High-Performance Radiology Practices Turn Endless Pressure Into Staying Power

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 - Jason Shipman, MD
Jason Shipman, MD

Once considered some of the most contractually stable and fiscally secure practitioners in all of U.S. medicine, radiologists are today concerned about their very future—and more than a few are right to be worried. From nosediving reimbursement to successive consolidation, from constantly expanding technologies to fitfully pinballing policymaking, the pressures have been varied and unrelenting for years now. What’s more, the pace of change is even now only accelerating. How best to rise to this moment with realistic hopes of emerging stronger than ever?

That was the question at hand in a recent webinar, “How to Become a High-Performance Radiology Practice.” Part of vRad’s ongoing series for imaging leaders, the session was led and moderated by vRad medical director Raymond Montecalvo, MD, and featured insights from two leaders of demonstrably successful practices.

Opening the discussion, Montecalvo contextualized its theme by pointing out that vRad interacts with radiology groups in all 50 states. “I get to see practices that are struggling with internal dynamics that are working against their best interests” and that are “hamstrung by a lack of resources or knowledge that prevents them from dealing with external forces,” he said. “Similarly, I get to see dynamic practices that make a conscious effort to confront their inner demons, which tends to free them to think differently about those external forces. These are the winning practices—the ones that are on the road to high-performance radiology.”

Before turning over the floor to the two guest speakers, whose practices Montecalvo said exemplify this ideal, he named four action-oriented characteristics that they and every high-performance practice seem to have in common: They tend to collaborate both internally and with value-adding partners, insist on clinical excellence, invest in IT and use data analytics to make informed decisions.

The future of radiology belongs to healthy local practices that can daily demonstrate those four attributes so as to deliver value to the hospitals they serve, Montecalvo suggested. “We believe most practices have the ability to be winners,” he added. “Most practices can be high-performance radiology practices.” 

Business not as usual

David Landry, CEO and COO of 220-physician Maine-based Spectrum Medical Group, confirmed that he’s seen the pace of change quicken for radiologists, particularly as driven by rising consolidation, falling compensation and clients’ expectations for subspecialization as well as “service orientation.”

“As we transition from traditional fee-for-service to value-based reimbursement, radiology is moving from a profit center to being a cost center,” said Landry, whose multispecialty practice includes more than 65 diagnostic and interventional rads and serves more than 20 hospitals in three states. Because of the accelerating shift in perception, radiologists “need to move from being strictly productivity oriented, grinding the stacks, to creating value that will complement their diagnostic interpretations,” he said. “Things like radiologists being gatekeepers for imaging management and consultants to the medical staff on imaging optimization will become more and more important.”

Jason Shipman, MD, president of 65-rad, Nashville-based Radiology Alliance—which, like vRad, recently became a part of the MEDNAX family of specialized health services—seconded Landry’s take on practices’ increasing need to exude a service attitude and, in the process, behave like a smart business.

“You need to continue to prove why you are of value to your medical community,” Shipman said. “We are certainly moving everything we can to not only demonstrate our value but also innovate as far as what that value can be. And that is certainly a challenge, but it is also an opportunity for groups that see their role in more of a value proposition rather than just as a group of radiologists who read films.”

Collaboration and clinical excellence

Acknowledging that, historically, tensions have not infrequently separated radiology groups from their hospital partners, Landry said that collaboration is key in this new era.

The trick is to “create multiple hooks and customer stickiness with our partner organizations, especially in the hospital world, where most groups don’t lose their contracts because of quality issues” but because of interpersonal issues, Landry said. He recommended investing in infrastructure to support collaborative communications on, for instance, critical findings and prior reports, as well as looking for openings to co-manage, by actual or virtual joint venture, imaging centers, hospital radiology departments and resident training programs.

“Another example, apropos to our call today, is the collaboration that we have had with vRad over the years,” Landry said. “We started our relationship with the traditional preliminary reporting of after-hour studies by the vRad team. We’ve evolved that to vRad now becoming really an extension of our practice and providing final interpretations, primarily after hours. It’s a collaborative model where we treat our relationship with vRad and the physicians of vRad the same as any of our own physicians.”

Shipman pointed out that Radiology Alliance’s formalized collaboration with MEDNAX and, by extension, vRad, brings the practice far more technological muscle than it could have afforded on its own. “As far as collaborating with hospital systems and referring physicians, [look for] any way that you can combine forces and align your values so that you are both going in the same direction,” Shipman said. “That has helped us out considerably over the past five years.”

His point on alignment dovetailed with one he made when the webinar discussion turned to clinical excellence as a must-have attribute for the high-performance practice.

“Frankly, hospitals want to tout the quality of their physicians,” Shipman said. “They want it known just how powerful of a radiology group they have. You can reluctantly participate in a quality program, or you can champion it and decide to be the author of what quality is in your area or in your hospital system. We’ve met with some success just by bringing up quality metrics over and over again, in every meeting.”

Technology and analytics

Shipman and Landry concluded the webinar by sharing some interesting observations on information technology and analytics.

Shipman on IT: “More and more, radiology groups hoping to grow and move to the next level have to invest in IT infrastructure. Patient follow-up, natural language processing, quality metrics—those things [only] come about with significant infrastructure investment. And it is hard to convince a group of doctors to invest in that kind of technology. If you are a group of partners, you are going to have to pony up your own cash to make that happen or you are going to have to look for another avenue. That’s one of the reasons we ended up moving toward MEDNAX and vRad.”

Landry on analytics: “We have invested a fair amount in data analytics, because we see that as a piece of de-commoditizing radiology and providing value. We do the basic analytics that I think most practices do, looking at turnaround times and radiologist productivity and rotations, but then we also do some things that are little more advanced, such as referral patterns, the percentage of positivity on various studies and potential patients who could fall through the cracks. This is an area that we think is going to both help our practice and also help our stickiness with our customers.”

And before taking questions from attendees, Montecalvo encouraged all to aim high as their practices pursue high-performance radiology. “Let your patients, your referral base and your hospital executives tell you how you can help them, and they in turn will trust your counsel,” he said. “Step out of the clinical realm and learn what else you need to know in order to succeed.”

The webinar is available in full for free. To hear it now, or to access the complimentary how-to guide “Becoming A High Performance Radiology Practice,” click here.