Szostak’s presentation, “Health Economics Driving Integration,” gave an overview of the healthcare landscape and factors influencing physicians and group practices to integrate with hospitals, providing attendees with information about the Affordable Care Act and a view of new health economics. With these changes rapidly approaching, providers of healthcare services are looking to vendors like Toshiba for guidance in navigating through the new payment models, requirements and terminology.

For more information from Tom about healthcare economics, view Szostak’s video, “The ABCs of ACOs,” or visit the Toshiba America Medical Systems YouTube page.

In August, Toshiba and AHRA: The Association for Medical Imaging Management announced the third year of the Putting Patients First grant program, which provides funding for facilities seeking to improve pediatric or adult patient care and safety in diagnostic imaging. This year, AHRA will provide six grants of up to $7,500 each to hospitals and imaging centers; three grants will be awarded for projects that improve the safety and comfort of pediatric imaging, and three grants will be awarded for projects that improve overall patient care and safety in imaging. Winning organizations will use the grants to develop their programs and to share the results with others.

In 2009, Memorial Hermann Healthcare System, Houston, Texas, was awarded a Putting Patients First grant for its pediatric CT technologist education and auditing program. With over 40 CT scanners spread between its eleven hospitals and 21 outpatient imaging centers, the organization performs around 14,000 CT exams a year on children under the age of fifteen. “The technology nowadays has outpaced a lot of the education when it comes to CT, and we found that a lot of our CT techs really wanted some education and guidance when it came to pediatrics,” saidKelly Firestine, RT, CT clinical quality manager at Memorial Hermann. “We needed to empower them with better education.”

With the help of its physicists, Memorial Hermann implemented new pediatric CT protocols, then put a monthly auditing process in place to ensure technologists were utilizing them. The organization also developed a one-day educational seminar on pediatric CT for its technologists, and worked with the American Society of Radiologic Technologists (ASRT) to have it approved for eight CE credits. “We want to keep this knowledge fresh in their minds and keep them excited,” says Firestine. “We really want them to look at every single patient every single time and say, ‘Am I doing the best thing for this patient?’”

Firestine says the pediatric CT seminar was a huge success—popular enough, in fact, that Memorial Hermann is now splitting it up into webinars to host on its intranet as refresher courses. The new monthly audits reinforced the program’s efficacy; beginning in February, they revealed 100% compliance with the new pediatric CT protocols and criteria. “Our sales team loves to share our progress with our community and referring physicians,” Firestine says. “We’re very grateful to Toshiba and the AHRA for the grant.”

Prospective Putting Patients First programs should seek to address one or more of the following: reducing radiation and/or contrast dose; reducing the need for sedation; improving communication with patients regarding the process; improving patient comfort; and/or improving the overall clinical pathway. Applications for this year’s Putting Patients First grants are due October 15; they can be completed and submitted at AHRA Online.

Eleven years ago, breast cancer screening at the University of Southern California’s Norris Comprehensive Cancer Center and Hospital (NCCCH), Los Angeles, was conducted in a manner familiar to many caregivers—imaging took place in one department of the facility, while follow-up care was provided in another. “Back then we were all located in different places and were very spread out,” recalls Linda Hovanessian-Larsen, MD, associate professor of radiology at NCCCH. “Doctors would have to physically come to our section to get imaging results for their patients.”

In 1999, Norris opened a new women’s imaging center, one designed to accommodate radiologists, oncologists and surgeons within the same space. “The Breast Center has a U-shaped floor plan—the surgeons and oncologists are in one corridor and we’re in the next, literally six feet away,” Larsen says. “We’ve created a one-stop shop for women: they come in, we’re able to do their full work-up, if they need a biopsy they can get a diagnosis the same day, and if a patient does have cancer, a surgeon can meet her and begin the treatment planning immediately.”

Larsen explains that the goal of the Harold and Henrietta Lee Breast Center is to provide the best possible patient care, which includes minimizing women’s anxiety by arriving at diagnoses quickly. Design plays a key role: co-locating diagnosis, treatment, reconstruction, after-care treatment, image enhancement and genetic counseling enables much faster, more aligned care. Every Wednesday, clinicians meet to review biopsies from the week before and make sure there’s concordance; “if the imaging looks worrisome but the pathology is benign, we may choose to repeat the biopsy,” Larsen says. On Thursdays, clinicians meet to discuss patients currently in treatment as part of a weekly tumor board.

