Policies and Guidelines for COVID-19 Preparedness: Experiences from the University of Washington.

The coronavirus disease 2019 (COVID-19) pandemic initially manifested in the United States in the greater Seattle area and has rapidly progressed across the nation in the past 2 months, with the United States having the highest number of cases in the world. Radiology departments play a critical role in policy and guideline development both for the department and for the institutions, specifically in planning diagnostic screening, triage, and management of patients. In addition, radiology workflows, volumes, and access must be optimized in preparation for the expected surges in the number of patients with COVID-19. In this article, the authors discuss the processes that have been implemented at the University of Washington in managing the COVID-19 pandemic as well in preparing for patient surges, which may provide important guidance for other radiology departments who are in the early stages of preparation and management.

How radiologists get paid: resource-based relative value scale and the revenue cycle.

OBJECTIVE: To learn the impact of health care reform, it is important for radiologists to first understand basic administrative aspects of medicine. This article describes the processes of radiology billing, reimbursement, and the revenue cycle, which includes the importance of proper coding, the resource-based relative value scale, and accounts receivable. CONCLUSION: An understanding of the basics of medical practice management can help radiologists effectively provide optimal patient care. This article provides an overview of one component of this topic--the current radiology reimbursement system.

Business of radiology: financial fundamentals for radiologists.

OBJECTIVE: The purposes of this article are to provide a primer on financial statements and to review several financial concepts that are at the foundation of the business of medicine. CONCLUSION: For radiologists to effectively contribute to the leadership and management of their practices, it is imperative that they understand the business aspects of radiology. Radiologists' understanding and participation in practice management may also facilitate job satisfaction and assist the provision of optimal patient care.

Business of radiology 101: the state of radiology business practice and health care policy curricula at US radiology residency programs.

PURPOSE: The aim of this study was to assess the prevalence, content, and perceptions of curricula focused on radiology business practice and health care policy at US radiology residency training programs. METHODS: The desired survey population was trainees and faculty members of radiology residency programs in the United States. Three anonymous survey instruments were distributed, including an e-mail survey to the membership of the ACR RFS, a paper survey to ACR RFS delegates attending the 2010 AMCLC, and an e-mail survey to the membership of the Association of Program Directors in Radiology (APDR). RESULTS: Response rates for the surveys were 12%, 25%, and 21%, respectively. Members of the APDR and RFS agreed that understanding and competency in business practice and health care policy topics are important to the future careers of residents (total favorable sentiment >86% for APDR members and >96% for RFS members). Most survey respondents' home institutions offer some form of a noninterpretive curriculum (91% of APDR respondents, 74% of RFS respondents), but the breadth of topics addressed and educational time devoted to these curricula were quite variable. Subjective effectiveness of curricula was infrequently rated as very effective by 12% of APDR respondents and 6% of RFS respondents. CONCLUSIONS: Despite the perceived importance of radiology business practice and health care policy education, and residency training requirements in competencies related to these subjects that have been in place for more than a decade, curricula addressing these items still seem to be in a stage of acceptance and development. Further commitment to and innovation within these curricula are requisite in educating our future radiologists.

Cost analysis model: US versus endometrial biopsy in evaluation of peri- and postmenopausal abnormal vaginal bleeding.

PURPOSE: To develop a cost minimization analysis model from the societal perspective of Medicare reimbursement to determine whether endometrial biopsy or transvaginal ultrasonography (US) is less expensive in evaluating peri- and postmenopausal women with abnormal vaginal bleeding and to assess whether this strategy is equally effective in populations at low and high risk for endometrial carcinoma. MATERIALS AND METHODS: Clinical algorithms were constructed that detailed diagnostic evaluation of the target population by using office-based endometrial biopsy versus transvaginal US as starting points. An economic model based on Medicare reimbursement and average wholesale drug price data and using disease prevalences and modality sensitivities from the scientific literature was then created to examine common bleeding causes in this population. All models included the cost of obtaining a tissue diagnosis for focal or diffuse endometrial thickening found at US. Modality sensitivities and prevalences of disease states were varied within the model to discover limits at which each modality became cheaper versus the other for assessing a population of women. RESULTS: Population prevalence of neoplastic disease is the principal factor governing total cost between competing diagnostic algorithms. In populations with 31% or less combined prevalence of endometrial carcinoma/atypical adenomatous hyperplasia, algorithms utilizing transvaginal US as the initial test are most cost minimizing. At combined endometrial carcinoma/atypical adenomatous hyperplasia prevalence of 10%, savings of up to 11% and 16% over pathways initiated with endometrial biopsy are predicted. In populations with a high incidence of neoplastic disease (>31%), biopsy-based algorithms should become least costly. CONCLUSION: Transvaginal US-initiated triage predicts substantial cost savings versus biopsy-based algorithms in evaluating typical populations of peri- and postmenopausal women with abnormal vaginal bleeding seen in clinical practice.