Imaging’s New Calculus: Balancing Quality and Productivity

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Chad CalendineJon GrimesOne of the most emotionally loaded conversations in imaging is that concerning efficiency and productivity. In recent years, these considerations have become increasingly vital to groups’ survival, according to Chad Calendine, MD, CMO of Optimal Radiology Partners and President of Premier Radiology (Nashville, Tennessee). “As peoples’ incomes began to decrease with decreasing reimbursement, they became more focused on how to regain that lost income, and the way to do that is through additional efficiencies and productivity,” he says. “It’s an emotional issue because it strikes to the heart of whether you are a good radiologist and a good partner. Are you pulling your weight?”

Complicating the issue is what those in the corporate world might term optics: the public perception of a business’ priorities. Jon Grimes, president and CEO of Optimal Radiology Partners, explains that in the case of imaging, the optics associated with the drive for higher productivity are negative. “When you talk purely about productivity and efficiency, it sounds like you have lost your higher calling with regard to patient care and have obviated it just to money,” he says. “It’s a taboo because it’s a difficult conversation to have with your partners and the public.”

Transparency and Taboos

Calendine cites that taboo (as well as the cultural issues underlying it) as an obstacle that radiology groups should work to overcome. “There are extremes at which it’s all about money, but there are also extremes at which your productivity is too poor to keep up with service,” he notes. “Radiology groups tend to be pathologically democratic, and in a purely socialistic environment, there is no consequence of lack of productivity. The problem is that you are rewarding a potentially bad behavior. People do what they are given incentives to do.”

Michael MorelandMichael Moreland, senior vice president of Optimal Radiology Partners, calls this particular conversation the third rail—for nonclinical professionals, that is. “From an administrative perspective, radiology groups are partnerships. You don’t want to attack problems with physician efficiency on an administrative level,” he says. “You need to have strong physician leaders and to get them the data they need to manage the issue.”

Calendine, Grimes, and Moreland agree that data-gathering and transparency are the best ways to make a subject that was once unmentionable part of a practice’s culture. “We have a real-time, unanonymized work-RVU dashboard present, throughout our practice, that is open and available to all partners,” Calendine says. “They can see their own productivity on a work-RVU basis and procedure basis, and they can see it for all of their partners.”

Quality can be similarly treated, Calendine notes. Optimal Radiology Partners uses RADPEER™ for 3% of its cases, and findings are reported on a quarterly basis to an internal quality-assurance committee. The practice also replicates the morbidity and mortality conferences common in medical residency to facilitate further transparency and discussion. “We show misses, undercalls, follow-ups, and exceptionally good calls,” Calendine says. “Those cases are displayed at our monthly group meetings so we can all learn from difficult studies.”

Cultural Change

Some might argue that this kind of transparency erodes morale, but Calendine believes the opposite. In fact, he says, it is this attitude that is at the crux of radiology’s current cultural conundrum. “This is a partnership,” he says. “Why would you not want the people who are owners of the business to have full access to and understanding of that information? The reason many people don’t address productivity concerns is to avoid conflict.”

Unfortunately, Calendine says, avoiding this conflict is more than a poor business practice: It is. itself, a hazard to morale. “In trying to avoid these conversations, you alienate the hardest-working members of your group,” he says. Grimes adds, “As the economics of radiology continue to get tougher and tougher, people will realize that this needs to be addressed. If it goes unaddressed, it’s as damaging for the radiologists at the top as it is for those at the bottom.”

The practice elected not to link productivity to income; as Moreland points out, productivity is already linked to income in a group partnership. “There has never been a financial penalty associated with inefficiency, nor have we given some people more money than others,” he notes. “It’s