Technology is equally important, enabling the center’s clinicians to provide patients with answers faster than ever before—in many cases, during the same day as their screening exams. “So many recent advances in imaging technology really benefit patients,” Larsen notes. “Digital mammography is outstanding and much quicker than analog. Ultrasound helps distinguish between cancers and benign lesions, and MRI is very helpful in indentifying occult cancers, showing the extent of a cancer or just solving problems. We also use it as a screening tool for women with the BRCA gene.”

Ultrasound also aids in lesion biopsy, which Larsen says can take as little as five minutes, and in ruling out cancer when, for example, a lump in the breast turns out to be a cyst. “With ultrasound we can biopsy lesions very quickly and have final pathology available in 24 to 48 hours,” she says. “When a woman feels a lump, it’s very anxiety-provoking, although the majority will be benign. When possible, we like to have the patient go home with a diagnosis the same day as her imaging exam. That’s the direction medicine is going: patients are becoming the focus, and we, in turn, are focused on how we can take care of patients better.”

Larsen says that the interdisciplinary approach is critical to providing faster diagnoses and better, more comprehensive care—in women’s imaging and other specialty areas alike. “Medicine is dividing into organ systems—I’m part of the breast team, neuroradiologists and neurosurgeons form the neuro team, and so on,” she says. “I don’t see a lot of other radiologists, but I work extensively with the breast surgeons and the oncologists. That’s the way it should be, and that’s the way radiology should be moving in order to provide the best patient care.”

For nearly 20 years, Toshiba America Medical Systems has been a vanguard-level sponsor of the RSNA’s Research and Education Foundation, which funds grants for young researchers in the imaging field. Since its inception 26 years ago, the foundation has provided more than $25 million in grants to 630 radiology investigators and educators. “These grants align with Toshiba’s focus on education and research,” Cathy Wolfe, director of marketing services for Toshiba, explains.

Toshiba’s education-focused collaboration with professional associations has expanded in the past few years to include the American College of Healthcare Executives (ACHE) and AHRA: The Association for Medical Imaging Management. The company sponsors the AHRA’s Putting Patients First Program, and has completed its second round of grant giving.  The program seeks to improve the safety and quality of care in imaging both pediatric and adult patients. Putting Patients First provides six grants of up to $7,500 per year to hospitals and imaging centers to help fund programs, training, or seminars focused in this area.

In 2008, one such project involved developing a patient-handoff system to facilitate transferring patients from the hospital to the imaging department. Another looked at creating a bar-code system for identifying patients with allergies to contrast media. All grant recipients agree to share their results with others so that facilities around the country have the ability to implement similar systems, according to Ed Cronin, executive director of AHRA. Cronin notes that one of the 2008 recipients developed a seminar to present to other hospitals in the region; others wrote articles on their results for the AHRA’s journal, Radiology Management.

A similar partnership with ACHE gives a boost to midlevel managers who aspire to be leaders in the radiology field. Beginning this year, Toshiba will sponsor scholarships for 60 executives to attend a series of three leadership seminars throughout 2010, 2011 and 2012. “This is a program we developed several years ago to help middle managers move into roles in the C-suite,” Peggy Gordon, vice president of development at ACHE, explains. “It’s very intensive. The seminars happen three times a year, for three days at a time and are given by a very distinguished roster of faculty teaching management and leadership.”

The first 2010 seminar occurs in June and focuses on establishing leadership; the second takes place in August and looks at innovation and overcoming the financial challenges facing the health care industry; and the third, themed Manage for the Future, is slated for October. “Part of the reason for participating in the ACHE program is helping to strengthen health care leadership through quality education,” Wolfe says. “ACHE is an impressive organization in terms of its mission and vision, and of its focus on integrity, which we thought was a good fit with Toshiba.”

