Spring is my favorite season. Everything is in bloom and my dead grass is showing signs of life. No other time of year has such a transformation. Speaking of transformation, my job as a physician in Lynchburg has transformed as well.

 

Since my last article, I have a new title -- adjunct professor. A local university created a DO school which opened this past fall. Local physicians, including members of my group, have helped with curriculum development and have given numerous lectures to the students.

 

This brings me to the point of this article -- why radiologists need to take an active role in medical school education.

 

I will admit that when approached about lecturing to medical school students I first thought -- why?  I can count how many radiology based lectures I received during my 4 years of medical school on one hand. I thought to myself, why should the curriculum change now?

 

That is when I remembered an article from the August 2014 issue of the ACR Bulletin -- Med School Reboot by Jenny Jones. After reading that article and recalling some interactions with local Family Practice residents and new attending MDs, it became pretty apparent that radiology should definitely become part of each medical school's curriculum. Radiologists should step up and teach medical students and residents the appropriateness of imaging.

 

Here are the facts. The use of diagnostic radiology has dramatically increased over the past decade. Radiology is intertwined with nearly all aspects of health care and its importance has dramatically increased. Radiologists are under utilized as consultants -- especially in private practice. Non-radiologists frequently teach imaging in both pre-clinical and clinical settings.

 

All of the facts mentioned above have lead to the problem the ACR is actively trying to solve. How does the radiologist become an integral part of the evolving health care system and how do we demonstrate our worth as consultants to other healthcare providers? This is a primary goal of the ACR's Imaging 3.0 initiative. This can begin in the early years of medical training.

 

After realizing the significance of educating upcoming and young physicians about the importance of radiology and the radiologist, I was left with a difficult question -- how and what do we teach medical students and residents? This was the most difficult part of making my first lecture for the new first year students. I took the approach that was mentioned in the ACR Bulletin article. I did not focus on how to interpret the images. I stressed that image interpretation should be performed by those trained to do it. I focused on appropriateness of imaging and the role of radiologists as consultants. Interpretation of images was definitely a part of the lecture -- but by no means did it dominate. I thought it would also be important to teach students how to use and understand the radiologist's report.

 

My first lecture was a success (there was clapping at the end, which I took as a good sign). I was invited back to give more lectures -- which I thought was a good sign as well.

 

I would encourage all those who are able to teach medical students and/or residents to do so. My practice is developing a rotation for medical students and we have an ongoing elective for our local family practice residency. The students and residents will learn the importance of the radiologist and appreciate us more as a consultant. This could be very beneficial to you and your group. As my group has learned -- some of the residents we teach (and hopefully some of the new medical students) stay and practice locally upon completion of their training.

 

The many hours it takes to make lectures and the time spent reviewing films with the residents will pay off in the long run.   These physicians will be more likely to see us as irreplaceable consultants and thereby make us an integral part of the healthcare team.

 

This is my last correspondence as President of the VCACR. Dr. Tim Farrell will replace me as President of the VCACR at our next meeting in August 2015. This year's meeting will be at the Boar's Head in Charlottesville. Hope to see you there!

 

Also, the ACR 2015 meeting (formerly known as the AMCLC) will start on May 17th, 2015. This meeting is where professionals from all areas of radiology will come together to improve their clinical skills, business practices, government relations and patient care. Hopefully radiologists will leave with a better understanding of why they are ACR members or should be.

 

Please do not hesitate to contact us with any questions about these important upcoming meetings.  I can be reached via email at [email protected] or you can reach our Chapter Coordinator, Lara Knowles, at [email protected]. 

2015 VC-ACR ANNUAL MEETING   

ACR 2015 ™ - THE CROSSROADS OF RADIOLOGY
   

ACR 2015™ is a crossroads for radiology - a premier event where the radiology community convenes to share and build knowledge and to advance the future of the profession. Organized around ACR Knowledge Pathways, the ACR 2015™ meeting offers a comprehensive learning experience focused on skill building in advocacy, economics and health policy, clinical education, clinical research, ACR governance, informatics and innovations, leadership, medical physics, radiation oncology, and quality and safety.

