CXOFiles No.1 Leading Jefferson Radiology: Mark S. Grossman

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When Hartford, Connecticut-based Jefferson Radiology came calling roughly a year-and-a-half ago for Mark S. Grossman, he was happily ensconced in a large radiology practice in Cincinnati, Ohio. But the opportunity to serve Connecticut’s largest private radiology practice, founded in 1963, proved irresistible. All of the ingredients for success were well established in the 40-member group, which owns and operates six outpatient imaging centers throughout Greater Hartford County and maintains professional service agreements at four local hospitals. Grossman’s charge is to fine-tune, team build, and embark on a strategy of controlled growth and diversification. We are in a time of extreme tumult in medicine and radiology in specific. Is Jefferson Radiology in a contraction mode, an expansion mode, or preserving the status quo? GROSSMAN: Jefferson Radiology is the largest private-practice diagnostic and interventional radiology group and the largest provider of hospital radiology services in Connecticut. There is significant opportunity in the marketplace and we are in what I would call a managed growth mode. We are exploring many opportunities for expansion, and we want to be positioned to take on those opportunities while, at the same time, maintaining proper physician staffing. It is critical during this growth that we continue to provide quality service with the subspecialty expertise that Jefferson offers. We are in a recruitment mode right now. We are trying to grow the number of radiologists that we have within Jefferson. What are the current challenges for a non-physician CEO in a radiology practice? GROSSMAN: I am the first non-physician CEO within Jefferson’s history and have a 25-year background in academic, hospital, and private practice environments. Previously, the group had an executive director, but the group decided that it wanted someone who had strong business and leadership skills, with proven experience in managing not only physician groups, but radiology groups. Jefferson was a successful organization before I arrived, so what I am doing is a lot of fine-tuning. Jefferson’s formula for success does not really require rocket science. We want to deliver quality service. To do that, we have to have well-trained, sub-specialized radiologists, state-of-the-art equipment, and a knowledgeable and compassionate staff. We are 300 employees strong at this point. One of my focuses has been to enhance the alignment of our team and to make sure that every employee in every position within the organization understands the big picture and how they can impact Jefferson’s success. Another focus is on customer service. While we are the largest group, there is a lot of competition in outpatient radiology in the greater Hartford area. We are committed to doing more than just talking about customer service. We are committed to really delivering a quality product in every aspect of a patient’s experience with us: from first contact, to scheduling, to the treatment they receive from the front desk staff and technologists, down to the proper handling of billing and the timeliness of results to the referring physician. Last year, everyone in our organization, both physicians and employees, went through customer service training. They were taken out of the clinical setting and attended a multi-day program with professional trainers engaged by Jefferson. Our commitment to customer services doesn’t stop there. We benchmark our performance on a quarterly basis using patient satisfaction surveys that are administered by an outside entity, Press Ganey. We use those survey results to continuously enhance our performance. We also will be doing, for the first time ever, a physician satisfaction survey that will be conducted by phone using a third party professional so that we can gauge our referring physicians’ perception of the service we are providing. My role as the non-physician CEO is to serve as both a leader and a facilitator and, of course, to make sure that the finances, operations, marketing, billing and every other aspect of our organization is achieving and running at the peak of efficiency. We have made significant progress in the last year and a half. IMAGINGBIZ.COM: How do you take a successful radiology practice and make it more successful? GROSSMAN: Continuing to diversify our business is critical. We enjoy being a full-service radiology services company with significant expertise in running our business. We obviously want to continue providing services in outpatient imaging centers and hospitals, but we also want to continue to diversify our portfolio. Jefferson prides itself on having strong relationships with all of its partners, but we believe that by being diversified, Jefferson reduces the impact that any one relationship can have on us. In terms of fine-tuning, internally there really are three focus areas. The first is contracting. Even though the Deficit Reduction Act (DRA) will impact radiology reimbursement, we have been exploring opportunities to enhance contracts with other payors. This is an ongoing process. The second focus area is that we have been looking hard at all non-salary expenditures. We have gone through our entire organization. We’ve looked at medical supplies, contrast, radiopharmaceuticals, consumable supplies and office supplies. We are utilizing group purchasing contracts and buying groups, and have literally met with every vendor to ensure that Jefferson is getting the best price possible. I’ve told my team that I don’t want to compromise quality to save money. I want quality, pricing and service. The third area that we’ve focused on is efficiency within our practice and ensuring proper staffing for each modality. This organization does a great job - the best I’ve ever seen - at retrieving data from our IT systems and utilizing that data to effectively run the business. We are able to use this information, among other things, to make decisions about the appropriateness of staffing levels. Additionally, we’ve taken action to begin reinforcing our brand. For example, when I first visited Jefferson Radiology, the physician leadership asked for my observations from my tour of the clinical offices. When I came here, Jefferson had no uniforms at any of its offices. I couldn’t tell who worked here. The employees only sporadically wore nametags. One of the first changes I made was to require uniforms and nametags that enhanced the Jefferson Radiology brand so that we looked more like a team. There was resistance initially; but in the end, the staff realized the importance of taking this step. I felt that to be a cohesive team, we had to look like a cohesive team. It sounds like you might be