United Medical Instruments - Diagnostic Ultrasound Blog!

Technological advancements in the field of imaging have made ultrasound ownership a cost-effective solution to providing quality patient care in a private practice. However, with new technology comes required training and expertise so as more unlicensed health care professionals perform ultrasound exams; the government is stepping in to protect the general public and requiring imaging professionals to be licensed. Here is a look at the advancements in the industry, governmental regulations, and trends for the future.

There was a time when each vendor had its own advanced technology and they stood apart from the competition, but the natural competitive nature has caused an evolution for the Big Three to develop advanced software features such as one-button image optimization, panoramic imaging, 3D/4D technology, Elastography, and contrast imaging. Elastography is the latest imaging technique which began with breast imaging in evaluating and detecting tissue stiffness to determine the likelihood of benign or malignant cancers. This application is expected to aid in similar diagnoses with the liver and kidney. Several OEMs have pioneered the development of this potentially life-saving technology and studies have been published with successful findings when using Elastography.

It seems that availability of portable ultrasound goes hand-in-hand with the governmental acts being proposed. On one hand, Point-of-Care ultrasound is a valuable tool to collect patient information and make a diagnosis in a timely fashion. On the other hand, it means some providers who are not formally trained in ultrasound are scanning patients and possibly putting them at risk or missing pathology which could be costly by requiring follow up imaging tests. A federal bill in court outlines the following:

Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2011 - Amends the Public Health Service Act to require personnel who perform or plan the technical component of either medical imaging examinations or radiation therapy procedures for medical purposes to possess, effective January 1, 2014:

• Certification in each medical imaging or radiation therapy modality

• State licensure or certification where such services and modalities are within the scope of practice

Currently, Oregon and New Mexico have state laws requiring licensure, other states are waiting to see if the Federal bill passes before moving forward with mandates. For specific sonographer requirements the Society of Diagnostic Medical Sonographers is a reliable resource.

The trend really is toward advancements in the portable market, these laptop sized systems are often comparable to their big cart-based brothers, but in an economic and convenient package for private practice physicians. At United Medical Instruments, Inc. a selection of quality refurbished equipment with the latest advancements is available as well as compact SonoSite ultrasound systems. Contact us today so that we can help you determine which system is right for your office!

The times..... they are a changing. And rapidly. Are you ready? The clock is ticking for private practice physicians to implement electronic records or face penalties. How much time is left? What kinds of fines will be assessed? Should you select EHR or EMR software? Here's the info in a nutshell.

First, there is a difference between Electronic Health Records and Electronic Medical Records. According to National Alliance for Health Information Technology, they are described as follows:

EMR: The electronic record of health-related information on an individual that is created, gathered, managed, and consulted by licensed clinicians and staff from a single organization who are involved in the individual's health and care.

EHR: The aggregate electronic record of health-related information on an individual that is created and gathered cumulatively across more than one health care organization and is managed and consulted by licensed clinicians and staff involved in the individual's health and care.

Basically, if you are a specialist, the best option would be an EMR. The software for this technology is more streamlined for your type of work flow and is not as general as the overall health record information found in the EHR. An EHR is a comprehensive solution for that provides an overall snapshot of a patient's health, history, and will be used for future pay per performance incentives.

Part of the stimulus package requires that physicians implement a software that has been government certified in order to qualify for the bonuses. For a list of vendors and more detailed information regarding the certification requirements visit these websites:

http://onc-chpl.force.com/ehrcert

http://www.emrandehr.com/emr-and-ehr-vendor-list/

The deadline for EHR/EMR implementation is 2014 and the penalties that kick in afterward are in the form of levied Medicare/Medicaid reimbursement reduced by 1%-5%.  Besides not having reduced reimbursement, there are additional benefits to implementing electronic medical records which include:

• Increasing value of your practice if you choose to sell it - younger physicians are tech savvy and will demand electronic patient records

• Staying in good form with the government - at some point they will want patient records electronically and will expect to receive reports in a certain format in order to reimburse at full value

• Providing access of patient records to caregivers - 30% of the US population provides care by taking their loved one to doctor appointments, ensuring medication is taken properly, caregivers need online access to provide quality care

Surveys indicate that 40%-50% of physicians have already adopted electronic medical records in their practice, but time does fly, so if you need help starting the process and feel overwhelmed, check out this PDF from the American College of Physicians.  

There are 32 more days left in 2011 to take advantage of the Small Business Job Act of 2010. This is called Section179 Tax Deduction, and applies to both new and used equipment, purchase by small business. According to Section179.org it's explained as follows:

Essentially, Section 179 of the IRS tax code allows businesses to deduct the full purchase price of qualifying equipment and/or software purchased or financed during the tax year. That means that if you buy (or lease) a piece of qualifying equipment, you can deduct the FULL PURCHASE PRICE from your gross income. It's an incentive created by the U.S. Government to encourage businesses to buy equipment and invest in themselves.