 

The 2015 session of the Virginia General Assembly adjourned on February 26th.  The beginning of session was marked with a great deal of anxiety over the state's fiscal health.  By the end of session the economic picture was much rosier which allowed for more discretion in crafting the budget.  By the end of session there was a great deal of consensus surrounding the final budget.  This led to Governor McAuliffe signing the budget, without amendment, on March 26th.  The General Assembly will reconvene today (April 15th) to consider the Governor's amendments and vetoes relating to other bills that passed in the 2015 session.

 

This is also an election year for the entirety of the General Assembly.  All 100 seats in the House of Delegates and all 40 seats in the Senate are up for re-election.  There have been numerous retirements which have resulted in open seats and numerous primary challenges especially on the republican side.  At stake this year is control of the Senate of Virginia where republicans hold a slim one seat majority.  Republicans in the House of Delegates enjoy a very wide majority of 68 republicans to 32 democrats.  Control of the Senate is crucial to the Governor as it allows him a chamber that will champion his policy initiatives.

 

The 2016 session will see Virginia craft a new biennial budget.  Several factors will determine how smooth this process is. First, makeup of the Senate will be critical.  If democrats can regain control of the chamber it will allow the Governor to possibly revisit Medicaid expansion.  Secondly, revenue will play an important part. If Virginia can sustain its current positive revenue flow it will make crafting a budget much easier. Adding money is always easier than cutting funding, especially in the Big Three: Medicaid, Education, and Public Safety.

 

As election season progresses we will keep you informed as to likely outcomes.  We will also let you know of any actions effecting Radiology that might come out of the reconvene session in April.

 

Chair, Legislative Committee

Chair, Virginia Radiology PAC

  

THANK YOU to the following individuals and groups who made donations totaling $27,700.00 to the Virginia Radiology PAC in 2014:

If your name is not on the list, we encourage you to do your part and make your 2015 contribution today!  Contributions can be made by cash or check and mailed to Virginia Radiology PAC, 2821 Emerywood Parkw ay, Suite 200, Richmond, Virginia 23294. CLICK HERE for a PAC Contribution Form.

Fellowship is one of the most prestigious formal recognitions available to long-time ACR members and symbolizes exceptional achievements in the fields of radiology, radiation oncology, or medical physics. ACR Fellows have distinguished themselves through lifelong service to the ACR, organized radiology and/or medicine, and/or research, and/or teaching. ACR Fellowship has been bestowed on only 10% of active ACR members.

 

The Virginia Chapter of the American College of Radiology would like to recognize our newest fellows, who will be inducted during the ACR 2015 The Crossroads of Radiology Meeting in May.    

 

Michael Gregory Fox, MD

Lester Skolfield Johnson, MD, PHD

Michael P. McDermott, MD

Jatinder R. Palta, PhD

Mark S. Parker, MD

 

Congratulations to you all! Let's learn more about our new fellows.

 

MICHAEL G. FOX, MD

Dr. Fox is an Associate Professor of Radiology at the University of Virginia in Charlottesville, Va. Dr. Fox received his medical degree from the University of Missouri - Kansas City. He served as chief resident and completed his radiology residency at Madigan Army Medical Center; subsequently practicing radiology in the US Army for 4 years. Following completion of a musculoskeletal fellowship at Mayo Clinic Jacksonville and 4 years in private practice, Dr. Fox joined the faculty at the University of Virginia.

 

Dr Fox is a member of the American College of Radiology (ACR), the Radiological Society of North America (RSNA), the International Skeletal Society, the Society of Skeletal Radiology, Alpha Omega Alpha and the Virginia Chapter of the ACR. He serves on the RSNA scientific program committee and he is a member of the ACR appropriateness criteria expert panel on musculoskeletal imaging.

 

Dr. Fox has twice served as an examiner for the American Board of Radiology oral exam, has given invited lectures and scientific presentations both nationally and internationally and has over 25 scholarly publications.       

