Sunday, May 13, 2012

Health Care Reform Enters New Era

Posted: May 13, 2012 | 2:04 a.m.

Behind the rhetoric of health care topics discussed almost daily in this election year, there are serious changes happening in the medical field that will make a better foundation for health care in general through 2012. There are also some serious holes in medical reform that need to be addressed, say Las Vegas medical professionals who are eager to discuss the trends that will affect their patients, their businesses and what the country faces as technology and patient reform enter a new era.

There is an upswing in patient knowledge that will change the industry through 2012, technology that can mean better care when patients understand and use what is available to them, and consumer involvement in their care and billing that will also make moves for a better overall health care system, according to local health care sources.

The Deficit Reduction Act that came into effect Jan. 1, 2007, deeply affected the industry, said William P. Moore II, CEO of Desert Radiologists, and continues to do so.

"In our industry the major trend is decreased reimbursement," he said. "We've seen considerable cuts since that time, and Congress targeted imaging in particular, outside of radiology. We've seen significant cuts since 2007, and those cuts aren't over."

In the past, a patient might get a magnetic resonance image or computerized tomography scan separately to diagnose a problem from chest to pelvis. Now those tests are often bundled.

"It is our reality, so we in the imaging business have to find ways to do it more efficiently with lowering costs without adversely impacting quality," he said.

Desert Radiologists has been in Las Vegas for 46 years. Its first contract was with University Medical Center and it has continued to grow with six offices in the Las Vegas Valley.

"We've been with UMC for about 40 of those years, and we have built this company based on quality, first and foremost," Moore said. "We have lived up to that mantra that if you have the highest available care you will attract the best business. And we have. We're very proud of our record and what we've accomplished. We've worked with physicians and implemented many new technologies to assist our physicians."

Desert Radiologists employs 47 radiologists, a number Moore said is strong in the valley.

"While many businesses are shrinking, we are in a position to hire more radiologists and continue to grow," he said. "We will not compromise quality, so with that said, with technology, we have been able to introduce greater ways to assist our physicians and patients."

The company decided to introduce software that shaves days off of getting results. Physicians are able to review, edit and make corrections within minutes of a patient's initial imaging.

"It used to take doctors a day or two to transcribe a report, review edit and make corrections, then finally give a final report," he said. "Now, 95 percent of the reports we do, they are self-edited by physicians in minutes. Before the patient has left our office, the report is completed so they can know if they need to do another image or scan. It has allowed us to become more efficient and reduce costs. By that, I mean it allows us to continue to grow. The health care industry is very different from any other industry you think of."

The introduction of new technology and changing with health care trends has allowed Desert Radiologists to grow.

"We are in the top 95th percentile of radiologists in the country in regards to our efficiency as measured to work relative value units," he said.

Desert Radiologists is hiring with several positions open, from management to front office. Go to to apply.

"We are always typically hiring techs, ultrasound, mammogram, MRI, CT, X-ray," Moore said. "We continue to grow and hire almost weekly. It's nice to be hiring."

Health care reform plays a large part in the health care trends for 2012, said Shelby Decosta, St. Rose Dominican Hospitals chief strategy officer.

"One of the major health care trends we see is how health care reform will continue to shape the medical landscape," she said. "We also see technology continuing to play more of the role in all aspects of health care, including electronic medical records.  As consumers and employers search for value in health care purchasing, we will see an increased level of transparency and further need for providers across the care continuum to coordinate in order to minimize waste."

A bright spot in her field is the evolution of technology to better serve patients, both for medical and convenience purposes.

"Technology continues to evolve in health care, whether it is the latest medical advances or how we communicate with patients," Decosta said. "At St. Rose, we just opened our hybrid OR. This hybrid operating suite - one of the first in Nevada - provides a state-of-the-art setting where a patient's multiple health issues can be diagnosed and treated in one place and at one time."

The hybrid operating room is a universal operating room that easily adapts to endovascular, minimally invasive, open surgery and hybrid procedures.

"It's a cath lab (catheterization laboratory) environment, with its high-end X-ray system and trained interventional staff combined with the OR and its highly sterile environment, trained surgical staff, anesthesia and surgical instruments," Decosta said. "St. Rose's hybrid OR also features a high-tech, interactive audio/visual system that allows the cardiac team to call and consult with different specialists when needed."