If you are a private practice physician looking to add ultrasound to your practice, now is the time to take advantage of this tax break before the clock runs out. Examples of in-office ultrasound exams include AAA screenings, CIMT exams, Women's health, pain management, and endocrinology. Concierge medicine has grown to 5,000 practitioners and according to the American Academy of Private Physicians, embraces the philosophy of "improving the quality of patient care and care coordination, strengthening the bond between patients and their physicians, and empowering patients as healthcare consumers." Ultrasound is an excellent tool to improve patient services.

Leasing is an option whether purchasing just ultrasound equipment or one with an ultrasound service contract. Most systems come with a warranty, but having the extra insurance once the warranty expires can not only save you money, but it can help prevent a down system so that patient care isn't compromised. Leasing is flexible and depending on which program you go with, you can receive the following benefits:

• No money down

• Defer payments

• Generate revenue before your first payment is due

• Roll equipment upgrades into lease payment

Contact United Medical Instruments, Inc. today to learn about equipment, service, and lease options while you still have time to use the Section179 tax break!

According to a recent survey of 661 physicians who responded, the majority of you are happy, with a scale rating of 7.35/10, would choose your career path again, are working more than 40 hours a week and are becoming more tech savvy. While concerns swirl around reimbursement and reform, the majority will continue to do business as usual instead of closing up shop and working for a hospital or conversely, becoming a concierge physician.

At United Medical Instruments, Inc. we have pledged ourselves to becoming the premier resource for private practice physicians. What does this mean? To us, it means understanding your challenges from an administrative perspective, a clinical view, and a marketing standpoint. We ask ourselves how we can make your life a little easier. In the next year we will be announcing some new programs for our existing customers and for any physician looking for a source of reliable information and education to help grow their ultrasound practice.

Currently, however, we offer a consultative approach to physicians interested in ultrasound equipment for their office. Although SonoSite portable ultrasound systems are easy to use with a quick learning curve for clinicians, we work with you to identify your specific needs and meet your budget. A refurbished ultrasound system from GE Healthcare or a cart based unit from Zonare may be a better option for you depending on your clinical applications.

Once a system is purchased, or even if you have an existing ultrasound system, United Medical Instruments, Inc. offers onsite training for your staff, online ultrasound demos, and service contracts to keep your ultrasound investment in good working condition.

While you are busy running your practice, managing your patient load, and keeping up with the latest health care trends, rely on UMI for your ultrasound needs. So pull out your laptop, tablet or Smartphone and shop our online store to keep your practice stocked with necessities such as ultrasound gel, transducer cleaner, and media storage, visit www.umistore.com

As the term point-of-care ultrasound becomes part of popular vernacular to those of us in the medical community, it's important to consider what the phrase really means and how it is shaping the way physicians practice medicine. Portable or compact ultrasound systems are becoming smaller and the technological improvements are awe-inspiring, the industry has grown tremendously since the day of the clunky Siemens Elegra™ or refrigerator-sized Acuson 128/XP™, both of which can be found as refurbished ultrasound equipment, but just because the new systems are smaller and simpler to use, can any health care provider really be trained on ultrasound technology, how to scan, and most importantly how to decipher anatomy and pathology in just a few weeks?

Ultrasonographers attend several years of school to learn ultrasound physics and anatomy, interpret ultrasound artifact from anomalies and study the technologies offered on various ultrasound systems. After their initial schooling the advanced sonographers sit for boards and specialize in areas of cardiology, vascular, breast, etc. As point-of-care ultrasound increases there are unanswered questions: Who is responsible for this training? Who is monitoring their core competencies? Who is liable for a misdiagnosis?

According to the AIUM guidelines for physicians who use and interpret ultrasound, clinicians must have experience with at least 300 ultrasound cases within three years to become proficient in discerning anatomy, be versed in ultrasound technology, and gain experience in what is normal versus pathology. In addition, they must demonstrate one of the following:

• Completion of a residency program with three months of ultrasound training

• Certification in breast ultrasound by the American Society of Breast Surgeons

• Successful completion of the Endocrine Certification in Neck Ultrasound (ECNU)

• Completion of training in "Focused Assessment with Sonography for Trauma (FAST)" as recommended by the American College of Emergency Physicians (ACEP

• Successful completion of one criteria in "Training Guidelines for the Performance of the Musculoskeletal Ultrasound Examination"

• Successful completion of one criteria in "Training Guidelines for the Performance of Ultrasound Examinations in the Practice of Urology

There is a complete list of AIUM guidelines for ultrasound that were approved November 5, 2011.  For health care providers who are currently proficient with ultrasound you can contact United Medical Instruments, Inc. for refresher courses on your existing ultrasound system, to train a new staff member who is a licensed sonographer, or to purchase ultrasound equipment.

The American Society of Echocardiography (ASE) has worked diligently since 2008 to raise awareness about the safety of contrast agents used in ultrasound. They have established thorough training programs, supplemented with videos, guidelines and coding information. Earlier this year the FDA held a multi-committee hearing to gather public opinion from groups including Cardiovascular and Renal Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee (DSaRM). The purpose was to review the safety requirements of contrast agents and hear feedback from other healthcare professionals in regard to its use.

