Bronson Healthcare Group, a stand-alone, nonprofit organization governed by a community board, operates Bronson Methodist Hospital, Kalamazoo, Mich, and its associated facilities. The hospital is on track to complete about 158,000 imaging studies in 2003, according to Brook Ward, director of radiology. That represents a significant increase over the hospital's procedural volume prior to its picture archiving and communications system (PACS) installation. It is really through such volume increases that a PACS pays for itself, Ward says.

Reductions in film use also help offset the cost of a PACS installation and necessary upgrades. The Bronson Methodist Hospital PACS is now in its third year. "The film budget has been cut in half in the past 3 years," Ward says."

Ward adds, however, that film savings alone will never pay for a PACS. "We're never going to be able to put a return-on-investment statement together based on film and chemicals. I don't think you'll find any hospitals that can," he says. "A hospital gains in improved patient care, enhanced radiology efficiency, better patient throughput, and increased physician satisfaction. Those are the areas in which a PACS either makes or breaks an organization. I think all those have been accomplished here."

Ward says overall volumes in radiology have gone up by double digits each year (except for general diagnostic radiography, which has been averaging increases of 4% to 5%) For fully digital modalities such as CT and MRI, the increases seen with the addition of PACS have been far greater. CT has been averaging increases of nearly 30% per year, and MRI volume has gone up between 10% and 24%. Nuclear medicine procedures are up more than 20%; special procedures, over 20%; and ultrasound, 12% to 20%.

In 2002, Bronson Methodist Hospital recorded over 400,000 outpatient visits, surgeons performed about 18,000 operations, and there were 68,000 patients seen in the emergency department (where visits are expected to reach 75,000 for 2003). "It's the volume increases that justify PACS, not the film savings," Ward repeats.