A capital plan.

A panel of experts responded to the Health Care Financing Administration's proposed capital reimbursement regulations at the recent Annual Conference of the Federation of American Health Systems in Orlando, Florida. What follows are edited versions of some of the panelists--but not all--concerning the issue and HCFA's position.

Equipment selection in a DRG environment.

New equipment will continue to be purchased by the healthcare field. It is imperative that those who are considering equipment purchases keep in mind the various factors affecting our healthcare system today. With the increased cost of equipment and the increased risk that this equipment will not be financially successful, it is imperative that those purchasing the equipment be aware that successful adoption of equipment under the PPS will require that special consideration be given to the following: technologies, ability to enhance an integrated healthcare service, and its potential to serve as a cornerstone for a health service program.

Falsification of clinical credentials by physicians applying for ambulatory-staff privileges.

As part of a quality-assurance program, we reviewed the clinical credentials listed on applications from 773 physicians applying for clinical positions in the Humana MedFirst national ambulatory care program between March 1 and December 31, 1986. In 39 applications (5.0 percent), physicians presented false clinical credentials: 27 physicians (3.5 percent) gave false information about their residency, 10 (1.3 percent) falsely reported board certification, and 2 (0.3 percent) provided false information about both residency and board certification. There was no significant difference between the falsification rates among graduates of U.S. medical schools and those among graduates of foreign medical schools, or among those in the various medical specialties. Falsification was more common among physicians recruited locally than among those recruited nationally, and was significantly more common among applicants who graduated before 1970. Because of this sample included only applicants for ambulatory privileges within a single organization, the findings may be of uncertain generalizability to groups of physicians applying for other classes of privileges in other institutions. We conclude that in applying for some clinical privileges, physicians present inaccurate clinical credentials more frequently than might be expected.

Medical imaging's dynamic future.

Radiology's survival as a specialty is threatened because of the significant changes that have occurred in the healthcare environment over the past five years. Changes in reimbursement, expectations by referring physicians, and demands by insurance carriers and the employees they represent have all had an impact on the volume of patients admitted to hospitals and being referred to various physicians. This has directly impacted radiology practice in terms of the types and numbers of procedures performed as well as through competition which has developed for providing traditional radiology services. It is clear that changes will continue to affect radiology practice in terms of reimbursement and specialty needs far into the future. Various entities that are involved in providing services to hospitals as well as to radiology practices will continue to have an impact on what radiologists do and how they do it. It is important that radiologists be willing to restructure their own individual radiology practices and modify their educational background and experience so that they can provide the best possible services to the referring physicians and the best support to the various insurance programs that are provided to them. The greater the extent to which radiologists are willing to improve the quality as well as effectiveness of their support services, the greater the likelihood that their practices will be successful into the future.

Current perspectives on medical imaging.

Advances in biomedical technology have expanded the potential of medical imaging. Selected aspects of developments in sonography, nuclear medicine, nuclear magnetic resonance and digital imaging are addressed, stressing the wide scope permitted by these newer modalities.

The role of hospitals and physicians in technology diffusion.

Hospitals and physicians play pivotal roles in the diffusion of health care technology because they, for the most part, are the owners and operators of medical equipment. At the same time, the way in which technology spreads through the health care community has an impact on the number of patients seen, and revenue earned, by hospitals and physicians. This synergistic relationship has been subjected to new forces with the ongoing development of new technologies and the reduction of insurers' generous cost reimbursements. "Competition" is the rallying cry about which much of this change has grown. Medicare's prospective payment system, federal and state cost-containment activities, and an increase in the number of alternative health care providers continue to incite competitive activities among hospitals and physicians as they vie for patients. To survive financially today, hospitals and physicians must have a clear understanding of the health care technology environment in which they function. Only then can a strategic plan be designed that identifies the tactics that would enable the hospital or physician not only to compete, but to succeed, in the battle to offer high-quality services that attract patients.

Simultaneous bi-plane digital video-fluoroscopy.

A prototype system for digital subtraction angiography that is capable of acquiring digitized video-fluoroscopic images simultaneously from both anterior and lateral imaging chains of a conventional bi-plane system was developed. A hardware module that takes images from both the anterior and lateral video cameras and displays them both on a single video image prior to digitization was designed and constructed. The three-dimensional information provided by a digital bi-plane images should improve the accuracy of cardiac-ventricular function studies. In addition, bi-plane imaging should reduce the need for additional views and the associated repeated injections of contrast media. With this technique, digital bi-plane imaging can be carried out with commercially available systems without duplication of the digital-processing chain.

Radionuclide ventriculography: evaluation of automated and visual methods for regional wall motion analysis.

Regional wall motion (RWM) abnormalities are sensitive indicators of left ventricular (LV) dysfunction, but quantitation of RWM with gated radionuclide ventriculography (RVG) has been limited, particularly in the left anterior oblique (LAO) projection. Regional LV performance was studied in 18 patients undergoing LAO RVG immediately prior to contrast ventriculography (CVG). Wall motion was analyzed by semiautomated and visual methods using several coordinate systems. For semiautomated methods, RVG and CVG wall motion were closely related in the two 90 degrees polar sectors at the apex and posterior wall (r = .85) and in the five 45 degrees polar sectors from midseptum through posterior wall (r = .82). The basal sectors on RVG had weak relationship to CVG, due to adjacent vascular structures. Semiautomated and visual grades for polar sectors on both CVG and RVG were closely related (r = .88- .94). Measured regional wall motion on LAO RVG compared favorably with near-simultaneous CVG in nonoverlapping portions of the LV and allowed objective quantitation of regional LV performance.