Seminars in breast disease最新文献

This article aims to describe how ethically and efficiently research has been conducted in our practice. What started out as a very informal set of internal checks and balances at our practice has evolved into a very busy research department. We now have numerous internal and external studies. Research opportunities include computer-aided detection, full field breast ultrasound, elasticity imaging, cone beam computed tomography of the breast, and breast tomosynthesis. There are many ways a mammography center can conduct research; we have found that commitment is a major factor. Each project needs adequate time and supervision. The dedication must be there to see the projects through to completion.

The integration of picture archiving and communications systems (PACS) into our private practice in order to create a more efficient workflow and office environment has been a challenging and time-consuming work-in-progress affair. While transitioning to a digital environment, we began to incorporate PACS into our daily practice. Since 2005, we have been working with our PACS vendor to continue to change our PACS to suit our needs. We worked through initial connectivity and technical issues, and these problems were resolved through the combined efforts of our PACS vendor, the imaging vendors, and our dedicated homegrown IT and PACS departments. As time has progressed, over the last 4 years so has the role PACS has played in our office. We continually make innovations within our facility to create more efficient workflow and office environment, but also continue to provide excellent patient care, and our PACS continue to play a major role.

In our outpatient Breast Center, we have spent years establishing a workflow pattern that is efficient for our facility. In the following pages, we will describe the unique and effective workflow designed to meet our patients' needs. We have developed a Radiology Information System (RIS), which includes patient scheduling, film requests, patient tracking, pathology results, and patient health history. We average 250 screening patients a day, with an additional 50-100 diagnostic patients. We are now 100% digital, using a picture archiving and communication system (PACS) and a homegrown RIS. Daily we strive to maintain the highest professional standards while providing the patient with excellent service. With an efficient behind-the-scenes workflow, the patient experiences seamless professional interaction in an environment that serves her needs and addresses her concerns.

To maintain our portion of the market share and to recruit new patients, our practice has used different marketing methods and tactics to promote our practice and advertise our standard of care. We have spent time and energy investigating the types of customers practices are competing for, including patients, referring physicians, employees, and payers. You cannot know enough about your business or competition. We use many different methods when designing our marketing plan, including tactics to develop physician referrals, tactics to develop new patients and maintain current patient volume, and education of the patients, public, and physicians. We will go into more detail in the following pages. We believe that marketing is not doing any one thing well; it is doing many things well all at once. We continually solicit feedback through surveys and going out into the community, from our patients and referring physicians.

As clinical research in the last several years has continued to reveal the importance of magnetic resonance imaging (MRI) use in breast imaging, we forged ahead to implement breast MRI in our private practice workflow. The initial start-up costs were prohibitive, so our facility decided to start our MRI experience with a mobile unit. This enhanced our experience and comfort level and initiated our ongoing negotiations for MRI growth with our referring doctors, our patients, and our local insurers. It has been a learning curve for everyone involved with the implementation process. In the end, we established an outpatient MRI practice and built a stationary MRI suite that has suited our work environment. This happened slowly, always with serious consideration to finances, local environment, and workflow issues.

Periodically, a practice needs to evaluate contracts with payers and renegotiate the contracts that are performing poorly. Using a relative value unit (RVU) cost analysis, one can determine what the costs are per unit of service. Before you can attempt to negotiate, you must know your practice expenses, demographics, and clinical outcomes. It is important to consider the following about your practice: specialty services or procedures, location of the practice, accessibility, convenience of parking, and patient satisfaction data. Will the loss of your group's participation create a marketing problem for the plan or payer? What percent of your income is from this payer? Can you walk away from this contract? Using RVU cost analysis, you are able to review procedure expenses and profitability, internal and external fee schedules based on practice expenses, and a contract negotiation starting point based on RVU cost and use.

The most prevalent disease in the American health care industry does not involve major organs and clinical systems, yet it represents the pulse of delivering care to the most vital life source—patients. A “new cancer” has resulted from broken systems attempting to survive in a disease state due to a lack of strategic thinking, absence of service line integration, and minimal focus on prevention. Many health care leaders are the hosts; they lack courage and decision-making in prioritizing programs that temporarily interrupt “cash cow” procedures in favor of less revenue-enhancing interventions that detect disease earlier, prevent its onset, and ultimately save lives. This article addresses the financial treatment guidelines that are needed to reconfigure breast centers in an economy that must balance other competing disease management demands with shrinking dollars and the threat of “in the red” distant disease. Organizations must embrace a new paradigm that results in delayed gratification.

When breast problems arise, most patients in this country are cared for in their hometown communities by physicians in private practice. Regardless of the setting, however, the goal of providing patients with the highest quality and most compassionate care must be foremost. In modern breast centers, a trio of physicians serve as the first team of consultants to assist primary care providers and their patients through the maze and uncertainties related to detection, diagnosis, and treatment of new breast abnormalities. This trio consists of the radiologist, surgeon, and pathologist. The critical and pivotal role of pathologists and their workload in breast disease is often underappreciated by administrators and under-reimbursed by payers. Despite these realities, the private practice of pathology can be rewarding and gratifying for those who commit to creating a work ethic based on best practices, meticulous attention to detail, and effective teamwork.

The adoption of mammographic service screening has led to decreased mortality from breast cancer due primarily to the detection of smaller, earlier stage cancers. Advances in breast imaging technology have contributed significantly to the presurgical evaluation of women, including use of the image-guided biopsy and interdisciplinary pre-treatment planning. The presurgical imaging and final pathologic reporting of tumor characteristics are often discordant. Modern imaging techniques, including functional MRI and 3-D ultrasound provide a spatial depiction of breast cancer extent not reportable using conventional pathologic techniques dating from an era when a minority of breast cancers were screen-detected. By incorporating imaging data into a large-format pathologic evaluation of surgically resected breast tissue, it is possible to improve correlation of tumor size and extent, multifocality, and the evaluation of surgical margins. The importance of pathologic tumor characteristics in guiding therapy mandates optimization of imaging–pathologic correlation in this era of screen-detected breast cancer.