Evaluating Radiology’s New Revenue Streams

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In January 2008, the ACR® appointed a task force to research and report on the efficacy of the increasing number of value-added services in radiology. Citing a rapidly changing business landscape for radiology services, the blue-ribbon panel was charged with the task of evaluating and providing insights into the value of evolving and novel business models for the practice of radiology. Its findings¹ are reported in the October 10, 2009, issue of Journal of the American College of Radiology: JACR. In determining the focus of its research, the task force evaluated two variations on the new radiology business models. One was based on additional activities related to the usual practice of medical image interpretation. Here, the committee recognized the value of radiologist involvement in ordering, examination design, and discussion of examinations and results with patients. The other variation reviewed was a described as a nontraditional role that can add value in novel business models. A theme central to the report was that radiologists must be positioned as highly qualified experts whose role in patient care goes far beyond the job of interpreting medical images. Also present in the report is a growing concern over the commoditization of medical imaging. The commoditization issue was addressed by urging review of new business models not only for new sources of value but also for potential losses of value. In other words, if commoditization of radiology can occur through outsourcing low-cost night coverage, that reduces the core value of a radiologist’s true worth, which could result in an altered impression being held by patients, referrers, and other key stakeholders. Enhancing Traditional Services The task force then addressed ways in which radiologists can enhance traditional services to add value. These are ways in which the traditional role of the radiologist gains a higher profile with patients, referrers, and the community through greater involvement. At this time, for example, the ACR is encouraging radiologists to meet with at least five patients per day. Not only do these patient meetings add value to the radiologist’s role, but they also lower the chances that the radiology group will be replaced by an outside vendor. On the professional side, the ACR recommends that radiologists call five clinicians per day. This activity does more than provide support for the enhanced image of the radiologist; there is an increasing likelihood that referring physicians will have a significant or enhanced role in how radiologists are paid. Essential to the success of the new radiology business models are the inclusion of quality components. Among those recommended are more face-to-face meetings, such as radiology morbidity and mortality conferences (to raise credibility), and the use of next-generation quality systems, such as a national, anonymous peer-review system, perhaps mediated through the ACR Imaging Network®, that could provide greater accuracy and better national standards. Clinical conferences were also suggested as means of providing professionals with a heightened awareness of the role of the radiologist in the overall delivery of high-quality care. New Revenue Options Acknowledging that nontraditional business models are often resisted by radiologists, the task force identified several key areas for revenue growth outside the traditional model (which is generating more scan volume in order to generate more revenue). The first is radiology utilization management, which follows a trend in overall imaging use. In August 2009, Mark Miller, PhD, executive director of the Medicare Payment Advisory Commission, testified on the growth of Medicare physician payments for diagnostic imaging. According to Miller, from 1999 to 2003, the per-beneficiary level increased by 45%, more than twice as much as for all other physician services. Some of the increase is attributed to a sharp rise in self-referrals; some, to defensive medicine. Other reasons include the increasing clinical usefulness of imaging technology, a growing reliance on medical imaging as a replacement for physical examinations, patient demand for advanced imaging, and a rising percentage of elderly and chronically ill patients. Despite what might be perfectly understandable reasons for the increase, commercial payors have increasingly relied upon radiology benefit management (RBM) companies to hold down costs. In response, the ACR task force suggests that radiology practices and radiology entrepreneurs with sufficient data-mining capabilities meet with their local payors and develop their own criteria, instead of submitting themselves to arbitrary criteria put forth by external utilization managers. In doing so, radiology practices might be able to bypass the RBMs and recapture some of the revenue that would have gone to such companies. The second option for increasing revenue is managing quality—that is, capitalizing on the possibility of a local radiology practice meeting with payors and establishing quality criteria that could create nontraditional revenue if the practice performs a quality audit for a set fee. “Up to 10% of all radiologic procedures are performed as retests because prior examinations were unavailable to health care providers at the time the health care services were rendered,”1 the task-force report notes. Storage and access to priors have proved troublesome, however. In response, a cottage industry providing external data storage has grown into a lucrative business. Here, the ACR suggests that individual radiology departments might be able to find new ventures partnering with storage companies, or might have opportunities to consult with companies designing products for this line of work. The fourth nontraditional revenue opportunity is risk-management consulting. After evaluating their lawsuits, radiology departments can begin to construct and deploy risk-management strategies to minimize their medicolegal exposure. Radiology departments that track their lawsuits can begin to categorize the reasons that such lawsuits occurred. This can then be used as the basis for a consulting operation. The task force found that most radiology practices have a least one radiologist working with a plaintiff’s or defendant’s attorneys in reviewing images, medical records, and depositions for medical malpractice lawsuits. It is surprising that the group also determined that these engagements can sometimes generate more revenue than the clinical work performed by a radiologist, compared on an hour-by-hour basis. Additional Opportunities The task force listed several other revenue-maximization opportunities that might not generate the volume of the four just described, but that are, nonetheless, options worth exploring. They are:
  • providing daytime teleradiology services for off-site imaging centers, smaller medical facilities, prisons, and Native American reservations, among other clients;
  • conducting independent image analysis for pharmaceutical development, acting as a surrogate endpoint imaging resource for measuring drug efficacy in clinical trials;
  • consulting with academic and nonacademic departments on a range of issues; and
  • being part of imaging center joint ventures for academic medical practices.
As medical imaging continues to evolve, new opportunities to enhance the role of the radiologist in patient management, as well as unforeseen entrepreneurial opportunities, will contribute to the growth and value of the profession. Steve Smith is vice president, client services, imagingBiz, Tustin, California.