A Global Review of the Impacts of the Coronavirus (COVID-19) Pandemic on Radiology Practice, Finances, and Operations.

The Coronavirus Disease 2019 (COVID-19) pandemic ushered in rapid changes in healthcare, including radiology, globally. This review discusses the impact of the pandemic on various radiology departments globally. We analyze the implications of the COVID-19 pandemic on the imaging volumes, finances, and clinical operations of radiology departments in 2020. Studies from health systems and outpatient imaging centers were analyzed, and the activity throughout 2020 was compared to the pre-pandemic activity, including activity during similar timeframes in 2019. Imaging volumes across modalities, including MRI and CT scans, were compared, as were the Relative Value Units (RVUs) for imaging finances. Furthermore, we compared clinical operations, including staffing and sanitation procedures. We found that imaging volumes in private practices and academic centers decreased globally. The decreases in volume could be attributed to delayed patient screenings, as well as the implementation of protocols, such as the deep cleaning of equipment between patients. Revenues from imaging also decreased globally, with many institutions noting a substantial decline in RVUs and revenue compared with pre-COVID-19 levels. Our analysis thus found significant changes in the volumes, finances, and operations of radiology departments due to the COVID-19 pandemic.

The value of referral information and assessment - a cross sectional study of radiographers' perceptions.

BACKGROUND: Radiology professionals are frequently confronted with referrals containing insufficient clinical information, which hinders delivery of safe and quality medical imaging services. There is however lack of knowledge on why and how referral information is important for radiographers in clinical practice. This study explores what purposes referral information is used/ useful for the radiographers, and the benefits of involving them in assessing referrals. METHODS: A cross sectional study was conducted of radiographers recruited through the International Society of Radiographers and Radiological Technologists (ISRRT) networks. A questionnaire was developed and distributed consisting of 5-point Likert scale questions on a) use/usefulness of referral information for 12 listed purposes and b) the benefits of radiographers assessing referrals for 8 possible reasons. The questionnaire was validated using a test-retest reliability analysis. Kappa values ≥0.6 were accepted. SPSS software was used for data analysis and chi-square tests to determine associations between using referral information and background variables. RESULTS: Total respondents were 279 (n = 233 currently in clinical practice and n = 46 in other positions). The participants in clinical practice ranked high all 12 listed purposes for use of referral information, and all except one received ≥60% 'frequent'/'very frequent' responses. Use for patient identification purposes received the highest score (97% 'frequently'/'very frequently' responses), followed by ensuring imaging of the correct body region (79% 'very frequently' responses). Radiographers not currently working in clinical practice ranked the 'usefulness' of listed items similarly. Significant associations between frequent use of referral information and education level were not observed, and only three items were significantly associated with modality of practice. All items on benefits of radiographers assessing referrals received ≥75% 'agree'/'strongly agree' scores. The items ranked highest were promotes radiographers' professional responsibility and improves collaboration with radiologists and referring clinicians, with 72 and 67% strongly agreed responses, respectively. CONCLUSION: Radiographers use referral information frequently for several purposes. The referral information is needed for justifying and optimising radiological procedures, hence crucial for ensuring patient safety and high-quality services. This further emphasis why radiographers perceive several benefits of being involved in assessing the referral information.

A Multicenter Survey on the Trend of Chest CT Scan Utilization: Tracing the First Footsteps of COVID-19 in Iran.

BACKGROUND: Chest computed tomography (CT) scan has been used widely to diagnose COVID-19 in Iran. OBJECTIVES: To trace the footsteps of COVID-19 in Iran by exploring the trend in using chest CT scans and its economic impact on radiology departments. Methods: In this cross-sectional study, the number of imaging examinations from 33 tertiary radiology departments in 9 large cities of Iran was collected from September 23, 2019 to March 20, 2020 (Months 1 to 6) and the corresponding months in 2018-2019. RESULTS: A 50.2% increase was noted in the chest CT scan utilization in 2019-2020 compared to 2018-2019. This increase was +15%, +15%, +27%, +2%, +1% in Months 1-5 of 2019-2020, respectively. In Month 6 of 2019-2020, a 251% increase in the acquisition of chest CT scans was observed compared to the Month 6 of 2018-2019. Following negative balance of revenue from Month 1 to 5 with respect to the inflation rate, the total income in Month 6 was further 1.5% less than the same Month in 2018-19. CONCLUSION: The observed peak in chest CT utilization in Month 3 prior to the surge in Month 6 could be explained by the seasonal influenza. However, unawareness about an emerging viral disease, i.e. COVID-19, might have underutilized chest CT in Months 4 and 5 before the official announcement in Month 6. The unbalanced increase in the workload of radiology departments in the shortage of cardiothoracic radiologists with the simultaneous decrease in income initiated a vicious cycle that worsened the economic repercussions of the pandemic.

