New Payment Models: Where Culture and Business Intelligence Meet

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Ted KernerThe specifics of how the traditional radiology practice model will fit with the emerging paradigm of the accountable-care organization (ACO) remain unclear, but it is clear that radiologists should be thinking about how to bend the cost and quality curves, according to Ted Kerner, MD, CEO of Triad Radiology Associates (Winston-Salem, North Carolina). “Being a physician is like anything else—it’s easy to get complacent, and if you’re complacent, what kind of impact are you creating?” he says. “New models of health-care delivery are challenging, and no one knows what will happen, but being able to influence it is why you must get involved.” Fundamental to any discussion of imaging in integrated delivery is utilization, Kerner says—and he notes that emerging payment models create an opportunity for radiology to regain some autonomy. “We used to be much more involved in controlling utilization, but under fee-for-service models, with hospitals and health systems vying for patients, they must be able to provide imaging anytime and anywhere,” he notes. “Now, we have a chance to convince administrators that we can also assist with patient safety, ensure high-quality imaging, and ensure ease of access. Even in a non-ACO model, we should impress administrators with the value of these services, although this is even more difficult than in an integrated environment.” Culture Shock The opportunity exists to win an active role for radiology in the continuum of care—but doing so will represent a major cultural change for many practices, Kerner says. Although culture is often treated as a soft (or intangible) topic, he argues that culture is directly linked to business intelligence and analytics. “Business intelligence is all about reinforcing the culture of your practice,” he notes. “On a basic level, it means that everyone in the practice recognizes that he or she is an owner of the practice. It demands a different skill set. It creates the obligation that you understand all of these things that have nothing to do with interpreting studies or performing procedures.” In keeping with this notion, Triad Radiology Associates collects and processes business-intelligence information, such as work RVUs—but new metrics will be necessary for participation in an ACO, Kerner believes. “We’re going to start collecting data that we never would have before,” he says. “If we really want to try to change our culture—and convince ourselves and others of our value—we have to assess how many consultations, how many physician encounters, and how many patient encounters we experience each day, and compare that with traditional RVU data.” This creates the potential for conflict within the practice, Kerner says, if some physician partners are reluctant to accept such changes. “We have to show everyone in the practice the benefit of the effort and time that it takes to sit on a committee or present a case to a tumor board,” he says. “Even then, there will be some radiologists who perceive their profession as simply reading films, and in that situation, there will be discord.” Developing a Strategy Radiology practices are likely to grapple with these cultural considerations as they contemplate joining new care-delivery systems, but it is also their physician-led nature that makes them ideal for ACOs and other payment models, Kerner believes. “When you look at an ACO model, you must have radiology alignment with the goals of the larger entity, and that can’t be accomplished solely from the management side,” he says. “Clearly, it needs to be cooperative. Having physicians in these types of roles is imperative in helping the other side of the table understand what we do.” Practices developing an ACO strategy should first look to their current hospital and health-system relationships to ensure that they are as healthy and cooperative as possible, Kerner says. “Developing that relationship takes time—it goes back to what their core goals are and how you have been assisting them (or can assist them, going forward),” he notes. “The sooner you can get that in place, the better your odds of being able to have an impact.” In terms of planning for ACO participation, Kerner emphasizes that radiologists should seek some degree of authority in the clinical management of the patient, which will allow greater impact on utilization and costs. “We need to have the ability to influence the direction of care,” he says. “That’s something that I suspect might frighten some of the other physicians at the table (in particular, nonradiologist imagers who are also paid under fee-for-service plans) because it threatens to have an impact on their bottom lines. It’s critical, though, to ensuring that radiology can effectively play the right role.” He adds that radiology practices should work to emphasize their ability to serve several different constituencies at once. “We can’t be monogamous with one ACO because that won’t be sustainable,” he says. “We have to be able to demonstrate that we can be good partners with a lot of different systems.” Cat Vasko is editor of RadAnalytics and associate editor of Radiology Business Journal.