Managing Change in Imaging

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By Enrico M. Perez, CRA, FAHRA

It is interesting to sit down and think about how our imaging industry has become one of the most frequently used ways to diagnose disease, identify the extent of trauma, plan surgical and therapeutic treatment, and discover post-surgical and treatment plans’ successes or setbacks. The computer changed all of our lives and our industry from being very hands on to having the computer hold the information we all had in our heads and “little black books” for every technique, protocol, and combination used to get the perfect image.

The basic physics behind what is required to get these images has not changed, but it really is amazing how the computer has not only replaced our “little black books” but also to a degree our memory because the computer’s memory can hold all of this information and have it ready for us immediately when we need it. Systems have replaced scheduling books, billing slips, data entry, logs, and the old QC processes, as well as chemicals and dark rooms.

Having seen much of this happen over the past 40 years has definitely been an adventure. One thing that has always been true is that everything will change. As imaging administrators, we are required to guide our facilities through these changes and continuously rethink how to make these changes fit into our workflow while maintaining high quality and safety for our patients and staff, and being inspection ready. Some days I stop and ask myself “why did I go into this business?” Then I get up, walk around, and see the patients, and I remember why: to be part of patient care and to ensure this business continues to develop and grow without losing the human touch.

Major changes in billing for our services with CPT codes, ICD codes, and medical necessity have become annual changes and developments. We need to monitor these changes and modify our process and billing accordingly to ensure we are compliant with local, state, and federal regulations and guidelines, as well as the payers’, since our business is dependent upon the revenue we generate.

Accomplishing all of this takes with a dedicated imaging staff. Our radiologists and techs guide our clinical practice, provide quality reports based off the images, and ensure our patients are taken care of with respect and dignity. Our referring physicians send us our business because they trust our technology, quality, availability, and the professionalism of our reports and communications.

Managing all these components of an imaging facility requires a leader who has a thorough knowledge of the technology in use, the people skills to deal with the workforce under their leadership, and the business savvy to ensure the service remains flexible to meet the needs of their facility, the referring physicians, and everyone else we rely on to make the business work. Communication with everyone who touches the patient is instrumental to our success, and the individual who everyone relies to get this job done in many locations is the imaging administrator.

So how do you find this individual who understands the various components of imaging and has the skills to work not just with the radiology staff, but the referring physician, the patients, human resources, finance and accounts payable, marketing, and administration? This is the criteria needed by someone seeking the CRA credential, so that would be something I would look for as soon as I have a resume! I am sure many who will read this are CRAs, but this is something we need to continue to push for as we hire managers, mentor our successors, and never stop “AIMING HIGHER.”

If you are attending the 2015 Annual Meeting, please visit the CRA booth (#623) in the exhibit hall to get answers to any questions you have about the CRA. Please also join us for the Annual Meeting CRA Reception on Monday, July 20, 2015 from 6:15-7:15 PM in Zeno 4701 at the Venetian-Palazzo and Sands Exposition Center. Click here to RSVP to the reception.

Enrico M. Perez, CRA, FAHRA is the director of radiology at Winthrop University Hospital in Mineola, NY. He is also the 2014 Chair of the RACC.  He can be reached at

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