Custeio Baseado em Atividade e Tempo (TDABC) em um departamento de radiologia hospitalar no sul do Brasil / Time-driven Activity-Based Costing (TDABC) in a department of radiology of a hospital from the South of Brazil

Objetivo: Mensurar o custo dos serviços do departamento de radiologia de um hospital privado no sul do Brasil e avaliar o desempenho financeiro do setor quando comparado ao repasse da tabela aos hospitais do Sistema Único de Saúde (SUS). Métodos: Estudo de caso baseado na metodologia Custeio Baseado em Atividade e Tempo (TDABC). Após a definição dos exames de maior incidência, houve a análise do processo de realização de exames de radiografia de tórax, ecografia de abdômen total, tomografia de crânio, tomografia de tórax, ecografia pélvica transvaginal, ecografia de aparelho urinário e ressonância magnética de crânio. Foram coletados os tempos das atividades para a realização de cada exame, informações dos custos do departamento, bem como as definições das capacidades dos serviços para calcular o custo dos exames em função das atividades e tempo. Resultados: Pode-se inferir que, na comparação com os valores de repasse do SUS, todos os exames analisados apresentaram custos superiores ao repasse. Além disso, observou-se que cerca de 80% dos custos estão relacionados ao custo fixo da estrutura do departamento de radiologia e 12%, ao profissional médico. Conclusão: O TDABC demonstrou ser um método oportuno para análise de custeio em um departamento de radiologia hospitalar. Por meio dos resultados apresentados, pode-se propor melhorias a fim de reduzir custos para um maior desempenho do serviço.

Objective: Measuring the cost of services of the department of radiology of a private hospital in the South of Brazil and to evaluate the financial performance of the sector when compared to the transfer of the chart to hospitals of the Unified Health System (SUS). Methods: A case study based on the TDABC methodology was applied. After the definition of the tests of higher incidence, the process of performing chest x-ray examinations, total abdomen ultrasound, cranial tomography, chest tomography, transvaginal pelvic ultrasound, urinary tract ultrasound and magnetic resonance imaging were analyzed. The time of the activities to perform each exam, information of the costs of the department, as well as the definitions of the capacities of the services were collected to calculate the cost of the exams according to the activities and time. Results: It can be inferred that in the comparison with the values of pass-through of the SUS, all of the examinations analyzed presented higher costs than the pass-through. In addition, it was observed that about 80% of the costs are related to the fixed cost of the structure of the radiology department and 12% to the medical professional. Conclusion: TDABC was an opportune method for costing assessment in a department of hospital radiology. Through the presented results, improvements can be proposed in order to reduce costs for a higher performance of the service.

Impact of the Professional Component MPPR Policy on Interdivisional Finances in an Academic Radiology Department.

PURPOSE: The professional component (PC) Multiple Procedure Payment Reduction (MPPR) policy reduces reimbursement for two or more imaging services rendered by the same group practice for a single patient in a single session. The purpose of this study was to analyze the impact of the PC MPPR on interdivisional finances in an academic radiology department. METHODS: A retrospective analysis of Medicare collections from imaging services rendered by a single academic radiology department in a tertiary care medical center for calendar year 2014 was performed. The impact of the PC MPPR on each division was calculated as the fraction of the total departmental PC MPPR, and as the proportion of the divisional revenue. RESULTS: The total decrease in Medicare collections as a result of the PC MPPR was 5.35%. The impact of the PC MPPR on each division as a fraction of the total departmental PC MPPR was: abdominal division (16.63%); thoracic division (23.56%); breast division (0.03%); musculoskeletal division (11.92%); neuroradiology division (34.40%); and noninvasive cardiovascular division (13.46%). The impact of the PC MPPR on each division as a fraction of the divisional revenue was: abdominal (2.82%); thoracic (11.83%); breast (0.66%); musculoskeletal (6.01%); neuroradiology (5.31%); and noninvasive cardiovascular (5.85%). CONCLUSIONS: The PC MPPR differentially affects divisions within an academic radiology department. The neuroradiology and thoracic divisions of our department were the most adversely affected, owing to the high frequency of combined examinations. We speculate that this impact has implications for divisional self-sufficiency, interdivisional relationships, and resident decision making regarding subspecialty training.

Determination of chest x-ray cost using activity based costing approach at Penang General Hospital, Malaysia.

BACKGROUND: Activity based costing (ABC) is an approach to get insight of true costs and to solve accounting problems. It provides more accurate information on product cost than conventional accounting system. The purpose of this study was to identify detailed resource consumption for chest x-ray procedure. METHODS: Human resource cost was calculated by multiplying the mean time spent by employees doing specific activity to their per-minute salaries. The costs of consumables and clinical equipments were obtained from the procurement section of the Radiology Department. The cost of the building was calculated by multiplying the area of space used by the chest X-ray facility with the unit cost of public building department. Moreover, straight-line deprecation with a discount rate of 3% was assumed for calculation of equivalent annual costs for building and machines. Cost of electricity was calculated by multiplying number of kilo watts used by electrical appliance in the year 2010 with electricity tariff for Malaysian commercial consumers (MYR 0.31 per kWh). RESULTS: Five activities were identified which were required to develop one chest X-ray film. Human resource, capital, consumable and electricity cost was MYR 1.48, MYR 1.98, MYR 2.15 and MYR 0.04, respectively. Total cost of single chest X-ray was MYR 5.65 (USD 1.75). CONCLUSION: By applying ABC approach, we can have more detailed and precise estimate of cost for specific activity or service. Choice of repeating a chest X-ray can be based on our findings, when cost is a limiting factor.