Time to Change?

The business model for hospital medical imaging operations may be undergoing a metamorphosis

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Photo courtesy istockimage.com/Steve Green

Every year there are new advances in medicine and medical technology. Yet new ways of delivering a professional service or making industry-wide changes do not happen as frequently.

Historically, when hospital administrators looked at changing their radiology providers, the options were limited. Do you continue the course with your current group and hope that discussions can change the results? Or do you speak to other local groups about taking over the contract and hope that they can staff their contracted facilities appropriately? 

For administrators who chose to stay the course, you probably had many years of frustration with a group that is set in its ways, didn’t recruit the appropriate number of radiologists to cover the facility, or dealt with a group that refused to add to their skills in areas where the hospital wants to grow. If you chose another local group, you knew that the new group would not be exclusive to you and won’t have the same motivation to grow the practice, since that could mean reducing volume and profits.

Both scenarios lack a true partnership and no consensus on strategic direction. Most of these groups are not large enough to provide every sub-specialty within radiology. And if they use a teleradiology company, they are probably only receiving preliminary reads on emergent studies after hours.

Rebuilding the Model

Imaging Advantage (IA), based in Santa Monica, Calif., is attempting to change the business model for hospital medical imaging operations. Dynamic clinical resource management and deployment is the strategy, not just adopting a hospital radiology contract.

IA, a full-service, radiology management company, has a contractual relationship with Massachusetts General Hospital radiology, through the Massachusetts General Physicians Organization, for 3-D processing.

With more than 50 hospital contracts in 15 states, IA provides on-site and off-site radiology services and can increase patient throughput while improving quality and efficiency, reducing operational costs, and increasing market share and revenue.

IA establishes an exclusive local radiology group in each community that consists of full-time, board-certified radiologists who will not compete with the hospital for business and whose skill sets match the needs of the hospital and referring physician base. This local group includes radiologists from the previous group or “known entities” to hospital administrations or referring physicians. It is not merely a rotation of warm bodies. IA supports the work on-site with 24-hour “final read” teleradiology services. IA’s board-certified radiologists, who are all based in the United States, take care of reading exams, and many physicians are equity holders with a vested stake in each client’s success.

Primary goals are to improve the overall radiology product and patient experience in local communities by introducing “best- in-class” services. By incorporating local groups and radiologists into their program, IA provides management tools and technology to maximize efficiency and results. Therefore, facilities increase radiology volume and department revenue by implementing a marketing and awareness campaign.

Partnering with the local administration and radiology directors enables IA to implement technology and management tools in hospitals and facilities to improve operational efficiency. They also attempt to advance the relationship between healthcare facilities and radiologists to increase revenue and hospital profitability, and deliver better patient care.

Serving a Need

Services provided by IA focus on the following areas.

• Strategic direction, imaging, and revenue growth strategies. IA’s managers work with hospital administrators to align goals with those of the facility to foster collaboration and long-term success for both groups.

• Implement a documented quality program. IA employs the ACR RADPEER™ quality program and provides monthly quality assurance reporting of quality findings.

• Improve workflow efficiencies. By maximizing radiology productivity, the results are faster turnaround times and improved overall approval ratings for the department. 

• Modality utilization appropriateness. Experienced IA operations managers work to ensure that orders and patient work-ups are appropriate.

• Improve communications. IA radiologists are trained to communicate effectively with all radiology department staff, referring physicians, and patients.

• Solidify on-site staffing. IA physician recruiters have a database of virtually every radiologist in the country and constantly update data to fill positions quickly. In most cases, IA starts a new radiology contract with most of the permanent radiologists in place. 

• Install technology solutions. IA’s PACS administrators and certified technology professionals implement physician portals and dashboards, as well as mobile and Web-based applications to track physician scheduling and real-time productivity. These steps allow referring physicians to view images and reports remotely.

• 3-D processing. Through Imaging Advantage's contract with Massachusetts General Hospital Radiology, clients have immediate access to 3-D renderings, which results in less invasive procedures.

• 24-hour teleradiology support. IA provides each hospital with final read teleradiology capabilities 24-hours a day, which gives clients the availability of sub-specialists, daytime overflow, after-hours, and weekend coverage.

Implementing a New Contract

A facility should notice dynamic clinical resource management and deployment within the first 100 days of IA assuming a new contract. The first objective is to make the facility the leading hospital in the area. Referring physicians and the community are informed of the new radiology initiatives. They also conduct grand symposiums with Massachusetts General Hospital, with invitations to the referring community, on innovations in imaging and patient care.

The second objective is to demonstrate real change. By partnering with local administration, IA outlines growth opportunities, including new channels for referrals, marketing new points of differentiation, and implementing targeted marketing campaigns. Web tools are developed by IA, including patient tracking and a 24-hour referring physician/customer care liaison phone number. IA deploys a 3-D vascular program, with 3-D services that include cardiac CTA, virtual colonoscopy, and 3-D surgery support. Also important is the time they spend communicating with the radiology and hospital staff to demonstrate how these changes can lead to overall departmental growth.

The third objective is to make the hospital a showcase for national healthcare. This task is accomplished by creating a “patient first” experience, standardizing protocols, providing a 24-hour, 7-day final read teleradiology program, streamlining the signoff process for reports, and facilitating treatment planning and discharge. The plan is to reduce the turnaround time and accelerate throughput, which optimizes the flow of information and reduces inpatient length of stay.

And the fourth objective is to manage costs, increase revenue, and target opportunities. IA business consultants scrutinize expenses to identify waste and redundancies. They work with radiology directors to optimize the utilization of each staff member and keep clinicians focused on achievable goals. Business consultants also analyze new healthcare policies and advise hospital administration on changes.

Improving Technology

IA uses Imaging Advantage 5.0 as its teleradiology platform. It allows IA to load balance, improve overall quality and clinical care, and interconnect all client facilities and radiologists. By using intelligent study assignment, workflow automatically directs studies to the appropriate radiologist using defined criteria, which includes location, facility, workload, specialty, study aging, and study priority. Mobile applications for iPhone and iPad put secure patient data in the hands of referring physicians, which provide access to patient reports, 2-D and 3-D patient images, radiologist notes, and patient history.

A Web-based thin client is easy to deploy and does not require on-site IT personnel. IA has a cloud-based PACS model that provides a secure platform that uses the Internet for end-user and facility-level access. And their work list is RIS driven. With this technology, IA can propose different staffing options for administrators. 

In addition, IA offers franchising opportunities for private groups. In this scenario, a local group becomes a member of IA and has the opportunity to increase income by reading additional studies from other IA contracted facilities. This additional work can be handled during the day if their volume allows, or they can choose to read after-hours from home. This approach creates another avenue for growth and shows true collaboration with local radiology groups.

Administrators and referring physicians like the franchising model because it keeps the local group intact. In turn, it adds to the group’s benefits, such as sub-specialty final reads, a 3-D imaging program in conjunction with Massachusetts General Hospital, and a sophisticated technology platform.

Todd Baker is vice president of Imaging Advantage in Arlington, Texas. Direct comments and questions to editorial@rt-image.com.