In January 2015, the National Board of Chiropractic Examiners published its Practice Analysis of Chiropractic 2015.
This is a comprehensive 158- page report that provides an in- depth view of chiropractic trends from 1991 to 2014, based on surveys completed by 1,379 chiropractors from across the U.S.
After studying the DCs’ responses and analyzing the data, it was discovered that, while roughly half of the chiropractic practitioners stated that they take radiographs in their office, less than one-seventh of them (14 percent) do it with the use of digital imaging equipment.1 But this is a trend that is likely to change due to some recent regulatory pressures to switch from analog X-rays to digital imaging.
MACRA, the HITECH Act, and consolidated appropriations
The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law on April 14, 2015, in an effort to “make it easier for physicians to earn rewards for providing high-quality, high-value healthcare, and it supports and rewards physicians for participating in new payment and delivery models to improve the efficiency of care.”2
It is the last part—the efficiency of care—where the call for newer, more technologically advanced systems comes into play, thereby affecting a healthcare professional’s level of Medicare reimbursement if this particular factor is not met.
Another regulatory pressure impacting chiropractors’ bottom lines is the Health Information Technology for Economic and Clinical Health (HITECH) Act. As a result of this law, healthcare providers were offered financial incentives for implementing electronic health record (EHR) systems prior to 2015, and financial penalties if no EHR was implemented thereafter.3
And while MACRA and the HITECH Act don’t mention digital imaging specifically, they are both certainly pointing chiropractors in that direction, by providing financial incentives for updating your in-office systems, and ensuring that you’re obtaining and maintaining compliance for governmental payment purposes.
Plus, there is one act that does talk directly about imaging, which will likely cause many chiropractic professionals to switch from analog X-rays to digital systems, and that is the Consolidated Appropriations Act of 2016, enacted on December 18, 2015.
According to the American College of Radiology, this act reduces reimbursement for plain film X-rays by “20 percent in 2017 and all subsequent years,” and also reducing computed radiography reimbursement by 7 percent from 2018 to 2022 and 10 percent thereafter.4 Therefore, the only way to receive full reimbursement is to switch to digital imaging.
So, whether you’re considering making this shift in your practice to receive an incentive or avoid a penalty, one thing is clear: There are a number of factors to consider when making this type of equipment-related change. Among them are office efficiency, imaging costs, and care compliance.
The case for efficiency
With legal incentives such as MACRA pushing for efficiency of care, this is a factor that may be at the forefront of your mind when considering whether to take your office digital. And it’s one that Bob Salzman, president of 20/20 Imaging, says makes a whole lot of sense.
Salzman has spoken with many chiropractors who have gone to great lengths to update and streamline their office procedures by purchasing EHR systems, yet they still have to file X-ray films because they are using analog equipment. “This is not efficient,” he says, highlighting the fact that not only do films cost more than ever due to reduced demand, but they also take up valuable office space and can be misfiled—all factors that can reduce a practice’s level of efficiency.
Nate Dominguez, sales manager for 20/20 Imaging, also explains that increased office efficiency means being more effective with your use of time, a benefit that digital imaging provides. Basically, instead of spending all of your time taking (and sometimes retaking) films, then developing and reading them, Dominguez says that you can make better use of your time “getting patients in your door.”
This can be accomplished by focusing on increasing your marketing efforts or generating more referrals because you’re able to better educate your patients, causing them to be more inclined to recommend your services to their family and friends.
One point that Salzman and Dominguez also stress is that some chiropractors think of digital as providing better quality X-rays, thus increasing efficiency in that way.
However, they warn that your images are only as good as your ability to take them. Or, as Dominguez puts it, “If you shoot cruddy films, you’ll have cruddy digital.” Therefore, making sure you take good images is essential if you’re looking for higher quality output.
Salzman goes on to explain that while film used to be the best media, nowadays digital is just as good. Plus, given film’s variables of “daily QC, oxidation, and human error, digital is more forgiving.” This is just one more reason why digital is a more efficient choice over analog. Regardless, there is also the factor of cost.
The case for cost
Matthew Chrisovergis, partner at RadmediX, says that the biggest objection he sees from chiropractors when it comes to converting from an analog X-ray system to digital is the upfront cost. Chrisovergis responds to this concern by pointing out that, “With analog film, one must continue to pay for consumables (film, chemistry, processor maintenance, etc.). This cost is forever.” The situation is drastically different when you use digital imaging equipment, an option that has “no ongoing costs or moving parts.”
Plus, Chrisovergis points out that the Section 179 tax deduction for 2016 provides financial relief as well. The IRS website explains that under this section, “you can elect to recover all or part of the cost of certain qualifying property, up to a limit, by deducting it in the year you place the property in service.”5 Put simply, Chrisovergis says that you’re able to fully deduct the entire purchase price.
Another financial benefit is the return on investment (ROI) this equipment provides. To help you determine the ROI for your particular practice, Chrisovergis suggests that you calculate several tangible costs for current exams per month; namely, “charges for exam, reimbursement, monthly processor maintenance fees, and costs of film and chemistry.”
Don’t forget about the intangible costs too, he says, “such as increased volume, the performing technologist’s or doctor’s time, elimi- nation of the film storage area, and reduced retakes.”
