ACR Bulletin July 2016

Final Read

final read july 16

Q: How does participating in outside activities benefit you as a physician?

I always encourage medical students to nurture a passion outside of medicine, be it playing a musical instrument or writing poetry.

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Resident Work-Life Balancework life balance

There’s an alarming trend across radiology: physician burnout. Recent articles in the JACR® and RSNA News have highlighted the declining job satisfaction of radiologists.

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Meet the ACR Leadership: Adam Specht, MD

This is the first installment of a series titled “Meet the ACR Leadership.” Throughout the series, we will interview the ACR Leadership to get insight into their background and involvement in the ACR.leadership

For the first installment, I will be interviewing Adam Specht, MD, who is in his second year on the ACR College Nominating Committee (CNC), for which he was elected Vice Chair.

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What’s a PTN and Why Should I Get Involved?66258397 thumbnail

You may have heard (read: you’ve definitely heard unless you live under a rock) about value-based care lately. “Value” is a hard term to nail down, but it’s not just a buzzword.

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Is Consolidation the Answer?

The RFS Journal Club debates the pros and cons of one of the biggest trends in health care today.consolidation answer

Despite the Federal Trade Commission’s anti-trust efforts, hospital consolidation continues to grow. Between 2007 and 2012, 835 hospitals were involved in 432 merger-and-acquisition deals, with another 95 occurring in 2014. Sixty percent of hospitals are now part of a larger health care system, and it is predicted that up to 20 percent of all U.S. hospitals will be involved in a merger in the next five years.

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JACR June 2016 Highlights


The June Issue of the JACR® covers the misuse of the term “intact,” knowledge and ordering habits of clinical residents, a radiology resident consultant service, a rebuttal to radiology commoditization and more. Here are a handful of articles of special interest to radiologists in training.

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News from the Chair of the Resident and Fellow Section

Growth and Maturation of the ACR Resident and Fellow SectionRFS

The American College of Radiology Resident and Fellow Section (RFS) has grown tremendously since its inception 28 years ago.

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Why I Belong to A3CR2

(And why you should too.)A3CR2

As a chief resident, have you ever wondered how to motivate and engage your fellow residents?

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A Resident’s View — AMA 2016

Attending the AMA meeting can have an impact on your career.

purakal ama rfs voices

Recently, I had the honor of being invited by Arl Van Moore, Jr., MD, FACR, to serve as an alternate delegate representing the American College of Radiology to the American Medical Association annual meeting.

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Culturally Connected: The RFS International Subcommittee

Do you have an interest in bettering the world around you?International

Some of my earliest memories take place at my best childhood friend’s home with her Italian born parents. I distinctly remember running through their backyard with rows of oversized aromatic rosemary bushes and soft, fragrant basil plants.

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RFS Voices: Job Search

Job searching season is here. Follow these tips to find a position that suits your needs.job search

It’s July, and change is upon us. For trainees in medicine, this heralds the beginning of a new academic year.

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Change Is Coming — But the ACR Stands Ready.

Is your practice on board?


In light of the new rules on value-based care, the College is determined to ensure that members realize all the tools and resources available to help them take advantage of the new payment models coming their way.

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The Groundbreakers

Advances in science and technology by the American College of Radiology Imaging Network are driving the practice of radiology into the future.the groundbreakers

"If I have seen further, it is by standing on the shoulders of giants.” It’s been nearly 350 years since Isaac Newton penned that thought in a letter about making new discoveries by building on those of previous researchers.

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RLI Leadership Summit Toolkit

Toolkit Main

By now, we all know that radiology and health care are going through fairly large paradigm changes. For radiologists, this has translated into a shift from fee-for-service to value-based imaging models.

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Immunity to Change - Closing the Knowing-Doing Gap

Thursday, Sept. 8 – 1:30 - 5:15 p.m.

Radiology has survived and flourished at the edge of innovation and change in medicine. Ensuring our continuing ability to not just envision, but also implement change, will guarantee our future.

Creating value often requires doing things differently. Such change is hard because what it demands from us goes beyond a checklist of tasks. Even if we accept change intellectually, our thoughts, feelings, unconscious biases, assumptions, habits of mind and action, and other commitments can be obstacles to executing change.

In this session, we will learn how to overcome these obstacles to change and to close the knowing-doing gap.


John Kotter’s Plan to Accelerate Your BusinessIn the fast-paced modern economy, businesses can no longer rely on just one organizational design.

How Have Kotter's Eight Steps for Change Changed?Four key revisions in John Kotter's eight step process for leading change.

Kotter's 8-Step Change Model: Implementing Change Powerfully and Successfully Whether you're considering a small change to one or two processes, or a system wide change to an organization, it's common to feel uneasy and intimidated by the scale of the challenge.

Overcoming the Barriers to Change in Healthcare SystemVarious studies show that 60 to 80 percent of major change initiatives fail. Here's how to not become a statistic.

