In November 2013, Virtual Radiologic (vRad) released its initial set of radiology patient-care (RPC SM) indices, the first findings-based benchmarking measures for imaging activity and utilization based on the global practice’s clinical data repository. Jordan Halter, vice president of solutions for the company, says, “With 23 million studies and growing, vRad’s database reflects practicing radiology on a large scale. That means that we have insight that reflects the national radiology market. vRad wants to use these indices as a way to start a dialogue in radiology. Everyone must start measuring value, quality, and performance as we transition from a fee-for-volume to a fee-for-value model. Until now, nobody quite knew how.”
By using a patent-pending, internally developed approach to normalizing its data, vRad was able to analyze the information associated with more than 750,000 emergency-department CT exams for the first RPC indices that it released publicly. The data, available on the company’s website for free and unrestricted use, can be filtered by age range, hospital type, body region, or geography (with a new state-specific option). “We wanted to show an alternative to drowning in big data and spreadsheets,” Halter says.
“RPC indices are an example of how relevant data, visualized in a fresh manner, can be used to make the case that radiology is anything but a cost center for hospitals,” Halter adds. “While our initial indices were targeted on one imaging modality (CT) in the emergency department, our objective, from the start, was to launch a set of RPC indices much larger in scope—with a much larger impact on the quality, value, and performance of radiology. We’re talking about a 24/7 visualization of all imaging modalities—or a look inside a day in the life of radiology.”
Halter explains that the day-in-the-life concept originated with the realization that radiology workflow and operational decision making could be much better managed with the help of evidence-based insight. “The recession and year-over-year cuts in CMS rates have taken their toll on volume and revenue. Practices, including vRad, can’t wait for things to get better. They won’t. We have to find new ways to survive and thrive,” he says. “It’s no longer OK merely to count how many studies you do, radiologists you have, or hospitals you cover. The days of pulling the obvious lever of working harder by reading more to make more are over; radiologists are reaching their limits.”
Halter continues, “If we don’t understand the economics of radiology, we’re going to continue making knee-jerk, emotional decisions to do more of the same. Opinions are nice; facts are much better. The rules of economics are not suspended simply because we are practicing medicine. We all must use analytics and understand the fundamentals of radiology if we’re truly going to understand our options for survival and growth.”
vRad’s approach, in the newest RPC index, is to divide a radiology practice’s day into three shifts: on-site, midhawk, and deephawk (Figure 1). Halter explains, “The on-site shift is best understood. It’s the hands-on, high-touch shift when most of the high-value imaging is done.”
He continues, “Midhawk is that 6 pm-to-midnight period when you’re not nocturnal yet, but for a typical practice, you don’t have many radiologists on-site, either. In the deephawk shift, your volume decreases significantly, as you’re primarily serving inpatients and the emergency department.”
Halter explains, “Once we broke it down this way, we realized that nothing was the same. Everything changes during these three shifts, including imaging-modality mix, patient type, and RVU-to-study ratios. This has critical implications for how you actually operate your practice, whether you’re independent or hospital employed.”
An Inconvenient Truth
“Hospitals want lower costs, higher quality, and higher service levels for radiology,” he notes. “Radiology groups want income, autonomy, and lifestyle. That creates a misalignment. Making decisions without the insight provided by the RPC indices is resulting in a widening of the gap—and that’s not healthy for hospitals, radiology groups, or patients.”
Halter explains that many practices are combating falling incomes by taking back the night—staffing and handling the deephawk shifts themselves, during both weekdays
Cat Vasko is a contributing writer for ImagingBiz.com.