Through a fourth, emerging partnership with the Society for Pediatric Radiology, Toshiba has helped the organization develop a survey to address the concerns of pediatric radiologists. “We try to look at ways to collaborate that are more unique, that provide new benefits to the organization and an opportunity for differentiation,” Wolfe says. “We believe in investing in the industry in which we work, and one of the best ways to do that is to help ensure ongoing education of the membership.”

Finally, Toshiba is continuing its support of the Society of Cardiovascular Computed Tomography’s (SCCT) Young Investigator Awards.  The SCCT is the leading international professional society dedicated to research, education and clinical excellence in cardiovascular computed tomography (CT), and is now accepting submissions for the fourth annual awards program. Sponsored by Toshiba, the unrestricted educational grants will be awarded to two residents or fellows in either radiology or cardiology for their patient care research in the categories of technical and clinical advancement of cardiovascular CT.  The deadline for submissions is April 2, 2010.   Abstracts are being accepted in two categories – Technology of Cardiovascular CT, or Clinical Applications of Cardiovascular CT.  Applicants may enter by submitting an abstract through the SCCT Web site.

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At this year’s annual scientific meeting of the American College of Cardiology (ACC), which takes place on March 14–16 in Atlanta, Toshiba (booth #1944) will showcase a range of advances in and enhancements to its cardiac-imaging technology.  Following is an overview of what Toshiba will showcase:

Infinix-i Hybrid Lab

When performing patient procedures in a hybrid setting, it is critical that the imaging system provides the flexibility to quickly and easily access both the patient and ancillary equipment. Toshiba will showcase its Infinix™ VF-i vascular X-ray system with 12” x 12” flat panel detectors and CAT-880B hybrid catheterization table, designed to create a best-in-class hybrid suite.  The new mid-sized 12” x 12″ flat panel detector expands the versatility of the Infinix-i line that features a five-axis C-arm positioner and enables unprecedented patient access and coverage. Along with the new mid-sized detector, the Infinix-i five-axis systems are now available with the new CAT 880B tilt/cradle hybrid catheterization table. This table is designed to allow greater positioning flexibility and patient access during imaging and surgery. The table functionality, with side-to-side cradle and head-to-toe tilt, permits clinicians to angle the table in the optimal position to quickly and comfortably complete procedures. The system on display will also include ancillary equipment typically used in a hybrid suite.

Cardiac Ultrasound Capabilities

The cardiac capabilities of Toshiba’s ultrasound technology will also be featured. The Aplio Artida™ system is a dedicated cardiac system which provides unique 3D Wall Motion Tracking, allowing physicians to rapidly identify wall-motion defects and the timing of cardiac events, as well as real-time, multiplanar reformatting for assessing global and regional left ventricular function. Also on display is the new Aplio™ MX system, which is midsized and cart-based for better portability. Aplio MX is a multi-modality system which includes Differential Tissue Harmonic Imaging, for better results with bariatric patients; ApliPure, which enhances image clarity and detail definition; Advanced Dynamic Flow, which shows flow with directional information for even the smallest vessels.

Cardiac CT Software Enhancements

CT will highlight cardiac-software enhancements for the Aquilion^® ONE and Aquilion Premium, including new ONE Beat Prospective Reconstruction, which shortens the interval window and reduces radiation exposure time, reducing dose by 21 percent; Real Time Beat Control, which calculates the running real-time average of the heart rate to predict the next beat more precisely (and thus, to time the scan more accurately); and optimizing timing for ^SUREStart, which accurately determines contrast uptake time for a better image. Wide Volume Cardiac Protocol on the Aquilion ONE, a work-in-progress enhancement, will enable clinicians to image the entire heart, lungs, and aorta in two rotations.

Cardiac MR

The wide range of cardiac MR capabilities on the Vantage Titan™ and Vantage Atlas^® systems will be highlighted. The Vantage MRI product line offers a range of advanced cardiac capabilities, including a cardiac coil for the Vantage Titan and noncontrast imaging for patients with renal insufficiency.

