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A Letter to Radiologists – past and future

Please take a moment to read this letter from one of your professions’ most passionate advocates and consider investing a little –  to help the future be as successful as the past.  Thank you, Dr. Olsen.

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Letter to Current and Future Radiologists:

From: John Olsen Emeritus OSU Faculty member   

Dear Colleagues:

A few of you remember me. Many of you I haven’t met, but I was on the OSU Radiology faculty for 36 years, 1976-2012.  I am writing to share some thoughts but mostly to ask you to share your money with what I feel are very worthy supporters of your own well-being.  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 neither of these ideas could be further from the truth.

I want to make an appeal for and justification of organized radiology and organized medicine with the hope of encouraging your participation, even if that means as little as only paying dues and giving financial support. Your status in the Ohio State Medical Community and your position in the new payment systems depends mostly on two things, and one of these is not the Chairman’s negotiating ability, as important as that is.  The first is how well each of you is perceived as creating value here at Ohio State and the second is how well organized radiology both is and is perceived as a creator of value within the universe of medicine.  Many of you instinctively do all the right things to be valued consultants and helpmates to our patients and clinical colleagues.  For the rest of us, adapting the American College of Radiology (ACR) imaging 3.0 concepts can set us on the right course for the future.  Also, as a Department, 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.  They also offer excellent training programs in leadership, management, business and human resources among others all designed for the busy radiologist.   I urge you to join the ACR and to contribute 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 recent budget resolution requiring computer order entry with decision support and not radiology benefit managers, is constructive for our specialty, but things like this 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 a physician 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 the proposal 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) for which you have an addressed stamped envelope.  Soon online contributions will also be possible.  Every member of Columbus Radiology (Grant Hospital) contributes regularly to both RADPAC and ORSPAC.  The ACR knows them well as one of the groups with 100% participation.

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 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 legislators, judges and candidates favorable to radiology to assist in their elections.

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.

Radiology has been good to me and my family, so I continue to support the future of Radiology, but we should all advance the future of our specialty by contributing generously to the Research and Education fund of the RSNA.

I have unashamedly just asked you to give away (invest) more than a little money.  I would like to provide some not intuitive money wisdom.  Long term department members might inform the younger and newer that I do have some knowledge in this area.    Money has an amazing property.  No matter how much you have or make, it will never be enough until you are giving some away.   Anyone who tithes can tell you that giving creates inner financial peace and actually enhances your ability to enjoy life that spending cannot compare with.  You will not miss what you give and what givers have left becomes enough. (This magic only works with what is freely given and not what is surrendered to coercion which has a different effect).

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 field 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 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. (In fact losing several favorable justices on the Ohio Supreme Court next November could undo 15 plus years of successful effort and renew the malpractice crisis.)

I would like to 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 the carrier they brought incredibly backward business methods 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.  Because of the CGS performance, 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 Dr. Earl Berman for Part B and Dr. Michael Montijo for Part A 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 have resolved this issue, only OSMA representing all Ohio member 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 with CGS, at one point 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 two 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 (PAC).  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 Trial Lawyers Association PAC which works to undo our favorable Ohio malpractice situation has 60% more money than OSMAPAC.

Two years ago in a major policy change implemented in hope of increasing physician participation, it was no longer required that OSMA members also join the local county medical society or that local members join the State. Our local society, years ago known as the Franklin County Academy of Medicine and now called the Columbus Medical Association (CMA), performs valuable services to the community.  While many physicians participate in various specific programs, most of the leadership function is provided by about 25 physicians eager for your help.  CMA programs such as the Free Clinic are worthwhile and a great way to meet other physicians and serve your community.  Resident and medical student participation is welcome as it is in the RSNA and ACR/ORS.

Dr. Rick Nelson in Emergency Medicine is very active in both organizations and would be happy to provide a more complete and up to date perspective but these organizations are important to the health of medicine, and a strong OSMA is especially important for Radiology.

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 at least one of the non-radiology organizations.

A review of Ohio Radiological Society achievements would include:

When Ohio Medicaid was revised by Governor Kasich we negotiated favorable terms for radiology that avoided most of the cuts experienced by other providers.

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.

Successfully maintaining the Ohio Department of Health’s education and training standard 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.

Radiology Assistant Legislation defining practice guidelines and disallowing independent practice.  This in response to a legislative proposal to recognize Radiology Assistants as independent practitioners.

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”)

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.

Regular interaction with State Agencies, OSMA and Medicare and “ad hoc” with legislators and other organizations.

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.

Legislation requiring the licensing of Radiology and Nuclear Medicine technologists and assisting the Ohio Department of Health in writing and maintaining the resultant rules.

Rachel WinderA Letter to Radiologists – past and future
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