On October 1, 36 states launched new health-insurance exchanges, beginning the influx of new patient volume for which the health-care community has been preparing itself since the passage of the Patient Protection and Affordable Care Act. For radiologists, who have been trying to redefine themselves in the eyes of patients for several years now, these new customers represent a once-in-a-lifetime opportunity, according to Harry Purcell, operations manager for Zotec Partners. “Radiologists have the chance to reinvent their image as more high-touch and integrated,” he says. “It will be key for forward-thinking groups to start making changes now.”
Purcell identifies four key areas in which radiology practices have the opportunity—not to mention the tools and resources—to redefine their brands. All four, he says, have a single concept in common. “We have to start integrating practice improvement standards in a more consistent manner,” he says. “With greater consistency, patients will receive better service and care; referral sources will receive better information. As the volume of patients continues to increase, consistency will become key.”
Care Delivery and Quality
The first opportunity for improvement that Purcell cites is care delivery. “For many of the radiology groups I work with, the focus now is on improvement of quality improvement and delivery of that improved care,” he says. “Groups are developing strategies around the protocols for their procedures, templates for their reports, and patient flow.”
These initiatives are fueled by the explosion of data generated and managed by today’s progressive groups. “With the data they have now, practices can see where there are shifts in the intensity of their services, making it possible for them to staff better and optimize turnaround times,” Purcell says. “That is a real benefit, not just to the efficiency of the radiology group, but to the organizations ordering the studies as well.” For instance, he says, hospitals working to reduce their readmission rates will see positive change as a result of certain conditions being identified sooner.
Radiology groups can also use internally generated data to develop consistent templates for reports. “One institution can have innumerable ways of defining a CT of the chest,” he says. “When radiologists develop universal protocols and templates, their referral sources are better able to manage patients.” Purcell also points to the growing prevalence of clinical decision-support tools as a step in this direction. “CDS may help to manage a higher volume of patients in a manner that also provides a higher quality of care,” he says.
Radiology groups should also enhance their outbound communication (that is, communication with both patients and referrers) by taking advantage of programs such as meaningful use, Purcell says. “Many practices have a wait-and-see attitude about this, and that may be a mistake,” he observes. “Even though they can delay complying with meaningful-use requirements until as late as 2020, what they may be neglecting is the opportunity to manage radiology results better—to share reports electronically with patients and referral sources. They may lose market share by not acquiring that capability now.”
Patients who decide for themselves where to get their imaging exams—a growing group—may come to expect rapid electronic delivery of results, Purcell says. More to the point, so may referrers, who could redirect volume to radiology groups that can give them what they want. “If you are not on the forward edge of this initiative, you may find yourself behind the curve,” he emphasizes. “Patients and referrers want—and need—improved access to information.”
Billing and Payment
A common misconception regarding the incoming new-patient volume is that it will consist primarily of Medicaid enrollees. In fact, Purcell says, many of these patients—particularly in states that did not expand their Medicaid programs—will have purchased commercial plans through health-insurance exchanges. “Another important consideration for practices is how carriers are going to deal with individuals coming through the exchange systems,” he says.
Payors might ask radiology groups to give them Medicaid rates for all of these patients, Purcell says, on the grounds that they will be part of a majority-Medicaid group—a premise that just is not true. “Radiology practices need to let their payors know that they