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Whatever form the health care legislation under debate in the House and Senate takes, one priority is shared by lawmakers from both sides of the aisle: improving quality and safety. President Obama’s proposed 2010 budget includes a recommendation to implement a hospital quality-incentive payment program; the budget projects that such an initiative could result in savings of $11 billion over the next decade. In addition, the Medicare Payment Advisory Commission has recommended that Medicare revise its payment-system incentives to adjust provider payment based on quality of care, and has suggested that Congress create a wide-reaching quality-incentive payment policy for hospitals and physicians.

With quality and safety in the spotlight on a national level, hospitals across the country are renewing their commitment to ensuring that their services meet or exceed the core measures for quality set by the government. For many facilities, this is a massive, daunting undertaking, requiring a comprehensive reexamination of even the simplest daily processes to ensure that all members of hospital staff are enforcing the common goal: improving patient care.

Memorial Hermann Healthcare System (MHHS), Houston, Texas, embarked on a new quality initiative in 2003. The hospital began by developing a brand promise that Michael Shabot, M.D., chief medical officer, describes as striking at the health care system’s core mission: “That the system provide the highest possible quality and safe health care combined with an outstanding patient experience.”

Shabot, who came onboard in January 2007 as chief quality officer, was hired, in part, to reinforce this renewed commitment to patients. “Everyone talks about differentiating themselves on the basis of quality care and safety,” he says. “Our commitment was actually to do it and demonstrate it. It required real dedication.”

Shabot was instrumental in implementing the second wave of the system’s new initiative, which became known as the Breakthrough in Patient Safety campaign. One idea that set the Breakthrough campaign apart was that it took cues from what Shabot calls high-reliability industries, such as nuclear power and naval aviation, which conduct specialized training for every single employee. “We brought in consultants from other industries to retrain all of our employees, including the kitchen staff, the maintenance staff—everyone who works for MHHS,” Shabot says. “We even train our volunteers to speak up when they think something’s not right. It’s everybody’s job to make every patient safe.”

All MHHS facilities honor a safety hero of the month (an individual who has intervened to ensure patient safety); the system has also designated 600 employees as safety coaches, who perform safety-monitoring services on work areas other than their own. In addition to meeting or exceeding safety and quality standards set by the government, MHHS ensures total transparency by publishing its own core measure data on its Web site.

In May 2009, the National Quality Forum presented MHHS with its 2009 National Healthcare Quality Award. By that time, the health system had been recognized by the New York Timesfor having the best heart-attack care in the city of Houston, averaging less than 90 minutes from the door to percutaneous coronary intervention. The system has revolutionized triage for both stroke and pneumonia, leveraging top-of-the-line imaging and PACS equipment to create what Shabot calls “a true culture change for everyone involved.”

“Our imaging capabilities are crucial to ensuring rapid, quality care,” Shabot says. “Modalities like CT angiography, CT, and MRI are crucial for rapid diagnosis of trauma. If a patient comes into the emergency department with chest pain, he or she gets an immediate ECG, and if there’s any evidence of an ST-elevation myocardial infarction, the catheterization laboratory is immediately activated.” In some cases, ECGs are actually read wirelessly from ambulances, meaning that the catheterization laboratory is ready by the time the patient arrives at the hospital. “It’s like a ballet,” Shabot says. “We have to make sure all of our staff is committed to this, on call, and available.”

Shabot and the team have also implemented a comprehensive program for appropriate dose in pediatric imaging. “In retrospect, we were often using more radiation than was necessary, like the rest of the country,” he recalls. “At appropriate lower doses, you can get the same quality images, and in the past few years, the need to attenuate these doses for children has become a priority.”

Though the Breakthrough campaign has already cost MHHS around $18 million, Shabot expects the investment to pay big dividends down the line. “We’ve made these improvements because it’s the right thing to do, but reimbursement is very important,” he says. “If we’re able to take a patient who was going to have a heart attack and literally reverse it—so that instead of spending days in critical care, clinging to life, he or she can go home in 48 hours or less—we’ve done the right thing for the health care economy. In our day-to-day operations, quality saves money and it saves lives. It’s a win–win situation.”

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“By funding these grants, we are giving hospitals and imaging centers the ability to continue improving imaging quality and safety for children and adults through the development of diagnostic imaging best practices,” says Cathy Wolfe, director, Marketing Services, Toshiba. Applicants’ programs should seek to improve day-to-day practices centered around imaging and address reducing the need for radiation and/or contrast dose, reducing the need for anesthesia, improving patient communication and comfort, and/or improving the overall clinical pathway.