St. Rose also offers transcatheter aortic valve replacement, a groundbreaking minimally invasive cardiac treatment that provides help and hope to patients who have been diagnosed with severe aortic valve disease.

For patients looking to make the most of their care, Decosta advised that they be involved in their total health care experience, from treatment to billing. Patients should never be afraid to ask questions or ask for their doctor's advice concerning medication or physical treatments.

"Consumers should be aware of their rights as a patient, whether they are in a physician's office or at a hospital," she said. "Another good tool is for consumers to write down their questions when going to appointments. Depending on the appointment, it may be good to have a support person as a second set of eyes and ears."

As they have for the past few years, pharmacies will continue to play a major role in health care as the American population ages and requires more intervention from many different medical professionals, from doctors to physical therapists.

"As we engage pharmacies and other community partners through our clinically integrated network, we anticipate greater transparency in pharmaceutical pricing," she said. "This will help us to effective managed escalating drug costs within the hospital system and offer some relief to patients who regularly rely on medications."

St. Rose Hospitals has implemented specific programs to further its goal for good health in the Las Vegas community.

"We offer a wide variety of classes through our WomensCare Centers of Excellence. Class schedules are published quarterly or can be found online at," she said. "Of note, we have a new physician speaker series, 'Dinner With a Doc.' This free ongoing seminar allows participants to take part in a free dinner and hear straight from physicians about medical services and technologies.

St. Rose plans three dinners through the summer: "ABCs of PAD" with Dr. Chandra Narala, "Inflammation and Heart Disease" with Dr. Herb Cordero, and "Tech Talk with a Stroke Doc." Call 616-4900 for more information.

St. Rose Dominican Hospitals is also working to make it easier for patients to take their medical records to other physicians, which makes for better diagnosis as well as overall patient care.

"We currently use EHR (electronic health records), however, we are launching a full system upgrade that will incorporate all aspects of patient care," she said. "As part of this project we also are working with physician offices to launch Mobile MD, allowing physicians to integrate into the hospital EHR seamlessly, ensuring a consistent patient experience and care."

Working with different physicians will become much easier for patients through 2012, said, Bryan Dieter, CEO of Endurance Health Inc. However, having one main physician could be key to keeping your health in check, no matter how good technology gets.

"We will continue to see a move to better coordination of care between providers, both directly and through accountable care organizations," he said. "There will also be a move to further push risk from the payers to the providers, which I believe is actually a good thing. The providers are increasingly recognizing that keeping people healthier results in lower costs."

Although not new, electronic health records are continuing to be adopted in the provider community and will eventually be common for patients in dealing with multiple providers and medical facilities.

But patients need to be involved in their health care, now more than ever.

"The first thing they can do is to find a primary care physician they trust," he said. "Make that person your partner in managing your care.  They will help you make better health decisions and direct you to specialists when necessary."

It may seem daunting, but it is manageable, and vital, for you to be a large part of your personal health care.

"Call them (primary care doctors) first before making major health care decisions, but if you feel they don't have time for you, find another one," he said. "Get educated, from trusted medical journals, about any chronic conditions you may have.  If your condition is less common, you may know more than your doctor about your condition, sometimes making the physician feel defensive."

And don't be afraid to speak up.

"You need to find a physician willing to hear what you have learned and integrate that into their overall plan for managing your care," Dieter said. "It is impossible for the physicians today to keep current on every disease, condition and treatment, but they are expert at assimilating medical information and helping develop a plan for most effectively managing your health."

While it has become common for patients to shop pharmacies, he recommends finding one good pharmacist within your provider group and sticking with that person to ensure that you are on track with the different medications you may be prescribed.  

"Pharmacies will continue to play the role they traditionally have, which is to provide you with the proper medications prescribed by your doctor to treat a particular problem," Dieter said.  "The pharmacies may, however, have more information than your physician when they prescribed your medication, most notably other medications you are taking and allergies you may have. They will partner with your prescribing physician to try and avoid any medication errors that might occur.

"Much of that is up to the patient, and I encourage patients to either keep a current list of all medications they are taking or actually bring your medication bottles with you to the doctor's office to insure they know your medications before prescribing anything."

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