All of these added together mean that digital costs less over time. So, while the upfront costs of switching from analog to digital may be higher than you’d like, the payoff is there in the long term.
The case for compliance
Have you ever had a patient fail to complete his or her recommended care plan? Of course you have. No health- care professional has a 100-percent success rate when it comes to getting patients to do what they’re supposed to do in the name of higher health.
But switching to a digital imaging system may help you raise your current care compliance rate, according to Steven Kraus, DC, founder and president of Biokinemetrics, Inc. “As the vast majority of people are visual- based learners, being able to show them what they need to understand in order to comply is critical,” he says.
To help you better understand this concept, Kraus says, “Let’s look at two scenarios where a woman comes home after seeing her chiropractor for headaches. In the first, she tells her husband that she needs to take $700 dollars out of the family budget to get some adjustments and then has to explain why. Maybe she does a good job, and maybe she doesn’t.
But in scenario two, she pulls up her digital X-rays with annotations showing why she has the headaches, and when he compares the red line that shows her current neck curve and the green lineshowing where the curve should be, it’s clear. As you can imagine, the latter is way more likely to garner compliance as it immediately validates the need for care.”
Ultimately, communication is the vital component in establishing trust in the doctor-patient relationship. “And utilizing digital X-ray technology takes that communication to a level the doctor simply can’t achieve without it. And with trust comes compliance—a critical factor in practice success,” Kraus says.
The case for switching
If you’re convinced that it’s time to move away from your analog system and switch to a digital one, the next step is to select a digital imaging company that is right for your needs. To help you do that, Eddie Massetti, national manager for channel sales at Fujifilm Medical Systems USA, says that there are four key areas that should be driving your decision.
“The first one is reliability,” Massetti says. Choose a digital imaging company that has a good reputation and can support your profession and practice long-term. Massetti explains that this is important as he’s seen some companies come and go within a couple of years’ time. Those who purchased their equipment from them are left with no one to go to with questions or system- based needs.
Additionally, a sustainable digital imaging company can provide the necessary updates and upgrades you want or need to better run your practice over time.
The second consideration when choosing a digital imaging equipment provider, according to Massetti, is patient safety and comfort. Ideally, you want a system that “uses less radiation to penetrate through,” he says. And while digital imaging generally uses less radiation than film, “not all companies are created equal.” That’s why Massetti recommends, prior to making a purchase, asking the company how their dose levels compare to others.
While some companies may choose to answer that question verbally, others do a demo to show doctors how to adjust their technique to improve their imaging, thereby getting higher quality images with lower doses. The result is greater patient safety.
Massetti says the third factor you want to consider when choosing digital imaging equipment is image quality.
Specifically, look at which system is going to give you “good detail, and good balance between soft tissue and bone.” Rob Fabrizio, director of marketing for digital X-ray and women’s health at Fujifilm Medical Systems USA, expands on this by noting that some companies get better images by increasing dose radiation. However, this is not the best-case scenario for the patient.
To improve image quality without sacrificing patient safety, Fabrizio suggests you ask prospective companies, “What is your typical dose and what does the image look like with that dose?” This enables you to make a more informed decision—one that is as good for you as it is for your patients.
Finally, the fourth factor to think about before making a digital imaging purchase is the company’s use of technology. Ideally, you’ll select a company that is constantly improving in this area. Recent advancements can potentially raise your quality of care.
Given the increasing number of regulations being put into place, the number of DCs who choose digital over analog will likely rise. Knowing the key factors involved can help you decide whether it’s the right time for you to make the switch and how to find a company that will suit you best when making the transition.
Christina DeBusk is a freelance writer who specializes in health and wellness and business marketing. She currently writes for ChiroNexus as well as other health-related publications. She can be contacted through christinamdebusk.com.
1 National Board of Chiropractic Examiners. “Practice Analysis of Chiropractic 2015: Chapter 7.” http://www.nbce.org/wp-content/uploads/chapter_07.pdf. Accessed June 23, 2016.
2 American Medical Association. “Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), H.R. 2, Pub. Law 114-10.” https://download.ama-assn.org/resources/doc/ washington/2015-05-07-hr-2-detailed-summary- branded.pdf. Published May 7, 2015. Accessed June 23, 2016.
3 Rouse M. “HITECH Act (Health Information Technology for Economic and Clinical Health Act).” SerchHealthIT. http://searchhealthit.tech target.com/definition/HITECH-Act. Published December 2014. Accessed June 2016.
4 American College of Radiology. “Frequently Asked Questions on the PC MPPR and Digital Radiography policy within H.R. 2029, the Consolidated Appropriations Act of 2016.” http://www.acr.org/~/media/ACR/Documents/P DF/Advocacy/Legislative%20Issues/MPPR/Freq uently%20Asked%20Question%20on%20PC%2 0MPPR%20and%20Digital%20Radiography%20 Policy%20II.pdf. Accessed June 2016.
5 Internal Revenue Service. “Electing the Section 179 Deduction.” https://www.irs.gov/ publications/p946/ch02.html#en_US_2013_publ ink1000107404. Accessed June 2016.