Driven by Data: Instinct Takes a Back Seat to Metrics
In early 2009, physician and business leaders of Advanced Medical Imaging Consultants, PC, Fort Collins, Colorado, found themselves wrestling with the decision of whether to add a new site of service at a rural hospital. Instinct told them that the practice was up for the challenge: With 27 radiologists and 17 staff members (including full-time billing personnel), it was already providing imaging services to 11 area hospitals and two imaging centers, in addition to reading exams for five or six physician groups. Performing extensive analysis using metrics and benchmarks, however—rather than trusting feelings alone—served as key factors in vetting this potential opportunity. CEO S.H. (Stan) Podolski III, CPA, CIA, CHBME, says, “The prospect of pursuing any new avenue—be it another site of service, an additional modality, or otherwise—is always attractive to us, as it is to most (if not all). It has long been part of our strategic plan and philosophy, however, that being data driven in our decisions, rather than following our gut, is a must to sustain and maintain the practice and position it for future growth.” Advanced Medical Imaging Consultants uses a proprietary IT system to track a variety of internal measurements and to assess the health of the practice. Ranking among these measurements, which are applied equally to forecast the performance of any new entity, are revenues, by modality and by site; productivity, by modality and site; RVU billing data; exam volumes; reimbursements; and payment/billing patterns, including the aging of receivables. These are compared monthly with internal and RBMA benchmarks, with adjustments in scheduling and the like then being made accordingly. To kick off a decision process that spanned six months, historical benchmarks from the database were used to create (and present to decision makers) a pro forma document for the proposed site. The pro forma laid out, in detailed format, expected volumes—by modality, as well as by payor. It also incorporated bad-debt projections. Peter Koplyay, MD, president, explains, “We looked at volumes, modalities, and reimbursements for a similar demographic market and benchmarked them” to arrive at part of the basis for a final conclusion. This, however, was just the tip of the iceberg. Koplyay, Podolski, and their team also manipulated the internal data and historical benchmarks derived from a similar market, proposing different what-if scenarios to assess whether the site’s modality mix rendered serving it a viable option, from a staffing and expense standpoints. The same benchmarks and data were used to determine (based on the number of RVUs for radiologists to complete on any one day) whether it would be necessary to hire additional staff, how many radiologists would be needed to handle the site’s work daily, whether there would be any time gaps for radiologists taking care of the site, and whether existing night-call coverage would extend far enough to meet the hospital’s needs. “There were a lot of questions,” Podolski elaborates. “For example, would the exam volumes be such that there might be holes in the radiologists’ schedules on the days they worked for the site? Could we pick up exams, based on RVU calculations? Given the expected RVUs and the nighttime-call volume from other hospitals, could we absorb calls for nighttime coverage, or would we need to add more of it? Fortunately for us, we had the metrics to answer the vast majority of these questions.” Forecasts of site performance for the first six months proved to be spot on, Koplyay states. Based on subsequent performance analyses and data assessment, the original contract for providing on-site service to the hospital was later expanded from one day every two weeks to one day per week. More important, Koplyay, Podolski, and their colleagues continue to rely on data analysis to assess future opportunities to expand the scope of service that Advanced Medical Imaging Consultants provides to the hospital. For example, the addition of MRI services is currently a possibility. Koplyay notes that while such a move would certainly boost exam volume at the site, it would also increase the complexity of cases—in turn, altering the payor landscape, and quite possibly, bringing to bear the need for radiologists to spend additional days at the hospital, as well as the need for additional manpower. “Assessing similar historical data, demographic data, and benchmarks will create, for us, a clear picture of what we would need (in terms of manpower and days of service) and whether we can justify the new modality,” he says. The option to add a second day per week of on-site service to the hospital’s contract has come under discussion as well, but repeated analyses of exam volumes do not yet warrant a change. “Although expanding in this fashion might have a positive effect, we believe it will be better, in the long run, to track the key metrics and continue to benchmark, then go in and proactively make changes in line with any emerging trends,” Podolski concludes, rather than to jump impulsively onto the bandwagon. He adds, “It’s one thing to collect data, but they need to be manipulated and benchmarked in litmus tests of current and future performance. While there is something to be said for instinct, data analysis is the true way to vet any opportunity.” Julie Ritzer Ross is editor of RadAnalytics.com.