CXOFiles No.7 Saunders and Mid-South Imaging Bet on Quality

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Worth M. Saunders, MHA, has served as chief administrator for the 32-radiologist Mid-South Imaging and Therapeutics, PA, Memphis, Tenn, since 2003. The position was a change of pace for the outpatient-imaging veteran, who worked for Radiologix for six years prior. Primarily a hospital-based practice, Mid-South serves six of the 14 hospitals operated by Baptist Memorial Healthcare Corporation, and also provides reads for numerous imaging operations located in physician offices, primarily multi-specialty clinics, billing for more than half a million CPT codes annually. The group made an early decision to participate in the Centers for Medicare & Medicaid’s Physician Quality Reporting Initiative (PQRI). Saunders talked to about the practice’s decision to participate in PQRI and quality initiatives in general in an evolving marketplace. What can you tell us about the governance/decision-making process there at Mid-South Imaging and Therapeutics?

Worth: Everybody who is a partner is a shareholder, so we have 30 shareholders at this point. The shareholders elect a nine-member physician board of directors every year. They serve two-year terms. The board is primarily charged with overall governance and broad decision-making powers for the group. I serve, as the chief administrator, as an ex-officio member of the board, but I am not an official member of the board. I attend all of the board meetings and help facilitate a lot of the overall decisions.

I am responsible for the operations, the business operations of the practice including billing, compliance, operations with regard to our outside read business as well interfacing with the hospital administrators and managers that interact with our group on a regular basis from the hospital-based operations.

With regard to PQRI, the decision to participate mainly was driven by our management team, our non-physician team, in concert with our billing company. We brought it to our board as a recommendation that we participate, and they approved it. There has not been a lot of interest in participating in PQRI thus far. Why did the practice decide to participate?
Worth: When we got into looking at the specific measures, we discovered there was only some basic communications we had to do. There weren’t any big changes we had to make to the structure of the reports. So we wrote some reminders to the physicians, cheat sheets if you will, just to remind them to mention the key findings that are in the measures.

Take, for example, the stroke measure. You have to mention whether there is a hemorrhage, mass, lesion or other pathology. They were doing that anyway, so it was fairly easy for the physicians, at least for those measures, to implement. The main work was on the billing and the coding side, the programming that our vendor had to do to ferret out the services that applied to the PQRI measures. They had to program their system to catch any of the CPT and ICD-9 combinations that would potentially apply to the PQRI measures. So they did that on the front end for the July 1 start of the program. Once they designed the programming of that, they had to set up a process for the coders to go through the reports that were caught to make sure it was coded properly relative to the PQRI algorithms that were set up.

We outsource our billing to McKesson. Per Se was acquired by McKesson a year or so ago, and the practice has a long-standing relationship with that company that goes back 25 years. They did most of the heavy lifting. We ultimately made the decision to participate, but they did the implementation, because they were responsible for billing, collections, and coding. The coders we use are McKesson employees. It was part of our overall arrangement, and they didn’t charge us extra for it. It was a standard percentage-based arrangement with them. So they did a lot of work that did not really have a return on investment, at least initially, but hopefully it will down the road, in setting up the processes and knowing how to implement it. I think there will be a long-term pay-off for them, but not a short-term pay off for the billing company, or for us. We may get a bit extra money next year for our participation, but it certainly wasn’t based on return on investment from a financial standpoint.

It was more of a strategic decision, wanting to be on the front end of this pay-for-performance wave that seems to be happening in the industry