Mary Lanning Healthcare in Hastings, Nebraska, USA, recognizes the trend toward transparency.
Mary Lanning Healthcare is a 183-bed facility in Hastings, Nebraska, USA. With an increasing trend toward transparency in hospital outcome measures, and maybe even public radiation dose reporting one day. They recognize the need to enhance patient experience and position the hospital at the forefront of diagnostic imaging.
Safe for patients, safe for the bottom line
In 2014, radiation dose once again emerged as a national topic in the U.S. with the establishment of NEMA XR-29. It is an industry guideline, referred to as the “Smart Dose Standard”, which is setting a baseline for radiation reduction technology and dose reporting. This guideline affects CT scanners used to image Medicare patients. To summarize what is required: These scanners must include pediatric protocols, DICOM-structured reporting, dose check, and automated exposure control.
These tools help ensure a safer procedure. Starting in 2016, there will be a 5% reduction in Medicare reimbursements for imaging procedures using non-compliant technology. In 2017 and beyond, the penalty will increase to 15%.
Mary Lanning Healthcare have to manage a high patient case mix (Daniel J. Herold, MD).
At most U.S. hospitals, Medicare is one of the single biggest payers. The situation created by XR-29 could have become even more acute for Mary Lanning Healthcare, where Medicare accounts for 53% of the hospital’s payer mix. Moving to XR-29 compliant technology should be about more than protecting Medicare reimbursement. It creates an opportunity to do more than just replace outdated technology with new scanners that have the base level of compliant technology. It represents a chance to bring in advanced diagnostic functionality that positions the organization to become a regional leader.
According to the American Hospital Association, Medicare patients present with a growing prevalence of chronic conditions and risk factors, such as obesity. Still, even meeting the needs of the aging population is one of the concerns associated with having such a high Medicare case mix. This can lead to a rise in Medicare beneficiaries’ use of healthcare, which has implications for resource utilization and payment.[1]
Dose reduction as a differentiator
Dose was probably the number one item that Mark Callahan (left) and the doctors considered as they negotiated for a new CT scanner.
The NEMA XR-29 Smart Dose Standard established a baseline for CT technology specifically includes functionality for reporting radiation dose levels. With trends toward greater transparency in other hospital outcomes, it is reasonable to think that in the near future the average dose for a hospital’s top CT procedures might be public information. If that becomes the case, investments in dose-optimized CT technology could play a significant role in a healthcare organization’s reputation. “Dose was probably the number one item we were looking at as we negotiated for a new CT scanner,” said Mark Callahan, COO at Mary Lanning Healthcare. “I also think dose values could certainly be a market differentiator for hospitals like ours.”
If we can reduce exposure to our patients, make their exams safer, and the images better, then that’s what it’s all about. We’re working to create the safest, most effective care for our patients.
To meet all these requirements, Mary Lanning Healthcare upgraded their eight-year-old computed tomography (CT) system with a new, 128-slice SOMATOM® Definition Edge. The SOMATOM Definition Edge is already helping Mary Lanning Healthcare lower the radiation dose compared with its previous CT scanner. “We compared average dose from our old scanner with the average dose from the SOMATOM Definition Edge,” said Jenny Utecht, CT technologist. “After adjusting for patient size, using SAFIRE1 we see overall dose reductions from 45% to greater than 50% in procedures such as chest imaging, abdomen/pelvis, and chest pulmonary embolism studies. With chest pain and shortness of breath representing two of the most common reasons people present to the emergency department, the SOMATOM Definition Edge is helping us consistently provide safer imaging to patients.” In addition, with its high table weight limit and ability to support fast, high-quality exams and higher patient volumes, the new scanner can help Mary Lanning Healthcare offset some of the concerns associated with having a high patient case mix. The SOMATOM Definition Edge even helps Mary Lanning Healthcare better meet the needs of the aging population while putting the hospital in a position to attract younger patients in the community.
Potential for expanded services
Our patient population is generally older. Many of our older patients have a hard time holding their breath. Now, with the SOMATOM Definition Edge, the scan is so fast that they hardly have to hold their breath at all
Mary Lanning Healthcare’s leadership sees dose reductions as a testament to the value it places on patient safety. The ability to dramatically lower the dose may also open up the potential to increase pediatric imaging at Mary Lanning Healthcare, which means expanding services for the benefit of the community and the hospital. Pediatrics is one of several potential growth areas for expanded CT capabilities at Mary Lanning Healthcare. They will also use the SOMATOM Definition Edge to expand services in cardiology and interventional imaging. “For physician and patient satisfaction, the SOMATOM Definition Edge can have a huge impact, especially for cardiologists,” said Tami Lipker, Director of Imaging. “The cardiologists have spoken to me personally about radiation dose reduction. It is a huge safety and patient satisfaction issue.”
Physician perception is equally as important as patient perception, especially when trying to recruit the best available talent. So the SOMATOM Definition Edge has become an important part of the organization’s physician recruitment efforts. Many of the hospital’s prospective physicians come from academic medical centers and they are accustomed to practicing medicine with premium diagnostic tools at their disposal. They tend to want to continue practicing in an environment that lets them work with a similar level of diagnostic confidence. This is why the SOMATOM Definition Edge is one of the first pieces of equipment that prospective hires see.
Changing vendors, easier than anticipated
As with any change in CT vendors, technologists at Mary Lanning Healthcare had some concerns. The new scanner uses Siemens FAST CARE (fully assisting scanner technologies and combined applications to reduce exposure) to automate and standardize many of the exam preparation steps. The CARE applications are aimed at helping technologists consistently optimize exam protocols for each patient and study type. “Some of the technologists were worried about the change,” said Utecht. “We thought imaging would be too automated, and we wouldn’t be able to make adjustments. So, we were skeptical about the scanner at first.” Installation and applications training were successful and technologists now have a higher level of comfort with the new CT system as a result.
Positioned for the future
The SOMATOM Definition Edge is helping Mary Lanning Healthcare meet its short-term patient care objectives while positioning the hospital to continue to be a leader in the community for years to come.
References
[1] Are Medicare Patients Getting Sicker? Washington: American Hospital Association. 2012 Dec [cited 2014 July 11]. Available at: http://www.aha.org/research/reports/tw/12dec-tw-ptacuity.pdf.
1 In clinical practice, the use of SAFIRE may reduce CT patient dose on the clinical task, patient size, anatomical location, and clinical practice. A consultation with a radiologist and a physicist should be made to determine the appropriate dose to obtain diagnostic image quality for the particular clinical task. The following test method was used to determine a 54 to 60 percent dose reduction when using the SAFIRE reconstruction software: Noise, CT numbers, homogeneity, low-contrast resolution, and high-contrast resolution were assessed in a Gammex 438 phantom. Low-dose data reconstructed with SAFIRE showed the same image quality compared to full-dose data based on this test. Data on file.
The statements by Siemens’ customers described herein are based on results that were achieved in the customer’s unique setting. Since there is no “typical” hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.
United States. Protecting Access to Medicare Act. HR 4032. Public Law: 113-93.
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