10 Principles of Change ManagementTools and techniques to help companies transform quickly

Building a Value-Based Performance

Saturday, Sept. 10 – 1:30 - 5:15 p.m

Radiology’s future will in large part depend on a significant focus on pricing and the customers’ willingness to pay, both of which hinge on a clear understanding of the derived value of services provided.

There is increasing discussion on how radiologists should view their practices in terms of the value they add to the larger health care enterprise. The challenge is figuring out how to convert this appealing but nebulous idea into something more specific and actionable?

This session, grounded in finance, will cover ideas to help you think more rigorously about value and adding value. How do you associate a value to an activity? How do you separate what are truly value-added activities from those that are not? What to do more of, less of, and to stop doing? How do you transition an imaging practice to a more value-added focus?

The ideas covered in this session will also help you in rethinking your organization’s operations and business model.


The Value of Hard WorkFind out how Samir B. Patel, MD, tangibly showcased his practice’s value to his administration via the value-based matrix.

Most Valuable (Radiology) PracticeFind out how to become a value-based practice with these suggestions from the ACR Managed Care Committee and RBMA

The Total Value Equation: A Suggested Framework for Understanding the Value Equation in Diagnostic RadiologyWhat is value, and when speaking of value creation strategies, what is it exactly that is meant?

The Strategy that will Fix Health CareThe strategy of value-based care

Defining Your Personal Brand

Friday, Sept. 9 – 8:30 a.m. - Noon

There are distinct examples of branding and personal branding that have brought recognition and the consequence of strengthened market share for both individuals and organizations in radiology.

Learn how the core concepts of personal branding can be applied to raise your professional profile and ultimately grow your practice. In this session, you will uncover your unique strengths, skills, and talents; learn how to create a compelling story, deliver a memorable elevator pitch, project a positive professional presence; and learn strategies to build your network in person and online.

The session will include a panel of your successful peers who will talk about their experiences in building a personal brand.


Personal Branding Is A Leadership Requirement, Not a Self-Promotion CampaignWhy should you work on your personal brand?

Define Your Personal Leadership Brand in Five StepsTake quick, actionable steps in determining your personal brand.

The Complete Guide to Building Your Personal BrandOne of the most comprehensive looks at how to build your personal brand

5 Steps to Building a Personal Brand (and Why You Need One)People want to do business with other people, not companies.

Governing in Today's Climate: Leading and Making Decisions Under Uncertainty, Speed and Change

Friday, Sept. 9 – 1:30 - 5:15 p.m

Radiology leadership has become more exciting and vital as margins have decreased, and as the way we do business changes in an environment with increasingly complex regulations and competition.

To better align with and address changes in technology, regulations, and the nature of health care, leaders must rethink how they govern their organizations. Given the rapidity and uncertainty of such changes, no longer can they over-analyze data before making decisions, nor can they rely on past experiences to determine the best future options. Risks must now be assessed differently, resources allocated in more dynamic and flexible ways, and decisions made faster while ensuring that subconscious cognitive biases don’t result in bad choices.

In this session, we'll look at how we govern today and what needs to change across mindsets, processes and decision making. We'll strive to develop a new blueprint that each organization can take back to begin a new model for governance in their practice.


Medical Practice Governing Agreements: A Little Planning Goes a Long WayAn effective governing agreement can mitigate risk and help your practice thrive.

The Anatomy of Group DysfunctionGetting to the root of practice management issues demands a look at governance structure and business model.

How to Have an Honest Conversation About Your Business StrategyOpen communication with staff at all levels can revolutionize the way you do business.

The Metamorphosis of a PracticeAs the health care industry moves toward value and away from volume, some facilities are finding both challenges and opportunities as they turn to a more service-oriented business model.

Dynamics of Value Claiming in Negotiations

Sunday, Sept. 11 – 8:30 a.m. - 12:30 p.m.

Radiology’s financial success is secured not simply through pricing and resultant payment; rather, securing payment and revenue generation, and therefore financial success, hinges on successful negotiation.

Negotiations play a role in both creating value and dividing it among the players involved.  Using experiential exercises, this session will help you develop your negotiation skills.  You will assess your current abilities in deals that require value claiming or basic bargaining skills.  You will learn the key attributes for claiming more value in deals.  These are fundamental ideas that can be powerful tools for any level of negotiator.


Negotiation Techniques for Health Care Professionals Learn the essential components of negotiation prep and common techniques for optimizing agreements.

Mixed SignalsBoost your emotional intelligence to improve your relationships, strength your negotiating skills, and upgrade your career.

The Value of Hard WorkCreating a system for quantifying value-added activities helped one practice save its hospital contract.

How Physicians Should Negotiate with Payers Even if the practice is run efficiently,  with low overhead, if the payer contracts are not properly negotiated or worded, it can  result in a loss in net revenue.

Negotiation Techniques for Health Care Professionals Basic negotiation terms and how-to for radiologists

Competing Through Operations

Saturday, Sept. 10 – 8:30 a.m. - Noon

Well-run radiology enterprises are identifiable, distinct, and are essential to success. Such examples typically have succeeded by paying very close attention to both production and financial management.

