When the Consolidated Appropriations Act of 2016, or Omnibus Bill, was passed late last year, it included text that requires imaging providers to start using DR. Providers using film will start being hit with 20 percent reimbursement reductions in 2017, and those using CR have until 2018 before they are subjected to reductions of 7 percent each year through 2022. 

In the months since that bill was passed, Rob Fabrizio, Fujifilm’s director of strategic marketing and product development for digital x-ray and women’s health, has dedicated a lot of time to working with providers on making that transition to DR.

Fabrizio sat down and spoke with Health Imaging at the AHRA Annual Meeting and Exposition in Nashville, Tenn., to discuss both the new legislation and its impact on providers.

What do providers gain when they make the move to DR? What are some of the primary benefits?  

There are a lot of benefits, and the most obvious one is image processing time. In DR, when you put a detector behind the patient and acquire an image, that image comes up immediately. When using CR, you have to take the cassette out, take it to the cassette reader, and process it; that means time away from the patient, which can be a patient safety issue. Also, with CR, the patient  may experience more anxiety because the technologist  isn’t there with them at all times, and exams are taking longer.

So with DR, you’re providing better patient care coupled with more facetime with the healthcare consumer. In short, DR helps deliver better patient satisfaction, better image quality, and lower patient dose – and that’s all just from one area of focus. There are also many ways DR can impact productivity, which is also a way to lower costs.

What were your initial thoughts on the DR-related provisions included in the Omnibus Bill? Has your opinion changed since then?

After looking at our sales in the year prior to the bill, hospital purchases were already 95 percent DR, and as one of our customers put it, it’s really perfect timing for this bill anyway, and it is in the best interest of our patients, providing better more efficient care and lower dose. In the area where the bill is directly focused, there is a noticeably immediate impact in the outpatient market, urgent care and private practices. Sales in those markets, prior to the legislation, were 85 percent CR. Once the legislation passed this past December, CR sales stopped pretty much completely and the entire market is now shifting to all DR.

From what you have observed, are providers that still rely on film moving quickly enough to avoid the 2017 cut to reimbursements?

It’s going to be especially challenging for the film market, because those still using film are doing so because they simply do not have the budget. It’s going to be harder for them, and they’re going to be looking for the lowest possible cost, which might compromise the benefits they get from DR. But manufacturers—especially companies like Fujifilm, which have been around a long time—are working with both film and CR customers and helping them find low-cost ways to upgrade.

What are some of those low-cost options? What can providers do that have been slow to make the move from film or CR to DR?

During this transition, Fujifilm remains committed to partnering closely with providers, providing creative solutions to help maximize their investment, with unique technology efficiencies to better serve their patients.

There are ways our customers can upgrade affordably. For example, according to a 2015 IMV survey of US hospitals, around 50 percent of all sites across the country have CR, and other surveys show that the number is as high 86 percent—many sites can leverage their existing workstation and may not even have to buy new workstation hardware. With Fujifilm, some existing customers can upgrade by purchasing a detector and minimizing the accessories they buy; that is a very low-cost way to upgrade, and they are saving on the hardware, saving on training for their technologists and ramp up time to the new transition. There are a lot of benefits to staying with your existing vendor, especially in the case of Fujifilm.

There are other creative ways to simplify the transition. For example, Fujifilm offers a docking stand with Image Memory Mode in the detector. So you can upgrade the room with just a detector and the docking stand if you already have a workstation. And by using the memory feature you can share just the detector with any analog portable or room to capture DR images anytime. Fujifilm offers other creative purchasing options as well—operational budget purchases, extended payment terms, trade-in discounts for existing customers, and even trade-in discounts for customers of other manufacturers’ equipment.

When providers are ready to move to DR, what are some of the things they should take into consideration?

To avoid reimbursement reductions, providers who use analog or CR equipment should begin planning their transition to digital now. The following three steps can help during your transition:

1. Inventory your assets and identify your analog and CR equipment. Starting with areas directly impacted by the legislation. Outpatient and ER and then your oldest equipment. Can you move some CR to inpatient areas?
2. Assess the volume of X-ray procedures performed on equipment affected by the reimbursement reductions to calculate the financial impact to your institution. Consider how DR can help with other goals you may have such as increasing volume and/or decreasing patient dose.  Factor in other costs such as age of equipment and costs to continue to maintain it and what happens when it fails.
3. Develop and execute an asset plan that converts your analog and CR X-ray systems to digital. Will you be accelerating active purchase plans, buying in phases over the next 2 to 3 years or scaling up in very small steps?

After installing DR, how long should providers expect to see a return on investment?

The short-term cost associated with accelerating a health care facility’s inevitable transition to digital radiography can be aligned with its goal of providing optimal patient care with current technology.

The return on investment is going to be up to the provider’s workflow and its goals. Are you looking to increase your exam volume capabilities? Are you looking to improve efficiencies and decrease mistakes/retakes? Are you looking to lower your service costs? Speeding exams will also help impact patient satisfaction by decreasing wait times. New equipment can help exams be more comfortable for patient experiences. You have to look at the whole picture.

You just led a presentation on this very topic at AHRA. What kind of feedback are you hearing about the move to DR?

Most customers are aware of the legislation, they’re looking to speed up that transition to DR and they’re looking for help from vendors on how best to do it. Many need to scale up slowly, step-by-step and Fujifilm is offering ways to do that. There are others who are looking at their room equipment and saying, ‘It’s really time to upgrade my complete room, it’s 15 or even 25 years old.’ This is almost a blessing for them, there’s actually a focus on purchasing new x-ray equipment. Customers are definitely looking for help and guidance, and we are offering our consultations to come in and look at their entire system and show them how they can transition within their means.