In Atlanta: Re-engineering the radiology practice

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 - Dr Lalaji cropped
Anand Lalaji, MD

When Atlanta-based The Radiology Group was founded in 2006, it looked like a traditional private radiology practice, albeit a family affair. Anand Lalaji, MD, a musculoskeletal radiologist, his wife Tejal Lalaji, MD (a neuroradiologist and breast imager) and his father-in-law Mahendra Patel, MD, (a body imager) grew the practice over the subsequent three years into a thriving enterprise with multiple hospital and imaging center clients in Northeast Georgia. 

That success, however, bred its own set of problems, and chief among them was inefficiency.  “We used to read and operate on three, four or five different PACSs, and over the course of time that becomes incredibly inefficient as the volume starts to grow,” Lalaji, the practice’s founder and chief medical officer, says.

At the same time, Lalaji and his partners were experiencing the successive reimbursement cuts that had the rest of radiology in a vice grip. “In order to be protected, the practice had to diversify,” he says. “We needed to get out of the traditional model of interpretation only.”

In 2009, the practice took initial step to improve efficiency by consolidating all of its clients onto one PACS that was efficient, had a decent amount of “bells and whistles” and, most importantly, allowed communication easily among multiple parties, Lalaji says.

Next, the principles came up with a three-part plan to squeeze waste out of their “production” system and diversify the practice. “Our company is built on innovation,” Lalaji notes. “We continuously look at our processes and create solutions to improve quality and efficiency. We felt that Viztek, given all of that, was a good platform to help us take that next step, and that’s what we did.”

Leaning the interpretation process

Today, the practice serves the needs of more than 175 imaging sites of service in 21 states, including imaging centers, urgent care and hospitals, with on-site radiologists at some hospital sites. During the past five years, the practice’s IT platform and the strategic plan have evolved in concert.

At the center of its drive to remove waste from the interpretation process is a system it calls radASSIST, developed by applying the principles of Lean Six Sigma to the interpretation of a radiology study and the development of the report.

“There is an incredible amount of time that is significantly inefficient that a radiologist has to spend to look for a lot of different things,” Lalaji says, whether that is looking for a history, a particular imaging sequence or prior study, or making a call to find a missing piece of information. “There is a lot of inefficiency in the set up of a radiology report.”

In response, the practice created a conveyor-belt methodology for the purpose of interpreting the radiology study with different teams “stationed” along the conveyor belt responsible for specific functions necessary to put together a radiology report.

This system has allowed the practice to achieve a .1% to .2% error rate compared to a nationwide average of 3% to 6%, Lalaji says.  “What was great about our partnership with Viztek, was that they modified and coded different aspects of the PACS so that we could create this virtual conveyor belt,” he says.

The radASSIST system creates efficiency, which in turn creates economy, and that economy is shared with clients. “Not only are our clients paying an economical rate, but they are also enhancing their quality,” Lalaji says.

Working with consolidators

A key market segment for The Radiology Group is imaging-center consolidators. “As reimbursement continues to decline, imaging centers are getting bought by hospital systems, private equity and banks,” Lalaji says. “It’s happening all over the country. The imaging center business is an extremely fragmented business: The five largest imaging-center companies represent less than 20% of the market.”

Much of the consolidation activity in the imaging-center market is regional, with hospital systems and local companies the most active players, but eventually national companies will be predominant, he predicts. “Goldman Sachs and other investment banks are taking more interest in this sector but the way they think is, ‘If we buy 1,000 imaging centers, this is the return we are going to get,’” Lalaji says.

After equipment, the biggest expense on an imaging center’s books is the radiologist’s cost, and that cost is variable and therefore unpredictable. With radASSIST, he says, the work of 10 radiologists can now be

Cheryl Proval is the editor of Radiology Business Journal and vice president, publishing of imagingBiz.