 

 

LESTER S. JOHNSON, MD, PHD

Lester S. Johnson grew up in North Berwick, Maine, the third of four children raised by two public school teachers, and graduated from Noble High School in Berwick, Maine, Class President and Valedictorian, in 1982. Les attended Washington and Lee University (W & L) in Lexington, Virginia, winning W & L Honors Scholarships for full tuition, room, and board, and graduated from W & L in 1986 summa cum laude, Phi Beta Kappa.

 

In 1987 Lester entered the MD/PhD Program at Columbia University College of Physicians and Surgeons in NY, NY, earning his PhD in 1994 in molecular cell biology and MD in 1995. Dr. Johnson then completed his residency in diagnostic radiology at Columbia and his fellowship in nuclear medicine at the Mallinckrodt Institute of Radiology, Washington University, in St. Louis, MO.

 

At the beginning of 2001, Dr. Johnson joined Medical Center Radiologists (MCR) in Norfolk and Virginia Beach, VA, and the teaching faculty of Eastern Virginia Medical School (EVMS). In 2002, after his first full year of teaching at EVMS, Dr. Johnson received the "Golden Apple Teacher of the Year Award" from the Radiology Residents at EVMS. In 2005 Dr. Johnson was appointed the Chair of the Department of Radiology at EVMS and the Radiology Residency Program Director, positions in which he continues to serve, now in his tenth year. Dr. Johnson has been a volunteer for the American Board of Radiology since 2006, serving as an Oral Board Examiner in Nuclear Radiology from 2006 through 2013, and on the ABR Nuclear Medicine Certifying/MOC Exam Committee from 2010 through 2014. In medical school Lester met his wife, Eveleen M. Oleinik, MD, who is also a radiologist and is a fellowship trained breast imager. Drs. Johnson and Oleinik have two teenage children, Katherine and Benjamin.  

 

 

MICHAEL P. MCDERMOTT, MD

Michael P. McDermott, MD is President and Chief Executive Officer of Mary Washington Healthcare, a not for profit regional system of 2 hospitals and 28 healthcare facilities in the Fredericksburg, VA area.  

 

Prior to assuming his role as CEO of Mary Washington Healthcare, Dr. McDermott was a partner with the Radiologic Associates of Fredericksburg.  Dr. McDermott's previous roles included serving as Medical Director of the Medical Imaging of Fredericksburg facilities, Director of Interventional Radiology at Mary Washington Hospital and Stafford Hospital, Chairman of Radiology at Mary Washington Hospital, and as a Trustee of Mary Washington Healthcare.   

 

Dr. McDermott completed his Diagnostic Radiology residency and Interventional Radiology fellowship at the University of Maryland Medical System in Baltimore, MD.   

 

 

JATINDER R. PALTA, PHD

Dr. Palta received his Ph.D. in medical physics in 1981 from the University of Missouri in Columbia. Prior to coming to VCU's Massey Cancer Center, he was Professor and Chief of Physics in the Department of Radiation Oncology at University of Florida, Gainesville, FL., where he achieved national and international recognition for his clinical research and educational activities in advanced radiotherapy techniques, quality assessment, and quality assurance.  

 

Dr. Palta is a recipient of several NIH awards in medical informatics and optimization research. He has served on NIH study section and the Boards of both AAPM and ASTRO. In his assignment at VHA, Dr. Palta is developing and implementing programs that will ensure safe, effective, state-of-the-art radiation treatments to our Veterans and bring VHA Radiation Oncology Services (ROS) to a position of national excellence. He provides subject matter expertise to the VHA National Radiation Oncology Program on policy development, criteria and evaluation factors of equipment, staffing, resource needs, and development of comprehensive guidelines for medical physics.

 

 

MARK S. PARKER, MD

Mark S. Parker, MD has practiced Cardiothoracic Imaging at VCU Medical Center since June 2001. He is currently the Director of Thoracic Imaging; Director of the Cardiothoracic Imaging Fellowship Program and Director of the Lung Cancer Screening Program at VCU Medical Center. Before then, he was the Director of Thoracic Imaging at the University of Texas Southwestern Medical Center in Dallas Texas and Director of the Thoracic Imaging Fellowship Program there as well. Dr. Parker received his fellowship training at Vanderbilt University Medical Center where he also received the "Teacher of the Year Award".  

