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The state of X-ray in the age of the ‘value-based’ compensation model

por David Dennis, Contributing Reporter | November 28, 2016
From the November 2016 issue of HealthCare Business News magazine

In the last 25 years, traditional X-ray has been joined – and has also been challenged – by ultrasound, CT, MR and, some would say, nuclear medicine. They’re all vying for imaging dominance. Every modality, for instance, has a protocol to image the breast. How do you decide which is best and which should be used first? Where do these “turf wars” leave general radiology, particularly in light of CMS’ value-based compensation model? We asked a number of top doctors and leading radiology administrators what they think.

Jason Launders, director of operations for ECRI’s Health Devices Group, said, “While basic X-ray hasn’t changed significantly since Roentgen X-rayed his wife’s hand in 1896, it was a miracle to see inside the human body back then, and today, 120 years later, it’s just as relevant. “It’s like a piece of paper. Slips of paper will always be around because they do the job well. We should not be distracted by bells and whistles of the other technologies and overlook X-ray. It is the baseline.”

Brad Hellwig, administrative director of radiology at Crouse Hospital in Syracuse, N.Y., agrees.“X-ray, and specifically digital radiography, will remain the highest volume imaging modality because it is the most appropriate way to assess a wide range of diseases, conditions and injuries,” he said.
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‘Sticks and stones…’
Dr. Ezequiel Silva, chair of the American College of Radiology Economics Commission, put it this way: “Plain radiology is not going anywhere. It is a good first-line study for many things,” especially in the sense of its negative predictive value. “X-ray is always going to be good at showing whether an ankle is broken or not.”Another mainstay is the simple chest X-ray. “This will always be one of the most common exams,” said Steven Jung, director, diagnostic imaging at Alexian Brothers Medical Center in Elk Grove Village, Ill. “Every morning doctors in ICUs and CCUs order chest X-rays to see what is going on.”

Improvements and innovations help expand X-ray use
Chris Tomlinson, senior director of radiology at The Children’s Hospital of Philadelphia, adds that “with new technologies including positioning devices, better mobility, flat screens, etc., the X-ray modality is actually becoming more flexible and keeping up with the more advanced things.” “We are seeing more advanced technology coming into radiography,” said Launders. “A lot of work and research has gone into getting the best possible images. Flat-panel detectors can produce [an] image in a few seconds almost anywhere at [the] point of care, in the emergency department, wherever you are.”

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