Improving Hospital-based Imaging Service

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Milan diPierroBob OldfieldThe pressure is on for hospitals to improve their imaging customer service. CMS is poised to begin linking 1% of annual reimbursement to improvements in patient-satisfaction scores; meanwhile, it is imperative that hospitals aggressively grow profitable service lines like imaging to combat declining reimbursement and utilization. Hospital-based imaging centers seeking to grow their outpatient volume by improving service, however, will encounter a unique set of obstacles not faced by their freestanding peers. Without engaging the referring-physician base, they will find themselves only reaching one segment of the community, leaving valuable market share on the table while failing to capitalize on huge investments in equipment. It is possible to overcome the traditional hospital mindset to provide outstanding outpatient care linked with a high level of customer service, but doing so requires a very different approach from that employed at freestanding imaging centers. Unique Challenges The principal challenge faced by hospital-based radiology staff is balancing the needs of three different patient groups: outpatients, inpatients, and patients coming from the emergency department. For obvious reasons, inpatients and patients in emergency situations naturally attract the majority of the focus in the hospital environment; because they have more acute and immediate needs than outpatients have, providing inpatients and emergency-department patients with an exceptional care experience is a full-time job. As a result, hospital-based imaging facilities tend to be organized around providing optimal service for these two patient groups. Unfortunately, optimizing outcomes and maximizing profitability for inpatients and emergency-department patients is often counterproductive to doing the same for outpatients. Very few hospitals were built with an outpatient mindset, and although hospitals have both the infrastructure and the resources in place to provide market-leading outpatient services, they often do not understand how to leverage these resources in a way that maximizes the outpatient experience. When it comes to imaging, hospitals already experience a serious disadvantage when competing with independent imaging centers: price. This puts an even higher premium on the customer experience, since differentiating themselves on price alone is not likely to be an option for many facilities. Although outpatients are not likely to be experiencing the same acuteness levels as inpatients, their presence at a hospital-based imaging center is more choice driven. If they have bad experiences, they are less likely to return, and they might spread the word to the physicians who referred them there, cutting off a source of potential future referrals. Assessing Service Issues An example of an oft-overlooked hospital resource for improving service is the physician liaison. Many hospitals employ at least one physician liaison, whose role is to open the channel of communication between the facility and its referrers, but we have observed that this staff member might be so caught up in hospital-based activities that he or she has fallen short in communicating with referrers. In contrast, the medical-marketing staffs of independent imaging centers actively reach out to referrers and promptly address any problems that they might have. Hospitals are failing to compete with the highly trained, professional medical marketers employed by independent imaging centers, leading some to try to leverage their physician liaisons to fill this role—but hospitals frequently underestimate the levels of focus and intensity required to compete for market share. Face-to-face communication with referring physicians is of the utmost importance, and frequency matters. It has been our experience that physicians will decline to cite a service issue the first (and sometimes, even second) time they’re asked; they will wait until they feel a level of attentiveness and trust from the hospital representative to share opportunities for improvement, and this takes repeated, in-person communication to establish. Equally important is maintaining this trust. Demonstrating your facility’s responsiveness (by letting referrers know that their complaints have been heard and by sharing how you have addressed the issues at hand) is critical, and soliciting feedback will help you identify areas for further improvement. Just as medical marketers for independent imaging centers seek to customize referring physicians’ experiences, so physician liaisons should help hospital-based imaging centers understand what is needed to keep referrers satisfied. The Retail Mentality Scheduling is a critical area of vulnerability for many hospitals; independent imaging centers offer a range of scheduling options, while many hospital-based imaging facilities do not. By tracking physicians’ preferences and allowing them to select the scheduling mechanism that represents the path of least resistance for them, you can demonstrate a commitment to exceptional service. Another area of opportunity for many hospital-based imaging facilities is results delivery. Again, communication with referring physicians is paramount, and tracking their preferences will enable you to deliver the kind of customized service more commonly associated with independent imaging centers. In both of these cases, hospitals often neglect to accommodate referring physicians’ needs because of a lack of what we call the retail mentality. With a retail mentality, a facility is willing to spend money to improve service, with the goal of incremental revenue gains (as opposed to sudden windfalls). As an example, when a hospital invests in an online ordering system, it might expect to see an immediate return on investment that can only be achieved by forcing all referring physicians to use the system. Forcing physicians to accommodate the hospital’s needs, however, rarely grows volume or improves relationships. In a retail mentality, businesses seek to establish lasting relationships with customers by aligning their operations to deliver on their service promises—and they understand where the bar has been set by the competition. Hospital-based imaging facilities cannot dictate to referring physicians or patients how they are going to work with them and expect to receive high marks on service because the bar has been set higher by their independent competition. A retail mentality also requires an understanding that gains in volume and revenue as a result of service improvements will be slow, but steady. This makes tracking return on investment (on a granular level) critical to understanding whether an initiative is working. Our data indicate that treating outpatient business with a retail mentality can ultimately result in increases of up to 60% in outpatient exam volumes. By understanding the unique needs of outpatients and the physicians who refer them, and by working to accommodate their requirements, hospital-based imaging facilities can effectively compete with their independent peers, gaining market share and growing profitable exam volume. Milan diPierro is COO of Ivy Ventures, LLC, Richmond, Virginia. Bob Oldfield is a partner and head of business development for Ivy Ventures.