  

Dr. Parker has served as an ABR Oral Board Examiner for the Cardiopulmonary Section of the board exam.  Since 2002 he has been part of the ACR-Continuous Professional Improvement (CPI) Cardiopulmonary Section Panel, having the opportunity to write exam questions, answers, rationales and cases for nine different CPI modules, and more recently, also being afforded the opportunity to serve on both the Thoracic and Cardiac Panels to write exam questions and cases for the Annual ACR Diagnostic Radiology In-Service Exam. 

 

His diagnostic radiology residency training was completed at the Eastern Virginia Graduate School of Medicine in Norfolk, Virginia. He graduated from the Eastern Virginia Medical School in Norfolk, Virginia in 1989. His wife Cindy, is an RN and published children's author to whom he has been married to for almost 26 years. Dr. Parker's son, Steven, is a graduate of VCU and currently resides in Fort Worth, Texas and his daughter, Casey, is a graduating Senior at Sweet Briar College this May.  

    

 

 

If you have questions about fellowship in the American College of Radiology or would like to suggest an individual whom the chapter should consider nominating for fellowship please contact Lara Knowles at [email protected] or me at [email protected].

 

The ICD-10 implementation delay will allow radiology practices to focus on the other challenge, Meaningful Use (MU). Now heading into Stage 2, the MU program continues to generate discussion with respect to its applicability to radiologists. Mu does pose challenges, but radiologists who have hesitated to proceed are missing out earning MU incentives and/or avoiding future penalties. The Radiology Business Management Association (RBMA) position supports the goals of the electronic health record (EHR) incentive program to improve quality, engage patients, and improve care coordination. RBMA is committed to making the MU objectives and measures relevant to radiology and address the barriers that keep radiologists from participating in the program. If these efforts are not successful, RBMA will continue to pursue options to make the current hardship exemption permanent. It is late in the ballgame, but not too late to get started.

 

The EHR incentive goals have yet to be fully realized because of the various problems inherent in the system. The current measures and objectives were developed for primary care physicians and not for specialists, especially for radiologists. The Centers for Medicare & Medicaid Services (CMS) are proposing more measures which would apply to radiologists, but that are not currently included in Stages 1 and 2. Many independent hospital based radiologists have had difficulty participating in the EHR program because of their hospitals' inability to provide the necessary EHR data. CMS provided hardship exceptions for eligible professionals (EP) in its Stage 2 final rule. The hardship covers practices which do not have face to face telemedicine interaction with patients or have no control over the availability of certified EHR technology. CMS has identified the hospital based practices as anesthesia, pathology, and radiology for hardship exception. The exception started in 2014 for 2015 and lasts for five years through 2019.

 

With respect to other physicians, the American Medical Association (AMA) recognizes the potential value of electronic health records. Effective use of EHRs is a key element in achieving three goals: improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care. Adoption and effective use of EHRs has been slow and poorly optimized to support efficient and effective clinical work provided by physicians and other clinicians. Physicians are concerned how to effectively use EHR. Research suggests that this is because of the challenges physicians have interacting with the EHR to safely and effectively deliver care. These challenges are due to the design and implementation of EHRs that do not align with the workflow requirements and preferences of physicians within and across specialties and settings.

 

Our MU Experience

Our practice's experience to participate in MU proved to be challenging. In 2011, when we requested access to the hospital system's certified EHR data, they stated their EHR is inpatient hospital only and would not satisfy the CMS EHR incentives registration process. We did not want to hear this explanation, but the hospital was correct. Over the next 2 years, we searched for a solution. In 2013, we finally arrived at an answer by purchasing radiology information system (RIS) software which met the CMS definition of a Qualified Electronic Health Record. The software was hosted by an independent IT company experienced in the MU process. The hospital agreed to send outpatient EHR data to a health information exchange (HIE) who then built an HL7 interface with our IT host and forwarded the host the necessary medical record information. We were able to successfully attest in 2013 to year 1, Stage 1. We are now in the process of participating in 2014 year 2, Stage 1. The first year was difficult because of the learning process. The second year has its challenges, but we are confident that we can successfully attest.