The competing through operations session will encompass two learning modules. The first module examines the concept of operational excellence as a component of strategy. Most organizations strive to be operationally excellent but very few achieve this level of excellence. Failure to achieve operational excellence often results from the failure to fully define the concept in the context of the organization’s strategy. Operational excellence is not a ‘one size fits all’ concept. The first module will explore the sources of advantage that organizations can secure through superior operations and the critical capabilities that an organization must develop in order to successfully execute an operations-based strategy. The second module incorporates a more external, customer-focused view of operational excellence. Specifically, the module will examine the role of customer loyalty, a desired outcome of operational excellence, as a driver of both growth and profit.


Analysis of Radiology Business Models
This strategic value framework helps radiology practices best position themselves in their environments.

Lessons From the Happiest Place on Earth
Lessons in customer service

Leading in the World of Business and Medicine: Putting the Needs of Customers, Employees, and Patients First
Tips from the business world on how to make the patient front and center.

Customer intimacy, meet operational excellence
Organizations that have historically competed on customer intimacy can simultaneously strive for operational excellence.

Family, Patient, Both

When family members become patients, physicians can find themselves in uncertain territory.

b2ap3 thumbnail jacrblog june kristina hoque

How do you navigate the doctor-patient dynamic when the relationship extends beyond the clinic? In June’s #JACR tweet chat, physicians discussed the pros, cons, and gray areas associated with providing medical care to family members. Participants shared their experiences and resources on the topic. We’ve gathered the top resources from the tweet chat below.

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The Rule of Thirds

At one of the world’s most successful companies, executives devote their largest fraction of time to one single thing.july bulletin ge leadership

It's a universal truth of business that where we focus our investments is where we place our value. If you look at the way your own practice prioritizes investment, what patterns can you pick out?

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Taking the Lead

Samir B. Patel, MD, created a document to safeguard his practice’s contract. What he didn’t realize is he’d started a national conversation on image

It's a challenge all of health care is facing right now — how do you define value? At its most basic level, valuable means being worth something to someone.

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Understanding Episodes of Care

The Commission on Economics is working to define radiology’s place in episode groups.july bulletin episodes of care

What role does radiology play in clincal care? This is a wide-open question with multiple potential answers.

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Mixed Signals

Boost your emotional intelligence to improve your relationships and upgrade your career.Emotional Intelligence

What qualities lead to success in business? The average response might be a high IQ or keen insight into upcoming trends.

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Catch Your Wave

As alternative payment models emerge, radiologists must find their place in the shifting paradigm.CatchtheWave

The tide of health care is turning. On one side is the traditional fee-for-service model, in which radiologists and other physicians are paid according to the number of exams they read and patients they see.

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September Is Radiology Expo Month

How can you educate medical students about radiology?RadExpo

In 2015, the radiology match results brought great anxiety to our profession, with 33 percent of diagnostic radiology residency programs going unfilled.

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July Case of the Month

Access case here.

Authors: Scott Sosin, DO, Radiology Resident, Department of Radiology, Atlantic Health System-Overlook Medical Center, Summit, NJ; Marci Handler, MD, PGY3, Radiology Resident, Department of Radiology, Atlantic Health System- Overlook Medical Center, Summit, NJ; Rita Yeretsian, MD, Attending Physician, Neuroradiology, Department of Radiology, Atlantic Health System-Overlook Medical Center, Summit, NJ

Why did you select this case for submission?

I have a particular interest in anatomic variants and their relative benignity and/or pathologic correlates. This case is one of many such examples that I have had the privilege of seeing at my institution.

What should readers learn from this case?

Vascular anatomic variants have significant implications with regard to physiology and flow dynamics, which can lead to aneurysm formation.

What did you learn from working on the case?

Recognizing a typically “benign” anatomic entity often is not enough. Rather, its identification should prompt closer inspection for any well-documented associated pathology.

How did guidance from senior staff at your institution impact your learning and case development?

I am fortunate to have terrific mentors at my institution (Atlantic Health System), who are always willing to teach and explain the details of our most interesting cases. Their enthusiasm is contagious!

Why did you choose Case in Point for submission of your case?

Case in Point is the most respected radiology case repository on the Internet. I felt this case deserved the kind of exposure within our profession that only Case in Point could provide.

What is the appeal of online learning tools such as Case in Point as opposed to print learning venues?

Online learning is just so accessible, and so easy to squeeze into an otherwise busy day of clinical or administrative duties. Print materials could never provide the level of casual convenience that electronic CME offers.

Are you a regular reader of Case in Point? What are your favorite types of cases?

Yes, I try to keep up with Case in Point on a weekly basis, at the very least. I find it is an excellent resource for keeping skills sharp, and reinforcing what I have learned from textbook readings. There is nothing quite like seeing a “real world” example.

Is there anything else you'd like readers to know about your case?

You never know what you might find in your stack of studies! I am learning to always keep my eyes peeled. Expect the unexpected.