For the pediatric projects we are generally looking for the same types of projects as we are looking for in the area of adult imaging,” Ed Cronin, AHRA CEO, explains. “For instance, one of the awards last year went to a facility that was developing a patient-handoff system, so that patients were transferred from the floor to the imaging department via a formal system, cutting back on errors. With pediatrics, there may be some specific features that make programs different for children, but the emphasis on developing new and creative ideas remains the same.”

Cronin says that this year’s program also features an improved application process and more lead time for submissions. The program accepts applications from any hospital or imaging manager seeking to implement a new safety/quality program. “Recipients will share their processes with our members by writing an article for our Radiology Management journal or our newsletter,” Cronin explains. “One of the projects we’re funding this year even developed a seminar to present to other regional hospitals.”

Six $7,500 grants will be awarded in 2009: three focusing on improving patient care and safety in diagnostic imaging and three focused on pediatric imaging. To apply, visit AHRAonline.org or medical.toshiba.com. Entries are due October 31.

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Earlier this year, Toshiba America Medical Systems, Inc., surveyed its customers who use the vendor’s Image Maker Marketing toolkit to understand the role of marketing in this challenging economic time. The survey results showed that marketing and outreach are more important than ever in tough economic climates. While the vast majority of respondents (from both imaging center and hospital environments) said that marketing was more important to their organizations in a difficult fiscal environment, 30 percent of imaging centers and 18 percent of hospitals represented don’t even have marketing budgets.

“If you speak to marketing professionals, they’ll always tell you marketing is more important in difficult times,” Jim Burch, director of communications at TAMS, Tustin, Calif., explains. “Most companies’ actions tend to be the opposite, however. What this survey indicates to me is that healthcare professionals understand the importance of being competitive, and in a downturn, they understand the importance of getting visibility for the type of services they offer, compared with the competition.”

The Image Maker survey reveals the ways hospitals and imaging centers market their new technology to referring physicians and patients, in spite of limited budgets. “If healthcare organizations have no marketing budget, they’re reliant on their partners to provide them with any marketing materials,” Burch says. “With the Image Maker program, we offer co-marketing underwriting, which dramatically increases the budget dollars available to them. We also provide assets like professional photography and design for promotional materials.”

Image Maker materials range from clinical images to templates for brochures and mailers, all customizable according to a facility’s individual branding and distribution requirements. In addition to providing pre-made marketing templates, Toshiba offers customers live consultation and assists customers with the design and copywriting for special projects upon request. “Our customers are front and center in the ads we help produce,” Burch says. “It’s not a Toshiba ad with their logo on it. It’s their advertisement, and we’re supporting them. The relationship is consultative.”

Burch notes that clinical images are a particular boon to facilities attempting to promote new equipment. “We supply images and information about the capabilities of the product,” Burch says. “If I’m in a facility with a new product, I may not have any images to show yet. That’s where Image Maker comes in; being able to show what the product can do is an important component of any marketing campaign.”

The survey indicates presentations and meetings are, by far, the number-one strategy employed for referring-physician marketing. “If you don’t have your referring-clinician population behind you, you can do all the direct-to-consumer marketing you want, but you’ll never be as successful as you need to be,” Burch notes. “Sharing best practices and showing what you can do for patients that’s different from the competition, or from what you could do in the past, adds another level of trust and confidence in your facility’s expertise.”

When it comes to targeting the patient population—an increasingly critical factor as health care becomes more consumer-driven than ever before—hospitals and imaging centers favor direct mail and print ads. “In the professional community, an event will probably resonate for a longer period,” Burch says. “The consumer world needs constant reminding and refreshing. More frequent communications through print ads and direct mail help make that happen.”

The survey also highlights marketing opportunities that the majority of organizations are neglecting in favor of more tried-and-true methods. For instance, few facilities are using Web-based outreach in either referring-physician or direct-to-consumer marketing. “I don’t hear a lot of people talking about electronic outreach,” Burch says. “This survey leads me to believe that the people marketing imaging services are tied more to traditional methods and need to explore other options. Those who do will probably have that field to themselves for a while, which gives them a competitive advantage.”

