Increasing Efficiency via Transparency: Quantum Imaging and Therapeutics

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Elizabeth BergeyQuantum Imaging & Therapeutic Associates, Inc, a 40-radiologist practice in Lewisberry, Pennsylvania, faced a problem common to radiology groups in the post-DRA era: improving efficiency without decreasing the quality of its interpretations. Elizabeth Bergey, MD, CEO of the group, says, “Radiologist efficiency and efficacy are based, somewhat, on internal factors. Everybody has his or her own personal work ethic, and in any population, there will be some variation. We also notice that some people tend to be more conservative in their interpretations, taking more time than someone else would with the same image set. Often, it’s not a matter of their aggressiveness to get the work done that can slow them down; it’s their comfort level in making a decision.” To address disparate levels of radiologist efficiency, Quantum Imaging developed a software tool that works “like a pacer rabbit,” Bergey says, letting radiologists know, in real time, how well their productivity matches the group’s benchmarks. “It keeps them focused and understanding what the expectations are,” she says. “It has a target level of RVUs set for them, and it lets them know, in real time, whether they are on pace to reach that target for the day.” Creation and Customization The practice implemented the tool in 2010. Bergey notes that the use of the tool arose out of a conversation surrounding compensation; the practice decided that all of its radiologists would make the same salary, as long as they performed an amount of work that would support the overall practice’s success, on a day-to-day basis. “If everyone is giving the same effort, resulting in acceptable productivity, then we should all be paid the same,” Bergey says. The tool works by popping up a window whenever the radiologist signs a report or sends a report to the transcriptionist editor; the window has to be acknowledged, with a single click, before disappearing. “The software is integrated with PowerScribe (Nuance Communications), and the window cannot be ignored,” Bergey says. “We have to respond to it.” This helps create an accurate reflection of the radiologist’s day, and it also creates a unique database of information on which the practice’s managers can base important manpower-related decisions. clicker_screenshot The tool can be customized to account for radiologists’ experience levels, as well as for the seats that they are occupying on that day. “New hires understand what they are expected to accomplish, and we adjust the target for those right out of training. We can start it at 80% and ramp it up, over time,” Bergey says. “We also have some seats that have more interruptions associated with them than others, and we don’t want the software to disincentivize our radiologists from participating in important non–revenue-producing work (such as answering the phone, teaching, or speaking with a clinician) because that behavior wouldn’t lead to good patient care.” She continues, “Instead, we recognize the value of clinical consultations and other non–RVU-producing work, in the same way that we credit radiologists for work for which we can directly bill. In fact, our tool has actually incentivized our radiologists to provide better service to our partners in care.” Impact and Aftereffects Initially, of course, levels of productivity varied widely from radiologist to radiologist and from seat to seat. The reaction to the new tool varied as well. “There was some unhappiness with it, at first, from people who may not have appreciated having the pressure on them to complete a day at a certain productivity level,” Bergey recalls. It wasn’t long, however, before the tide began to turn. “One of our radiologists told me he loved it because he felt he could make a phone call to his wife while knowing he was in the range of where he was supposed to be. Now that we’ve been using it for a couple of years, everyone is fine with it—it’s just part of our practice,” Bergey says. Almost immediately following the tool’s implementation, the practice was able to redeploy two seats in its rotation, Bergey says. ”There is an old business adage that we believe is applicable here: Whatever is measured improves. Our operations committee uses the reporting from the tool to make decisions on staffing and placement, and to talk about how we can improve our radiologists’ work environments,” she says. “Saving two seats is saving a little over $1 million in physician costs per year.” As a result, Quantum Imaging has been able to pick up one new hospital and several new teleradiology customers without adding a single FTE; its 40 full-time radiologists efficiently staff a total of 29 clinical seats. “Worklists that previously had been substantial were evaporating before everyone’s eyes,” Bergey recalls. “The health systems we already had as clients saw it as a big improvement as well.” In fact, Bergey says, the reporting from the tool enables Quantum Imaging to benchmark per-seat efficiency, documenting (for the first time) the value added by consultations that its hospital and health-system clients are receiving. “We can actually show health systems the extra perks we are providing to them as part of our professional services,” she says. “We can quantify the time we spend consulting and teaching.” The result of a simple workflow change, Bergey concludes, has been a more efficient, financially stable practice with a high focus on quality and consultation. “This tool has paid back our investment in it many times over,” she says.
Cat Vasko is editor of RadAnalytics and associate editor of Radiology Business Journal.