The number of patients a practice radiographs in year is one determinant of the needs of a practice when shopping for a veterinary digital radiography system. During our prepurchase consultations, we ask vets how many studies they take each year. The response is usually something like “we took 668 films.”
Most veterinarians charge by the film or projection rather than the study. This is a practice that must be abandoned as it is as outdated as The Safety Dance*. In my discussions with veterinarians, however, it is clear that change is difficult and most veterinarians are reluctant to change the way they charge for radiographs in their practice. Hopefully, this article will convince you otherwise.
This business of charging by the film or projection allows the tail to wag the dog when charging for radiographs. In nearly all cases, it is bad medicine to allow any patient to leave the x-ray table with a single projection. Charging by the projection or film penalizes owners by making additional (necessary) projections more expensive which , in my experience, discourages many vets from obtaining extra projections. I understand the fact that there is additional cost with film radiography (technician time, film costs, etc) but I contend that the incremental cost for an additional view does not even come close to the cost of missing a lesion or having the owner return to the practice for an additional projection.
With digital radiography the practice of charging by the film or projection is even more inane because with digital radiography the incremental cost of an extra projection is even less than with film as there is no cost for the sheet of film (but was that ever really a significant expense anyway?) and with DR systems the cost of technician time is even further reduced. As such, there is no real justification for charging by the film with digital radiography.
A failure to abandon the practice of charging by the film will also prevent hospitals from utilizing software features (soon to be**) present in the modern practice management software (PIMS) and digital radiography systems. In the near future we predict that integration and automated billing between PIMS and digital radiography will become commonplace in the veterinary practice. In the future, implementation of automated billing will require charging by the study a prerequisite to automated billing implementation.
The reason for this is that digital radiography systems operate in terms of a study. In DICOM, images are grouped as studies. When images are processed by the digital machine a processing algorithm is applied to all of the images in a study . Obtaining images of a different body part requires the application of a different processing which generally require starting a new study.
This grouping of images as a study and workflow of opening and closing a study to apply appropriate image processing to the images also enables practice management software to order a study (which includes a number of projections) and then bill for studies when the images are complete.
As you can see, if a practice is to maximize the efficiency afforded to them automated billing integration between digital radiography and practice management software it is essential to abandon the practice by charging by the film or projection and start charging by the study.
How you define a study in your practice is up to you. Presently we do not have industry standards for the number of projections that are included in a given study.
* The Safety Dance
**Kumbaya is coming. If things keep moving along as they have been I expect my next post to be a landmark one.
