The Future of the Hospital-based Radiology Group

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Chad CalendineJon GrimesAs the demands placed on hospitals and health systems continue to intensify, the hospital-based radiology group will have to evolve to meet its constituents’ changing needs, according to Chad Calendine, MD, CMO of Optimal Radiology Partners. “It’s a story that is being written as we speak,” he says. “The underlying principle is that radiology groups need to be more aligned with their hospitals, and they have to be conspicuously and actively involved in helping the hospitals reach their goals.” This means doubling down on core competencies—which Calendine defines as the radiology group’s commitment to rapid turnaround times and 24/7 subspecialty coverage—as well as new areas of focus, such as deeper department-management roles. Jon Grimes, president and CEO of Optimal, says, “As hospitals move toward metrics-based scorecards in the radiology department, you need radiologist involvement in (and ownership of) that.” Ultimately, Calendine and Grimes say, the hospital-based radiology group should be positioned to support the hospital’s strategic initiatives and deeper accountability—while retaining its independence. Deeper Alignment Optimal is currently undergoing discussions with some of its hospitals about increasing its input into and responsibility for the management of their radiology departments, Calendine says. Areas of focus include how radiologists will help augment the hospitals’ Hospital Consumer Assessment of Healthcare Providers and Systems, or HCAHPS, scores—a growing concern for health-care organizations as reimbursement is increasingly linked to patient satisfaction. “At the end of the day, it’s the radiologist who has to make sure that the patient’s experience of the radiology department is timely, personal, and interactive,” Grimes says. “Patients don’t know who read their study or what the quality of the interpretation was, but they do know how quickly, efficiently, and personably they were treated.” Radiology groups also need to support their hospitals’ strategic initiatives by adding staff and reconfiguring workflows to accommodate new service lines. “More often than not, the hospital tells us what it feels the market needs or requires—for instance, if it wants to become a neuroscience or trauma center,” Calendine says. “We have to be sure we meet those needs. The hospital should see us as an advocate in developing its service lines, and we need to support that.” Alignment should not be confused with employment, however. In fact, Calendine and Grimes posit that the hospital-based group of the future will provide better service as an independent entity. “We think radiologists managing radiologists and partnering with other radiologists can provide better service than employed radiologists will, but there needs to be an additional level of accountability and responsibility. We think we can get there together, as radiology groups, and that’s preferable to becoming employed,” Calendine says. Grimes adds, “Hospitals primarily employ radiologists when they can’t get the service levels they’re looking for from a private group.” Appropriateness and Accountability Accountability will be key to the survival of the hospital-based group of the future, Calendine and Grimes agree. “In the past, measurements of accountability have been soft,” Calendine notes. “Now, as hospitals routinely query their medical staffs on satisfaction with radiology, and as patients routinely give feedback on the same thing, there will be a brighter light on accountability and performance than there was in the past.” Radiology groups should be preparing to increase their percentages of peer-reviewed cases, for instance, as well as intensifying their efforts to monitor discrepancies. Another emerging imperative is the tracking of radiologists’ follow-up recommendations. “There are some radiologists who always recommend additional studies, and anecdotally, it becomes a problem for a lot of practices,” Calendine says. “If there’s a radiologist who recommends follow-up studies on 30% or 40% of the exams he or she reads, that needs to be addressed.” Nothing less than the specialty’s relevance in the hospital is on the line, when it comes to accountability for imaging appropriateness, Calendine stresses. “Many larger groups, including ours, are now providing dose-sensitive protocols—broken out by type of scanner, patient, and indication—to all of their hospitals,” he says. “We need to play an active role in curbing utilization, and we encourage our hospitals to embed computerized decision support within their IT systems. We do anecdotal decision support in that if a hospital physician calls us, we’ll tell him or her what the appropriate study is, but the process needs to be more formal and exhaustive. Radiologists will either become more or less relevant, based on how much energy they put into participating in this.” In conclusion, Calendine says, while it’s tempting to believe that radiology groups have improved past the point where further improvement is possible, there is always a way to demonstrate ongoing commitment to the hospital or health system. “Be attentive to your hospitals, referring physicians, and patients,” he says. “Be aware of their needs, and always be increasing quality and decreasing costs. We haven’t reached the limits of either: No matter the practice or circumstance, there’s always room to evolve.” Cat Vasko is editor of and associate editor of Radiology Business Journal.