Dear Colleagues:

As institutions change and more radiologists become salaried employees, there is a tendency to think “the institution will look after me”, or “I can’t do very much relative to my situation anyway”.  I assure you that both of these ideas are far from the truth.

Your status in the medical community and position in the new payment system depends mostly on how well each of you is perceived as creating value and  how well organized radiology both is and is perceived as creating value within the universe of medicine.  Long term these are probably more important than your groups negotiating ability.  Most of us do the right things to be valued consultants and helpmates to our patients and clinical colleagues, and embracing the American College of Radiology (ACR) imaging 3.0 concepts can keep us on the right course for the future. Employing data organized with ACR guidelines can aid in illustrating our value in the Health System. The ACR has favorably shaped the economic environment of radiology practice to the benefit of all radiologists for over 60 years. A weakened ACR will reduce the ability of our radiology profession to preserve a favorable position in the payment system. Those of us who are employed should remind our employers that they also have a stake in supporting the ACR as the long-term impact of a weak ACR is a reduction in our employers ability to generate revenue from our work.  Aside from profoundly impacting our socio-economic world, the ACR also offers excellent training programs in leadership, management, business, human resources and other related topics all designed for the busy radiologist.  I urge you to join the ACR and to contribute generously to the ACR Political Action Committee (RADPAC).

The egregious multiple procedure payment reduction, as an example, was not recently made less egregious because it was unfair but through intense lobbying of Congress.  The budget resolution requiring computer order entry with decision support rather than radiology benefit managers, was constructive for our specialty, as was the successful pushback against the Veterans Administration proposal for Advanced Practice Nurses to read CT and MR exams at the VA, but these outcomes do not happen by accident.

Here in Ohio, the Department of Health was about to adapt a policy promulgated by the Pharmacy Board that all radiology contrast would have to be injected by physicians and not by technologists.  This would have been disruptive to radiology practice and it came down to the wire that the Ohio Radiological Society (ORS) was able to induce the Pharmacy Board to withdraw this proposal which was already agreed to by the Health Department over our objection.   When you join ACR you also join ORS.

All government organs basically want to help, but any policy change or action has winners and losers, and it takes vigilance and money not to come out on the short end. Every one of us should contribute both to RADPAC and to the Ohio Radiology Society Political Action Committee (ORSPAC).  Online ORSPAC contributions are now possible.

The Pharmacy Board success described above was achieved by our attorney Victor Goodman who has been essential for much of our success. Victor and his colleague Rachel have relationships with most of the Ohio Government such that much of what might affect Radiology is communicated to them well before getting to the formal proposal stage. Their service has been invaluable through the years but it is not free, and were it not for our historical relationship such effective help might be beyond our means. Victor and Rachel are paid out of the ORS legal budget. Rachel manages ORSPAC but ORSPAC expenses are also in the legal budget. All contributions to ORSPAC go to supporting the election of legislators, judges and candidates favorable to radiology.

As the ACR is our political and socioeconomic organization, the Radiological Society of North America (RSNA) is our scientific organization. Both RSNA and ACR are among the most effective organizations in organized medicine, and we are truly blessed to have them and the great leaders who created and continue to recreate them.  I wish all radiologists belonged to both.  I want to make an appeal for the Research and Education Fund of the RSNA. Before creating this fund Radiology was at a serious disadvantage.  The public could identify with Heart Disease, Cancer, Arthritis, etc., so the respective organizations had an easier path for fundraising, but no one suffers from or dies of Radiology. Radiology was several generations behind most of medicine in terms of raising money to fund research. The Research and Education Fund has been an amazing success but needs continuous ongoing support. Grants from the fund have been multiplied forty fold by grantees obtaining additional funding from other sources such as the NIH. Always remember that today’s research leads to tomorrows bread and butter.

Please support yourself and Radiology by joining ACR which includes ORS and supporting RADPAC (National) and ORSPAC (Ohio) and joining the RSNA and supporting The Research and Education Fund.  If you follow your money with active participation, so much the better.

Your support for all or any of the above would be of great benefit to yourself and your profession but this is only part of the story. There are broader issues requiring attention. The Ohio State Medical Association (OSMA) has been essential to the well-being of all Ohio citizens and physicians. This includes for example dealing with unfair practices of medical insurance companies, guiding state legislation, and medical malpractice and tort reform. The favorable malpractice climate in Ohio is the direct result of intense work by OSMA members and staff even including electing Ohio Supreme Court justices who interpret the law rather than legislate law from the bench. Losing several favorable justices on the Ohio Supreme Court could undo more than 15 years of successful effort and renew the malpractice crisis.