Since its inception contrast agents have been used for clinical echocardiography studies to use a bubble effect to measure blood flow and look for defects in the heart where Doppler alone is not sensitive enough to highlight abnormalities. Knowing that ultrasound is a safe modality and produces less ionizing radiation than other imaging devices such as CT or nuclear imaging, "Dr. Barry Goldberg, radiologist for The American College of Radiology (ACR) and the American Institute of Ultrasound in Medicine (AIUM), expressed the desire of these groups to expand the approved uses of ultrasound contrast agents to include multiple other indications, such as vascular imaging, liver perfusion, and breast imaging..."

Concurring with what Dr. Goldberg expressed was Dr. Paul Grayburn of The International Contrast Ultrasound Society (ICUS), who also asked the FDA "to reconsider its current labeling and lift the black box warning." The decision was made in October to lift the warning label, confirming its value in patient safety and benefits to ultrasound scans, which will hopefully now open the door to more clinicians utilizing contrast agents.

Intersocietal Commission for Accreditation of Echocardiography Laboratories (ICAEL) has also released new guidelines in reference to contrast agents and ultrasound which state:

Equipment standards have also been enhanced, in Part IV, the section on equipment (1.1 on page 33), states:

"Ultrasound instruments utilized for stress echocardiographic studies must include, at a minimum,hardware and software to perform: 

A) Two-dimensional (2-D) imaging. The system should include harmonic capabilities and instrument settings to enable optimization of ultrasound contrast agents."

Regardless if you are conducting echo, stress echo, or general imaging ultrasound exams, United Medical Instruments, Inc. inventories a diverse selection of ultrasound systems to meet your needs, please contact us to learn which system will be best for your practice.

There was a time when the sales process was glamorous and meaningful. A physician would develop a relationship with a salesperson, be treated to celebratory dinners, become a reference site for purchasing the newest release of imaging software. Now there are laws that prohibit salespeople from almost buying a customer a cup of coffee, most of the ultrasound systems are comparable to one another and buyers are becoming savvier with their equipment purchases. In addition, budgets for everyone are tight, so trade show attendance is noticeably down.

So how do physicians purchase equipment today? Do they defer to the folks in purchasing who send out RFPs and buy based on price? Are relationships still a driving force? If for example, you bought an Acuson Sequoia system based on its performance AND your relationship with the salesperson, would you trade it for a GE Vivid 7 because your contact changed companies and went to GE? Is buying off the internet still an option? Experience has shown that purchasing from sites like eBay leave the customer in a lurch post-sale, no ultrasound system training provided, no warranty, not getting certain features enabled that you thought were on the system.

At United Medical Instruments, Inc. we have aligned with certain vendors whose equipment we feel is superior for certain clinical applications, but mostly, we work as a partner with the customer to really assess what your present needs are as well as future needs to ensure we match you with an ultrasound system that will allow you to grow your practice. Contact us to learn more.

Part III

Welcome to our final blog in our 3-part series on treatment for varicose veins. Finally, we will look at the type of equipment used when performing the more invasive procedures and some of the new trends that are being discussed in this field of treatment.

Part II

Last week we reviewed varicose veins – what they are, how people get them and conservative treatments to try. This week, we'll look at the various options available to patients. At United Medical Instruments, Inc. we are fortunate to have a phlebology expert, Jeanette Ashby, on staff who goes on-site to provide customers with training after purchasing ultrasound equipment to use in conjunction with vein treatments such as Endovenous Laser Therapy (Ablation), Radiofrequency Occlusion, or Endovenous Chemical Ablation. Jeanette describes these procedures as follows:

Endovenous Radiofrequency Ablation is a treatment alternative to surgical stripping of the greater saphenous vein. A small catheter is inserted, usually through a needle stick in the skin, into the damaged vein and guided under ultrasound to the treatment site. The catheter delivers radio frequency energy to the vein wall, causing it to heat. As the vein warms, it collapses and seals shut. The procedure is generally done in an outpatient or in-office setting. It may be done under local anesthesia. Following the procedure, the catheter is removed and a bandage or compression stocking is placed on the treated leg.   Endovenous Radiofrequency Ablation is FDA approved for the treatment of the greater saphenous vein.  To watch a video on the the VNUS Closure Procedure Using ClosureFAST Catheter, click here.

Endovenous Laser Treatment is a treatment alternative to surgical stripping of the greater saphenous vein. A small laser fiber is inserted, usually through a needle stick in the skin, into the damaged vein and guided to the treatment location under ultrasound. Pulses of laser light are delivered inside the vein, which causes the vein to collapse and seal shut. Following the procedure a bandage or compression hose is placed on the treated leg and the patient is encouraged to walk as well as to return to normal activities. Endovenous Laser Treatment is FDA-approved for the treatment of the greater saphenous vein.

 Endovenous Chemical Ablation is a common treatment method used to treat both varicose veins as well as abnormal veins well beneath the skin surface. Under ultrasound guidance a small gauge needle is inserted into the vein where a small amount of sclerosant is injected. The solution causes the treated vein to close. The vein is typically reabsorbed by the body in time.

To learn more about implementing one of these ultrasound-guided vein procedures in your office, contact us.