Burch was encouraged to see 30 percent of survey respondents reported that C-level executives were engaged in marketing and outreach. “That tells me it’s important to the mission of the organization,” he says, “and that’s what a marketer always likes to hear.”

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Pinnacle invited its community of referring clinicians to a presentation highlighting the Aquilion ONE’s features and capabilities; from the start, Henry knew the invitation had to be as unique as the technology itself. “We wanted the invitation to be catchy and to attract attention in a busy office,” she says. “The best way for referrers to understand the difference between the Aquilion ONE and a 64-detector row CT was to see the 3D images in color.” Because Pinnacle had yet to install the scanner, Henry’s team pulled clinical images from the Image Maker kit provided by Toshiba and loaded them onto cartridges for custom-made slide viewers based on the View-Master® model. “We mailed the slide viewers in a clear plastic tube so they would be noticed immediately,” Henry says. “It was a huge success. We had a great turnout at our open house.”

Becky Daghir Wardzala, public relations manager for Hendricks Regional Health, Danville, Ind., also felt that referring-physician outreach was crucial to marketing Hendricks’ new Vantage Titan™ MRI system. “When we get something new that’s better for patients, we like to give physicians some clinical information so they can understand the benefits,” she says. Hendricks conveyed this information using a letter from its radiology director, combined with print materials based on Image Maker templates.

“We inserted a customized photo of our machine, and we dropped in a paragraph about how we’re looking for the best-quality images for proper diagnosis,” Wardzala recalls, “There was already a nice list of bulleted points outlining the benefits for physicians and patients in the Image Maker materials, so we included that as well. The letter from our radiology director recapped those benefits.”

Anne Kolwe, marketing director for Cardiovascular Institute of the South (CIS), Houma, La, focused more on patient marketing following the institute’s acquisition of an Aquilion ONE CT system. “The referring physicians already knew what the technology was, but to reach our patients, we needed to use a lot of different media outlets, including newspapers and television,” she says. “We wanted to humanize the campaign and give patients a better understanding of how the technology relates to them.”

Though CIS developed its own print materials and television spots in accordance with its established branding, Kolwe used the camera-ready images provided by the Image Maker kit in the campaign. “The scanner is an example of how we offer the latest and greatest technology,” she notes, “so the commercials featured high-tech images. We wanted to give the feel that we are using the most advanced technology.”

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A study spotlighting the opinions and concerns of chief executive officers, financial officers, and operating officers (C-suite) of U.S. hospitals reveals their top initiatives for 2009. Commissioned by Toshiba and conducted by an independent research company, the survey includes interviews with 60 leading executives throughout the country.

Patient care and safety, improving patient satisfaction and recruiting and retaining leading physicians are the group’s top three concerns today. Another top concern is accessing capital funds to invest in facilities and equipment, not surprising in today’s economic environment.

Carrying on with the theme of improving patient care, most of the institutions surveyed have or will expand or modify their patient safety and quality programs and they have or are increasing administrative time to educate their staff on compliance with safety measures.

When it comes to diagnostic imaging, the C-suite views having state-of-the-art imaging equipment as an important component of their ability to recruit physicians and technical staff and very important to their overall success. They also believe these technologies have improved the speed of diagnoses for heart attacks and stroke.

Other topics addressed in the study include issues related to reimbursement. For instance, have they seen a drop in reimbursement due to the implementation of Medical Severity Diagnostic Related Groups (MS-DRGS)? Nearly 80% said “No.” Or do they plan to increase their percentage of on-staff physicians if MedPAC’s (Medicare Payment Advisory Commission) recommendation regarding restructuring hospital payments based on “Episode of Care” is implemented? (Episode of Care would provide one fixed payment for the treatment of a specific illness and combines the technical fee with the professional fee.) Fifty-seven percent said “Yes, they would consider hiring more staff physicians.”

The study was completed in December 2008. A copy of the complete results of the study are available for customers by contacting Mary Kienstra, senior research analyst, Toshiba, at mkienstra@tams.com.