reassigning non-clinical tasks to less expensive personnel? GROSSMAN: We like to align responsibilities with the person best suited to perform those responsibilities. As an example in CT, we utilize CT techs, but we also utilize facilitators. Those are mid-level clinical staff, such as medical assistants, who help facilitate escorting and preparing patients for their exams. We’ve been looking at each modality within our practice and making sure the staffing is appropriate for the actual volume and the anticipated volume resulting from our growth. Then, we benchmark our findings against available data, including the American Healthcare Radiology Administrators (AHRA) data, on staffing levels. These are just benchmarks, and you have to understand how they can be useful for your organization. So, we have been looking internally at our own organization to fine tune, making sure we are being efficient with scarce resources, trying to grow the revenue while controlling expenses, but never compromising on quality. That is making us stronger as an organization. How does this impact the radiologist owners? GROSSMAN: Our physicians have made the paradigm shift and are committed to supporting and making this organization the best that it can be. The partners in Jefferson recognize that they have done a lot to build a successful organization. Bringing me on was an acknowledgement of their commitment to take Jefferson radiology to the next level. I think that is one of the things that attracted me to the Jefferson position. They believe in giving management the tools that it needs to do the job so that Jefferson can differentiate itself in the marketplace. Obviously, in a partnership, the partners are the last to get paid. In any kind of partnership, you pay the expenses of the business, and what’s left is what the partners share as compensation. This organization is making investments in information technology, clinical technology, and human resources to help position Jefferson to be successful in the coming years. It is really exciting to be part of an organization that, despite the challenges of the DRA, is willing to make this kind of investment. How does outpatient imaging figure into your strategy for the future? GROSSMAN: Outpatient imaging is a very important core area for Jefferson. The outpatient imaging business really varies depending on where you are in the country, in part because some states require a certificate of need and others do not. The state that I came from, Ohio, was a non-CON state. In a non-CON state, all you need is parties that are willing to make the investment in opening an imaging center. Most of those centers in Ohio were single modality centers, either MRI or CT centers. Connecticut is a CON state and, as such, the state controls the deployment of CT, MR and PET scanners. The previous law had a dollar threshold before a CON was required. If you were putting in equipment under a certain dollar threshold, you did not need a CON. That law changed in 2006 and now any practice that wants to install MR, CT, or PET must have permission from the state. The applicant must justify the need for the service as well as demonstrate financial feasibility. The approval process requires a substantial amount of work and typically takes six to nine months. Jefferson is in a very good position technologically and has a very good track record of working with the State of Connecticut. For smaller providers, it may be difficult to add additional technology because of its cost and decreasing reimbursement. Jefferson is committed to continuing to offer full service, multi-modality centers. We currently have six full-service centers spread out over greater Hartford and we are building a seventh in another suburb of Hartford. Jefferson really aims to offer one-stop service for all of a patient’s radiology needs in a convenient setting. I would expect that outpatient imaging will remain an extremely important part of Jefferson’s future. How would you describe your leadership style? GROSSMAN: My leadership style is participative. My own leadership approach has really evolved over the years as I have realized that I am only as good as the people who surround me. My focus is on mentoring those around me. I truly want to develop leaders at many levels – in the site manager of one of our offices or in a director. I want my staff to be positioned to make decisions and to really be responsible for their respective areas. I want to empower people and educate them about the big picture and how together we can achieve our goals. It makes everyone feel good about their contribution and helps the organization move forward. If people know they have the support of leadership, they are not restrained by a fear of making a mistake and are willing to take on challenges and responsibility. The personal satisfaction and rewards will follow. Will leadership in and of itself be more or less important moving forward? GROSSMAN: It’s definitely going to become more important. The larger groups are the ones that are poised to be successful. The reason is simply this: the smaller radiology groups will not have the breadth of resources to survive in this evolving marketplace within the United States. They can’t make the investment in the enterprise IT infrastructure and clinical technology that will gain them efficiency. We are starting to see referring practices putting in electronic health records (EHRs), so our ability to respond, in this case, to our customers’ needs for that IT connectivity is an advantage. If a doctor has web-based PACS connectivity with the ability to import our reports into their electronic health record, an alignment is created that helps to ensure referrals in the future. Leadership is going to be extremely important in the future, to chart the waters and to make the decisions about where and how we want to expand and position ourselves for success in the future. Who are your role models? GROSSMAN: My father, who is still working, was really my first role model. I have always looked up to his self-starting ability as well as his willingness to do whatever it takes to get the job done. More recently in my professional career, there was an individual in Cincinnati by the name of Dan Gahl who had a lot of experience in physician private practice and came to the University of Cincinnati to head the faculty practice plan, where I was a department administrator early in my career. He was a role model and a mentor for me. He was someone who helped me grow in my career and who I worked hard to emulate. I give him credit in part for where I am today. It was his fireside chats and talks at the end of the day and his availability to me that has helped me grow. I have tried to emulate his leadership style in doing what it takes to build an organization.