Partnering for Progress: Imaging and the Rapidly Growing Hospital
Brian IviePhyllis BaltzMercy San Juan Medical Center is a 370-bed acute-care hospital in Carmichael, California, that is part of the not-for-profit Dignity Health System. It has experienced significant growth since it opened its doors in 1967—particularly following the 2009 introduction of a new patient tower that added 110 beds. Brian Ivie, president of the level II trauma center, says, “Mercy San Juan Medical Center is the busiest emergency department in the region, in terms of ambulance traffic. Most patients are affected by imaging, so timeliness, access, and partnership in care of the patient are critical.” As the patient load seen by the facility has increased, so have the service lines offered to those patients, according to Phyllis Baltz, COO of the hospital. “The case complexity of the patients we are seeing continues to increase over time,” she says. “In addition to being a level II trauma center, we feature neurosciences as a key service line. The volume of our emergency-department visits has increased: Patients see it as the fastest route to diagnosis, and we anticipate huge demand, in the future, for the emergency department.” Bracing for Volume When patient volume is a key consideration, nothing is more critical than throughput, and the need to get patients through the hospital quickly and appropriately has made imaging a linchpin of care, Ivie says. “Five to 10 years ago, radiology was on its way to becoming a commodity,” he observes. “Now, we are more reliant than we’ve ever been on radiologists’ clinical expertise, in our drive for quality and efficiency. Without radiologists partnering with us and aligning toward that effort, we will not survive.” Toward that end, Dignity Health System has taken a hybrid approach to its radiology coverage, using a radiology group that is part of the Dignity Health Medical Foundation for daytime and on-site work, in addition to using subspecialty teleradiologists from Virtual Radiologic (vRad). “Radiologists, both in-house and remote, are becoming more integral, regardless of the time of day. Physicians need immediate responses to make critical decisions,” Ivie says. “This model allows them to access radiology seamlessly. Even at the busiest of times, vRad can help us load balance so that we meet the turnaround times the referring physicians (and our quality/performance metrics) need.” Baltz adds that she expects the volume and clinical complexity faced by Mercy San Juan Medical Center’s physicians to continue to increase. “If we look forward, one of the pressures we see coming is that California will have one of the fastest-aging populations in the country,” she says. “The percentage of patients over 65 years of age will double by 2030. When you look at the number of hospital bed days that population uses, it’s clear that it will be more and more critical to have radiologists helping with diagnosis decisions and treatment plans.” The complexity of cases, she adds, will only intensify over time. Balanced Approach Ivie and Baltz agree that given these pressures, a balance between on-site radiologists and remote subspecialists will position Mercy San Juan Medical Center well to meet its patients’ evolving needs. An example is the stroke service line offered at the hospital, Baltz says. “We have an extensive specialist group of neurologists, neurosurgeons, and interventional neuroradiologists,” she notes. “We’re quickly becoming the center of choice for ambulance and transfer patients from other hospitals for diagnosis and treatment of any type of neurology-related condition.” Without both subspecialty radiologists working remotely and on-site interventional neuroradiologists, this offering would not be possible, Ivie says. “Until we had our biplanar suite and our interventional neuroradiologist, we were not as well equipped to provide the highest level of care for stroke victims,” he says. “With this partnership, we’ve opened up the door to providing that expected level of care. It’s a service line we are able to offer because we have access to those well-trained radiologists and supporting specialists.” As US health care transitions from fee-for-service to pay-for-performance reimbursement, Ivie believes, the balanced approach to imaging will be even more critical to survival. “There’s a continued push for better throughput and patient flow,” he says, “but quality is also becoming more and more transparent. The radiologist needs to be the person who not only provides efficient, high-level care, but also collaborates with the ordering physicians.” Baltz adds, “Timeliness on evenings and weekends is truly key, but you also can’t replace the relationship piece that happens when radiologists are on-site.” Ivie concludes that radiologists who collaborate with their hospital partners in meeting key goals—improving throughput, participating in quality initiatives, adding new service lines, and guiding referring physicians in developing effective and appropriate treatment plans—have reason to be optimistic about the future. “Caring for patients through the system, appropriately and quickly, will continue to be challenging. Doing so requires a re-engagement of the radiologist as a partner in that process,” he says. “Our future in health care is going to be all about improving quality and eliminating waste. Who is better to participate in that than our radiology partners?”
Cat Vasko is editor of Medical Imaging Review and associate editor of Radiology Business Journal.