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Biomedical subjects

R G Evens

Publications and source records attributed to R G Evens.

At least 19 recordsLinked to original sources
PubMed1995

Radiology.

Radiologists' interpretation of mammograms can differ, sometimes substantially. Advances in interventional radiology emphasize the use of stents in the treatment of vascular lesions. It is now possible to digitize any radiographic image and allow it to be stored electronically.

Humans↗
PubMed1995

Soft-copy computed radiography in neonatal and pediatric intensive care units: cost-savings analysis.

PURPOSE: To determine whether soft-copy interpretation of computed radiography (CR) in neonatal and pediatric intensive care units (ICUs) can result in a cost savings compared with screen-film radiography for the radiology department. MATERIALS AND METHODS: The actual cost of CR equipment, maintenance contracts, and the estimated cost for data storage were compared with the potential savings that could result from eliminating film, decreasing the number of librarians and lost radiographs, and improving technologists' efficiency. RESULTS: After the 1st year, net cash flow from use of soft-copy CR interpretation is projected to result in a slight savings for the radiology department but not enough to offset the capital equipment purchase price. CONCLUSION: Soft-copy CR ICU imaging will not result in a cost savings. To have a balanced net cash flow would require either more than doubling potential savings or decreasing capital equipment cost by greater than one-half. The justification for soft-copy CR needs to be judged by its effect on increasing physician efficiency and timely decisions on patient care.

Capital Financing↗
PubMed1994

Radiology.

Potential cost-effective advantages of interventional radiology may lie in the performance of more common (and high-volume) procedures. The Food and Drug Administration has recommended that a mammography facility meet defined quality standards before payment by the Health Care Financing Administration.

Radiology↗
PubMed1994

The challenge of managed care and managed competition.

Payment for health care in the United States changed rapidly during the 1980s, with the changes often identified by three-letter acronyms such as HMO, PPO, DRG, and RVS (health maintenance organization, preferred provider organization, diagnosis-related group, and relative value system). Changes are likely to be even more rapid and fundamental in the next few years. "Managed care" and "managed competition" are the principal terms being used to describe these pending changes. In this paper, we briefly present the problems that have led to changes, the changes that have occurred, the changes likely in the future, the implications of these changes for radiologists, and how radiologists can respond most effectively. We concentrate on the implications of changes for radiologists and on how radiologists can respond effectively.

Competitive Medical Plans↗
PubMed1993

Radiology.

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Angiography↗
PubMed1993

Radiology performed by nonradiologists in the United States: who does what?

OBJECTIVE: When nonradiologists perform radiologic procedures, rather than referring their patients to radiologists, utilization--and therefore costs--are high, and quality appears often to be poor. In light of these public policy concerns, the American College of Radiology developed a detailed descriptive analysis of radiology performed by nonradiologists. MATERIALS AND METHODS: Medicare data from 1989, which make up a uniform record of one third of the nation's health care, were the source of the information. These data are reasonably, although not exactly, representative of patients of all ages. We measured radiologic work, and nonradiologists' share of it, in professional component relative value units, using the Medicare radiology relative value scale. RESULTS: Nonradiologists performed 25% of all radiologic work in the United States; their share was 46% in offices and freestanding centers, 27% for hospital inpatients, and 8% for outpatients. Counting procedures (rather than work measured in relative value units), nonradiologists' share was 64% in offices and freestanding centers and 8% for inpatients. Nonradiologists performed two thirds of all work in sonography, half of interventional radiology/angiography, 15-17% of general radiology and nuclear medicine, and a few percent of CT/MR and radiation oncology. Cardiologists performed 10% of all radiologic work in the United States; internists 5%; and orthopedists, ophthalmologists, and family and general practitioners, 2% each. Almost half of radiologic work performed by nonradiologists consisted of coronary angiography and cardiac sonography, done principally by cardiologists. Radiologists do less than 5% of this work. Office and freestanding center general radiology, performed mostly by orthopedists and primary care physicians, accounted for one fourth of the radiologic work done by nonradiologists. CONCLUSION: The general radiology performed by nonradiologists is of a magnitude that easily could be transferred to radiologists, particularly because many unnecessary imaging studies would most likely be eliminated as a result. Such a transfer would reduce costs and probably improve quality but might sometimes decrease patient convenience. However, because many radiologists do not perform coronary angiography and cardiac sonography, a transfer of these responsibilities to radiologists would be problematic and likely to require extensive additional training of radiologists.

Diagnostic Imaging↗
PubMed1992

Radiology.

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Humans↗
PubMed1992

How accurate was GMENAC?--A retrospective review of supply projections for diagnostic radiologists.

In 1982, the Graduate Medical Education National Advisory Committee (GMENAC), a prominent national panel, predicted there would be 25,650 full-time equivalent (FTE) diagnostic radiologists, a 34% oversupply, by 1990. The radiologists involved in GMENAC, however, using models developed by the American College of Radiology, projected 19,800 FTE diagnostic radiologists in 1990, which was similar to the GMENAC estimate of need. The disagreement arose principally from different assumptions about residents entering the specialty. Recent data show there actually were approximately 21,900 FTE diagnostic radiologists in 1990. The radiologists' projection was 10% below this figure; the GMENAC projection was 17% above it. GMENAC erred principally in assuming diagnostic radiology residencies would not replace general radiology residencies, but rather be an addition to them. The radiologists erred principally in their assumption about the effects of the financial problems of hospitals on the number of residency positions. Accurate long-term projection of physician supply in individual specialties may well not be feasible.

Forecasting↗