Exactly what portion of the hospital bottom line comes from imaging? It’s a straightforward question, but even hospital executives occasionally grope for an answer.
The difficulty often stems from an inability to see the proverbial forest for the trees. As a 26-year imaging-industry veteran, Brian Baker, president of Regents Health Resources (a consulting and development company based in Franklin, Tennessee), has seen the lack of big-picture strategy all too often. It starts from the top, filters down to the director level, and ultimately inhibits the coveted goal of system-wide integration.
“Imaging directors are in the forest, working as hard as they can to solve day-to-day operational issues,” Baker says. “Administrators are overwhelmed and trying to manage without the proper tools and support. They don’t get the opportunity to think strategically about their business objectives.”
At Intermountain Healthcare (Salt Lake City, Utah), an integrated health system, Baker encountered an institution in a state far from disarray. Instead, the massive network of 23 hospitals and 160 health-care facilities had picked up awards for excellence and was singled out by President Obama as an island of excellence.
Even with these accolades, Intermountain Healthcare administrators sought out Regents Health Resources to boost operational efficiency within the imaging sector while preparing for accountable-care organizations (ACOs) and other changes in health-care delivery. Baker and Regents Health Resources’ CEO, Bob Maier, began the massive task more than two years ago, with a subtle shift in Intermountain Healthcare’s culture plus a slight change in terminology.
The ACO, for example, was eventually replaced by a shared-accountability model, which involved all technical, administrative, and physician staff members. As a result, utilization management, patient care and safety, and appropriateness review are now within the systemwide jurisdiction of the medical imaging medical director and an entity called the Guidance Council.
With the council’s direction, the fragmentation of more than 100 radiologists’ services throughout Intermountain Healthcare is being transformed into a cohesive alignment strategy, with uniform clinical and business relationships throughout the system. “Some physicians had professional-service agreements with hospitals and others did not,” Maier explains. “In the new model of clinical integration, every radiologist has the opportunity—and in some cases, the obligation—to participate in establishing clinical standards that all radiologists and technical staff will adhere to in a consistent, accountable process.”
Ultimately, every group sends a representative to participate in the systemwide Guidance Council to discuss important elements of clinical care before policies are established—something that was done inconsistently (or not at all) in the past. “Standardization of quality reporting, universal access to images, peer review, and other protocols are now being established in this manner,” Maier says. “Business relationships with the groups are also the subject of an integrated and consistent program so that transparency and equal treatment for all radiologists provide for a more cohesive and beneficial process for the system and the radiologists.”
With a focus squarely on radiology, Maier and Baker have followed the nuances of health-care reform and how it applies to imaging departments. They view ACOs essentially as integrated HMOs under a different organizational structure.
Much as HMOs were originally intended to do, ACOs are designed to put accountability back in the hands of care providers as an integrated network. Maier points out that a lack of integration often leads to patients getting trapped in a cycle of referrals involving primary-care physicians, orthopedists, radiologists, pain specialists, and physical therapists.
“The time and cost to patients pile up,” Maier says. “Let’s integrate all of those parties so they are accountable to each other. Let’s coordinate care around patients, because the cost of providing imaging services can quickly get out of hand for patients who require multiple exams.”
With patients struggling to pay for costly imaging studies, Intermountain Healthcare officials also recognized that reimbursement rates from government entities and insurers would continue to go down, in the long term.