The Growth Paradox: How Should Radiologists’ Behavior Be Rewarded?

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Tom VaughanAll over the country, radiology practices are merging, consolidating, and forming networks in order to grow in size and, in theory, negotiate from a more powerful position while making the most of economies of scale. Tom Vaughan, MD, president of Kent Diagnostic Radiology Associates (Dover, Delaware), points out that the emphasis on growth raises some challenging questions, from a practice-management perspective. He says, “As you grow from being a small practice to being a large one, management becomes much more challenging. In some ways, it can be a luxury to be small.”

Vaughan’s practice membership has grown from four radiologists to 16, while the group exclusively serves Bayhealth Medical Center. “We aligned ourselves with the hospital long ago, and we always try to see things from its perspective as well as ours in order to promote long-term relationships,” he says. “Our philosophy is that the focus has to be on service and quality, and everything else should flow from that.”

The Growth Paradox

As practices grow, the use of data becomes more imperative to effective management, but Vaughan points out that big data are rife with hazards as well. “Productivity is very important, but numbers of RVUs or volumes of cases read will never accurately portray what a good radiologist does during the day,” he says. “When you become too focused on numbers and output, you’re not incentivizing physicians to do all the things that are best for your practice. There are vital practice functions, many of which are assumed or unappreciated, which can disappear quickly when the focus is turned to maximizing what is measured. It can be a very dangerous thing, and can destroy a previously high-functioning group.”

The activities to which Vaughan refers range from clinician consultation, participation in hospital administration, and attending meetings of hospital committees to speaking with patients and responding to their concerns or complaints. “There’s a big push now for patient-centered imaging, and that’s certainly a great thing,” he says. “We’ve all been striving for that in the past, without putting a name to it. For instance, several years ago, our practice developed a marketing campaign with the theme, ‘Behind every image, we see the patient.’ It is, however, a dichotomy: Patient-centered imaging requires productivity, but it also requires those things that are more difficult to measure.”

In short, Vaughan says, radiology groups are facing a paradox. Even as data become more central to effective practice management, the growing focus on data risks undermining the care element in health care. “Data doesn’t produce innovative and thoughtful staff,” he says. “That’s become the million-dollar question for radiology groups: How do you maximize productivity while encouraging your radiologists to turn their considerable knowledge and skills toward providing exceptional patient experiences and service for referring clinicians, department staff and hospital systems?”

Feedback on Change

Vaughan hypothesizes that the problem comes down to incomplete measurement. “Productivity is a central topic of discussion and interest for all groups,” he notes. “Groups have a wide variety of ways that they handle productivity, ranging from publishing anonymous productivity data all the way to implementing financial incentives. Of the groups and solutions I’ve seen, however, none have been particularly successful at enhancing the service and quality of their practice. Some may increase the numbers of the lower-volume producers, but none that I have seen have transformed group performance.”

Radiology groups need a more accurate means of measuring the work put into interpretation of cases as well as traditionally undervalued, non-RVU-producing work, which Vaughan believes is essential for developing an elite practice. “We need to value the time and skill it takes to review a case with a referring physician, problem-solve with the staff, decrease radiation dose on CT protocols or discuss the implications of an abnormal mammogram with a stressed patient,” he says.

As Vaughan sees it, even this more-robust (and hypothetical) system of measurement would be incomplete. “We need to be able to define the value of practice building,” he says. “An ideal tool would be customizable, so that each group can come to a consensus on what it values and adapt the tool to their individual needs and goals. When a system like that becomes available, the road