There is little question that consolidation and integration in the health-care sector is in full force and will continue to dominate the landscape in 2014—given the markedly high level of healthcare entities merger and acquisition activity in 2013, of that we can be certain. Price compression, consumerism and regulatory influence are creating an environment in which scale is critical to success, both in order to enhance competitiveness and to enable continued access to, and influence with those customers who will be shaping healthcare delivery in their markets and the roles their partners will play in any emerging transformation and alignment they bring to the market.
Radiology groups, though historically most successful as independent, entrepreneurial entities, must now not be left standing on the platform as the consolidation train comes through town. If their hospital customers are consolidating, affiliating and integrating, how can supporting physician practices, like radiologists not follow their lead?
More to the point, will they even have a choice one day soon? Even before the onset of the factors shaping the current business environment facing hospitals and health systems, these large entities always preferred uniformity among physician group performance across the system when it could be achieved. Traditionally, radiology has often been left on the sidelines and out of the thought process of health system leadership, but imaging’s vital role in helping hospitals and the medical staff to innovate and identify opportunities to manage costs for episodes of care has put the specialty in the spotlight.
If radiology practices do not at least explore the benefits of affiliation and collaboration with one another, hospitals might force the issue through a mandate, resulting in either a “shotgun marriage”, employment model solution or outright replacement. This is a nightmare scenario that can be avoided by being “part of the solution” rather than “part of the problem” being discussed in the c-suite, as early in the process as possible.
Helping Lead the Process
Fortunately, if you ask health system leadership what they want, organizationally, from radiology groups, the answer will generally be that they don’t care, as long as certain objectives are fulfilled and needs met. They want their disparate radiology groups to speak with one voice; to bring forward initiatives which demonstrate added value to the customer and consumers; to achieve service consistency throughout the continuum of care; to supply both innovative solutions to guide imaging utilization management appropriateness; bring forward demonstrable quality differentiators for those they serve; and to commit to meaningful and effective collaboration with the medical staff.
It is equally important to be highly visible and available, directly interacting with the medical staff and patients—doing so will create a relationship of value with the hospital and payor customers, which will be essential to the role of radiology in the newly emerging health-care model.
With all that being said, there is no need for groups to cede the independence and entrepreneurial spirit that have made them successful in the past—in fact, it is advantageous for all parties for them to remain nimble, efficient and quality-focused. Coming together under a collaborative or affiliated model will enable them to differentiate at the local level, and at the system-level meeting health systems’ changing needs while maintaining healthy autonomy.
Merely forming a collective or loose affiliation will not be enough to secure the future of the radiology group, however. It will certainly not be enough to fulfill the needs of its customers, nor demonstrate the awesome contributions that radiologists can bring to the new health-care delivery system. The collaboration and affiliation of groups must bring something to the party – something meaningful.
Managing Data to Succeed
Critically important will be the ability of the integrated organization to collect, mine and leverage the deep and broad data available in an integration and collaboration model in a scale typically not available to a single practice. Scale is important. Leveraging this data and transforming it into actionable information to demonstrate the effectiveness of initiatives that support the imperatives of the hospital customer will be a game changer of enormous proportions, as will obtaining the data and information to craft and understand with specificity, the implications, measurable risks and opportunities of emerging alternate payment mechanisms as they evolve in the market. Again, scale is important to these opportunities.
Specifically, the most valuable assets in emerging care paradigms will
i be “inward-facing information” such as efficiency, quality assurance, peer review and outcomes data as well as “outward-facing information” that affiliated radiology groups will have a unique and unprecedented ability to access and publish results on a large scale. Groups typically have access to data on the patient populations they serve throughout the continuum of care and throughout the referring physicians they work with throughout the communities they serve, and pooling that information into a comprehensive picture of utilization of imaging services can be very instructive to health systems grappling with how they differentiate themselves with patients, payors, and the medical staff while simultaneously preparing themselves for population health management and new payment mechanisms as they emerge.
How are subsets of referring physicians behaving? How are patients with certain clinical indications and episodes of care faring? And what can radiology practices, as the experts in imaging, be doing to guide both groups toward the right study, at the right price, for the right outcome? This value-added information will prove invaluable to reducing system costs, improving efficiency and securing an unprecedented level of quality of care.
Sustaining and Growing the Practice
Uniting under a collaborative or affiliated model will secure a competitive advantage in the local marketplace for groups forward-thinking enough to strike while the iron is hot. But how can that advantage be sustained in an era of declining reimbursements and increased regulatory scrutiny?
Here, again, the access to a large and robust data pool enabled by inter-group collaboration and scale will prove invaluable input to decision-making on future payment mechanisms implications and opportunities —but this time, the added value will be to the groups themselves, who will have given one another the gift of facts and demonstrable data in support of appropriate payment for their services. The scale, depth and breadth of datasets available through all affiliated members in support of independent negotiated positions will serve the combined organization well in a highly competitive, rapidly evolving environment.
The universe is changing, and radiology will change with it. Groups currently have a unique opportunity to seize a seat at the leadership table and to exercise their expertise in a meaningful way—and remain independent. But if they don’t take advantage of this chance to meaningfully collaborate on their own terms, eventually their customers will force the issue.
Send comments to: firstname.lastname@example.org