Emerging Practice Models: Integrated Care and Alignment
Many radiology practices, by now, have been persuaded of the importance of deeper alignment and integration with their hospitals and health systems. Jana Landreth, director of practice management for Zotec-MMP, says, “If your hospital approaches you wanting this, you need to embrace it. Going into this with reluctance or hesitation will not move your relationship forward, and the odds are that you will wind up doing it eventually anyway. If you embrace it now, you will be able to set the goals with the hospital and make them realistic for what your practice can achieve.” Elizabeth Dobbs, a manager with Zotec-MMP, has guided practices through this process, beginning with the request for deeper alignment from the hospital. She notes that the typical radiology group’s initial reaction to this kind of request is defensive—and that responding accordingly is a mistake. “When the hospital says it wants more physician involvement, it can cause radiologists to panic. In execution, however, it is typically something they find themselves pleased to be involved in,” Dobbs notes. Clinical Integration Practice–hospital alignment necessarily takes place on two fronts: clinical and operational. “Hospitals are demanding greater levels of partnership, cooperation, and integration, using methods that stop short of employment,” Landreth says. “They want the physicians working inside their walls to be on the same page with them. They cannot afford to be at odds with people who are delivering clinical care in their facilities.” Radiology groups should make a concerted effort to involve their physicians in every aspect of the hospital-care continuum, Landreth says; though this goal might sound obvious in theory, in reality, it fell by the wayside, for many groups, as productivity became a growing priority. “This is the way radiology groups worked with hospitals years ago, before the economic pressures of the past few years created the drive to be more and more productive,” she notes. “When hospital administrators come to a group and say they need the physicians to do more, they may just be trying to bring the physicians back into the discussions they participated in years ago.” Once at the table for the alignment discussion, radiology groups should be prepared to establish realistic measurements related to clinical integration. Dobbs observes that once again, radiologists might find themselves pleasantly surprised by the opportunities for improvement—not just among their own ranks, but in the hospital’s approach to imaging as well. “In the case of one practice I worked with, the hospital wanted all of its hospital-based groups to participate in comanagement agreements for its departments,” Dobbs says. “It needed more physician involvement because health care is looking at payment for performance, instead of volume.” The radiology group brought priorities of its own to the table, including more guidance on appropriateness and improving the patient experience. “At the end of the day, they both had the same goal in mind, which was improving patient satisfaction and care,” Dobbs says. “There was less fear, as we went along, and more excitement: The radiologists realized that the alignment with the hospital was positive for them as well.” Operational Integration The most common approach to the operational side of alignment/integration is comanagement, Landreth says, in which the hospital and radiology group share responsibility for management of the department. “When you talk about alignment, it is somewhat conceptual and nebulous,” she notes. “It sounds like a theory, versus something that may actually happen. Comanagement agreements can make actionable items out of concepts, documenting and formalizing the changes to come.” Dobbs suggests that hospitals and practices alike start small with their integration goals. “You do not want to set too many goals and find that none of them has become a priority,” she says. Examples of early goals could include deeper radiologist involvement in equipment and technology selection; cost containment for the radiology department; identification and promotion of new imaging-service lines; timeliness of patient starts and report delivery; and helping to set imaging-related policies. “The point of the agreement is to define expectations and document them. Groups should sit down monthly with their hospitals and establish goals in terms of patient satisfaction, reducing turnaround times, starting on time, and so on,” Dobbs says. She reiterates that groups should not view the invitation to formalize these initiatives as an accusation on the part of the hospital: “Comanagement can sound punitive to the physicians, but underneath the broad ideas, the goals are in line with what radiology practices are most likely to be attempting to do already,” she says. The more deeply practices align with their hospitals, the rosier their futures will appear, Landreth and Dobbs agree. “Integration will make your practice much more valuable to the hospital, in the long run,” Landreth says. Dobbs adds, “If a group is approached for this by its hospital, I encourage the physicians to see it as positive. Moving into the future, radiology groups should seek as much involvement as possible with the hospitals—and should try to be advisors to them in as many ways as they can.” Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.