Let me describe an episode mostly known only to those who deal with medical billing where only OSMA was able to fix a serious problem.  Since the start of Medicare, Ohio Medicine had constructive relationships with Nationwide and then with Palmetto as our Medicare insurance carriers. When CGS became our carrier , they brought incredibly backward business practices that compromised physician payments and they were callously unresponsive to physicians and their representatives.  In addition, the Medical Director seemed to have a particular animus towards Radiology. OSMA enlisted our senators Sherrod Brown and Rob Portman to arrange a meeting with Kathleen Sibelius the then Secretary of Health and therefore head of CMS (Centers for Medicare and Medicaid services) to discuss the Ohio situation. CGS was ordered to correct all deficiencies or lose the Medicare contract. CGS Immediately modernized their business practices, and they also replaced the Medical Director who was antagonistic to Radiology.  The new Directors are excellent leaders, supportive of physicians and working hard to make the system work well for all three constituents, patients, physicians and the federal government.  Radiology could not resolve this issue, only OSMA representing all  Ohio physicians could succeed.

An anecdote… The Ohio Radiological Society and the radiologists of Kentucky (the other CGS state) worked together on our particular CGS problem to share costs, demonstrate solidarity, and avoid duplication of effort. During the joint OSMA/ CMS discussions, CGS claimed that all the problems were unique to Ohio. OSMA soundly refuted CGS based on the ORS work with Kentucky…. and this ended the last shred of CGS credibility.

OSMA performs valuable service to the medical community but as more physicians become salaried (over 50% as of three years ago) the membership of OSMA is declining. OSMA is just as important for salaried physicians but the value is not yet as well recognized.  Also declining are contributions to the OSMA political action committee (OSMAPAC). Last year the Nursing Association PAC raised 40% more money than the physicians which is not a good situation as nursing continues to lobby the legislature to allow more encroachment on the practice of medicine. The Ohio Trial Lawyers Association PAC, which works to undo our favorable Ohio malpractice situation, has 60% more money than OSMAPAC.

Four years ago in a major policy change implemented in hope of increasing physician participation, it was no longer required that OSMA members join the local county medical society or that local members join the OSMA. So far this has not increased physician participation, perhaps it has slowed the decline, and the local societies still supply the delegates that form the grass roots of OSMA governance.  Generally, the local societies also perform valuable services to the community such as Free Clinics, attempt to adjudicate local issues and are a great way to meet and bond with other physicians and serve your community.

Please remember your contributions to ORSPAC, RADPAC and the Research and Education fund of the RSNA and join the respective organizations if not already a member.   Also please give thought to joining and supporting a non-radiology organization.

A review of Ohio Radiological Society achievements would include:

1. Successfully lobbied Ohio Medicaid and most insurers to pay for Breast Tomosynthysis and have sponsored legislation (in progress) to mandate coverage.
2. When Ohio Medicaid was revised by Governor Kasich we negotiated favorable terms for radiology that avoided most of the cuts experienced by other providers.
3. In the recent Breast Density Legislation, we Influenced the bill language and composed the wording of the patient notification letters even though we opposed the legislation as an intrusion on medical practice.  We made the bill as innocuous as possible and excluded it from being the basis of any malpractice action.
4. Successfully supporting and maintaining the Ohio Department of Health’s education and training standards for all applications of therapeutic radiation.  (Same as the Nuclear Regulatory Commission standard.)   Dermatology was asking for a dispensation from the rules so they could use their own in office equipment to employ therapeutic amounts of ionizing radiation to treat patients with skin cancer without obtaining the requisite training, and had garnered some political support to allow this.
5. Radiology Assistant Legislation defining practice guidelines and disallowing independent practice.  This in response to a legislative proposal to recognize Radiology Assistants as independent practitioners.
6. Telemedicine Legislation requiring an Ohio Medical License for out of state practitioners providing services to patients located in Ohio.    (Several legislators consistently referred to this bill which affects all Ohio Medicine as the “Radiology Bill”)
7. Legislation requiring that hospitals billing globally for screening mammograms must actually pay the agreed payment to the radiologist.  Bill also separately required additional payment for digital mammography and CAD.
8. Regular interaction with State Agencies, OSMA and Medicare and “ad hoc” with legislators and other organizations.
9.  Legislation allowing patient self- referral for Screening Mammograms at a time when Ohio law required physician referral for all ionizing radiation.  This included Ohio adopting the ACR’s MQSA standards well before they were a Federal requirement.
10.  Legislation creating training standards and requiring the licensing of Radiology and Nuclear Medicine technologists and assisting the Ohio Department of Health in writing and maintaining the resultant rules.