That's why the practice management piece of this is so important. We are now all thinking in terms of, 'What do we get paid for? How do we staff to get paid? What scanners do we open and which do we close? Do we get authorization?'...It takes us seven days to get authorization from the insurance company.

Today those are some of the biggest challenges -- how to continue to do good work in a safe way and get paid for doing it.


Imaging industry staffing

Lopez: Cyclically, one the most challenging things is always staffing, because of the way our education system works. The schools sense that not all of their grads are getting jobs and the next year they want to cut their program in half.

Not too long ago I was at a meeting at a local college that has an X-ray technologist program and while they are trying to watch this wave just like we are, they are trying to match the number of students [admitted to the program] with our hiring allocations.

Accreditation

Olivi: I think another issue that we are seeing is accreditation. ACR accreditation seems to be where we're going, but we're hearing that maybe ACR won't be the only accrediting body - does that mean that you have to be accredited by all the potentials? We spend a lot of time dealing with these sorts of regulatory issues...but it's a highly regulated industry and we understand that.

Lopez: One of my first questions would be: Will they have all the same standards? Because if they don't, it is going to be very difficult for our members to be able to sort through and make the right decisions.

Olivi: I hope that however it is set up it becomes something that is safer for the patient and not just another bureaucratic hurdle. I think in mammography we saw it work. MQSA standards came out and the less satisfactory centers closed. There were access issues -- and we have to be ready for all that -- but those who were doing good care were able to overcome and get through the accreditation. I hope very much that it works out that way.

Legal and legislative challenges

Olivi: I was personally extremely disappointed to see the non-passage of the 'no more self-referral' bill. I think the crux of all the bad press imaging gets about leading to the high cost of health care is solely because of self-referral. Any doctor who has imaging in his office is self-referred. Even if they say 'I'm seeing you today and you'll write the script.' It is still self-referral and it goes into that doctor's pockets. I really thought we were making strides and that was going to be such important legislation.

The high cost of imaging

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