, its reimbursement rises by 5% of Medicare payments. If the practice reaches a higher level, reimbursement goes up by 10%. More specifically, if a practice meets a certain level of compliance with the quality standards, it then receives reimbursement for all services to CIGNA/PROMINA patients that is set at a 5% higher multiple of Medicare reimbursement than the baseline multiple set in the contract.

The incentive program begins on January 1, 2003, and will be based for a year on performance in the second half of 2002. With each succeeding year of the program, the performance levels required to win incentives will rise by amounts negotiated with CIGNA.

A similar program was slated to begin this fall in California, with Blue Cross of California keeping a quality scorecard on the 43,000 physicians who are part of the insurer's PPO network. Blue Cross says it will spend $1.1 million to run the program for 3 years, and will pay bonuses to physicians who meet high standards of care. The scorecard will incorporate measures such as being board certified, opening the practice to new patients, and prescribing generic drugs when appropriate.

CRA EXAM RESULTS RELEASED

The American Healthcare Radiology Administrators (AHRA), Sudbury, Mass, recently announced the results of its inaugural certified radiology administrator (CRA) examination: 86.44% of the 236 radiology administrators who took the CRA examination this past July received a passing score and are considered to have earned the certified radiology administrator designation, which they can now use after their name.

The program, funded by Eastman Kodak's Health Imaging Division, is designed to raise professional standards, enhance individual performance, and recognize administrators who demonstrate knowledge essential to radiology management. Candidates who were required to meet experience, education, and other credential requirements took the 185-question test, which contains questions based on knowledge, problem solving, and analysis. Test questions focus on human resource management, asset resource management, fiscal management, operations management, and communications and information management.

According to AHRA communications manager Karen Guy, the idea for the certification program began with a market research survey conducted by the association, in which the majority of administrators polled reported that a certification program would support and advance their professional roles. "We are also currently putting together dates and locations for 2003 examinations," says Guy. "The first round has been a success, and we are encouraged with the results."

CT SCANS MAY BE INADEQUATE FOR MODELING LUNG TUMORS

A study presented at the American Society for Therapeutic Radiology and Oncology (ASTRO) annual meeting in New Orleans in October suggests that conventional CT scans do not adequately take into account the way lung tumors move as patients breathe.

Researchers from the Department of Radiation Oncology at the University of Michigan, Ann Arbor, evaluated 14 patients treated for primary lung cancer, 12 of whom had non-small cell cancer. All patients had CT scans at inhale, exhale, and free breathing on a fast helical scanner, with a physician contouring tumors on each of the scans consistently. A composite tumor volume was created to combine the inhale and exhale tumors. Then, two expansion methods were used to compare this volume to the free-breathing tumor: first, the free-breathing data set was expanded uniformly by one centimeter; next, a nonuniform expansion was generated in all six directions to ensure complete coverage.

After the researchers measured the amount of excess normal lung tissue treated with each of these two expansions, they found that there was a significant amount of normal tissue treated with the uniform one-centimeter expansion as well as with the nonuniform expansion. In addition, there were cases where the technique led to marginal misses of the tumor, including one instance where 34% of the overall tumor was missed with the one-centimeter expansion.

In summary, Aaron Allen, MD, the lead author of the study, reported that breathing causes movement and potential shape change in lung tumors that are not fully appreciated using conventional, free-breathing CT models. Traditional models of expanding the tumor volume by one centimeter are less that ideal, he claims, and can lead to parts of the tumor being missed and healthy tissue receiving radiation.

IMAGING REDUCES UNNECESSARY SURGERY FOR WOMEN WITH SUSPECTED APPENDICITIS

A study published in the October issue of Radiology reports that imaging should be considered part of the routine evaluation of women with suspected acute appendicitis.

The study, led by R. Brooke Jeffrey, Jr, MD, professor of radiology and chief of abdominal imaging at Stanford University Medical Center, says that CT and ultrasound improve diagnostic accuracy, reduce unnecessary surgeries, and facilitate early treatment.

According to the researchers, the accuracy rate when diagnosing appendicitis is 80%, meaning that 20% of patients undergoing an appendectomy have a normal appendix removed. Diagnosing women is challenging because the symptoms of appendicitis are similar to those of acute gynecological and urinary tract abnormalities. The diagnostic accuracy rate for women with suspected appendicitis is between 60% and 68%.

The study reviewed the medical records of 1,130 consecutive patients who were preoperatively evaluated and underwent an appendectomy between September 1997 and August 2000; 462 of those patients were diagnosed with suspected acute appendicitis. After dividing them into four groups based on gender and age, the researchers analyzed the effect of preoperative imaging on the removal of a normal appendix. The results showed that, of the four groups considered, women with suspected appendicitis had better outcomes after preoperative imaging. Based on the data, women had the highest rate of normal appendix removal, at 28%, when no preoperative imaging study was done. That rate decreased to 7% when CT was obtained and to 8% when ultrasound was performed as part of the preoperative evaluation.

The study did not identify a statistically significant benefit to preoperative imaging for the other three patient groups. The researchers suggest that for these groups, only patients with confusing clinical signs and symptoms undergo preoperative imaging.

INDUSTRY NEWS

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Harris L. Cohen, MD

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