Investing in Radiology IT: The Practice Perspective

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This article is the second in a four-part series. To read the first article, click here. neal_petersonRadiology practices trying to prioritize their IT investments must consider the needs of multiple constituencies in order to make smart decisions. While the needs of referrers—and increasingly, patients—are important, the practice must also look at its own internal technology needs to make investments that serve its strategic goals. In today’s radiology market, that technology must provide the practice with an on-demand snapshot of its performance and enable it to benchmark that performance against itself and against similar practices to establish targets, according to Neal Peterson, director of client development for Medical Management Professionals (MMP). “When radiology groups were making money hand over fist and could not lose, no matter what, decision making was a looser process,” Peterson says. “The climate, especially the downward pressure on reimbursement, is the reason that practice technology is so much more important now. All the radiologists want the practice to have this technology, and they want to have access to it.” Dashboarding and Benchmarking Practice-management technology would, ideally, offer radiology groups three levels of data, according to Peterson. He describes dashboards, the first level, as a transparent window into the billing operation: “Your dashboarding is going to provide topical, day-to-day, key performance indicators,” he says. “It will reveal whether someone is only running charges on the last five days of every month, or whether there is a coding lag. It is not for the radiologist partner to micromanage, but it offers some comfort that the group is on track, at any given point in time.” Next, Peterson says, is the level at which benchmarking occurs. Data points to benchmark include productivity levels, volumes/procedure counts, charges, reimbursements, and RVUs; practices should compare these measurements with their own performance in the previous year. “Everyone wants to think that the best way to benchmark is against other groups like yours, but the most important thing is to benchmark against yourself,” he notes. “No one else has the exact challenges, payor mix, modality mix, or hospital systems you have. Quickly benchmarking where you are now against where you were last year gives you insight into how your practice is doing.” Benchmarking against other practices can be useful as well, but is made more difficult by the scarcity of data. Nationwide billing providers such as MMP, Peterson notes, have access to the data from an array of practices, which can be anonymized and matched against the characteristics of a given group to yield useful information. “Local benchmarking will be your best because it shows the same payors and similar volume,” he says. “Reimbursement should be compared against your own practice, against other local practices, and against national benchmarks.” He continues, “The national benchmarks are great for practices to see that their struggles with bundling, decreased reimbursement, and costs are not singular, and that everyone is experiencing similar pains. Your group may have taken a 3% hit for CT bundling, but looking across the country, that average could be closer to 6%, for many groups. National benchmarking is more of an exercise in perspective. ” Radiologists are increasingly benchmarking themselves against their fellow physicians, within their practices. “This can become political, so you want to have the ability to blind the data,” Peterson says. For instance, looking at procedure volume might make one physician appear more productive than another, while RVUs might tell a different tale. “The information can be contentious. You may have a plain-film radiologist operating at 1,600 procedures a month, while an interventional radiologist is doing 200. When you convey that in RVUs, however, it is a different story,” he says. Each group has to decide for itself how revealing it wants to be about radiologists’ performance, Peterson adds. “We often talk about transparency from a billing perspective, but there is also transparency within the practice to address: What is everyone doing in terms of productivity or reimbursement? That is a political issue within groups,” he says, “but when groups are using these data for compensation, it becomes very important to offer quick access to the data so physicians can know where they stand.” Granularity and Access As Peterson’s comments highlight, offering radiologists on-demand access to information is increasingly critical—especially at the third level, which is that of highly granular information broken down by physician, location, modality, and/or CPT® code. “At this level, you are going further and further down the rabbit hole,” he says. “As a radiologist, I may want to know how many vein ablations I did during the month of January at a given hospital, compared with the same figure from last year. Then, I might want to stratify that by referrer to see who is sending me these high-dollar procedures.” Offering physicians access to this level of data enables them to be more agile in their decision making, Peterson says, but only if they can find the information quickly, when they need it. “If a physician asks for something and it takes a week and a half to get it to him or her, there already is another decision to make,” he says. “The key is being able to get the information in a timely manner, so as to make the correct decision.” Mobile access to this information (through Web-based portals) is an emerging need for that reason, he says. Data should also be formatted in such a way that they are immediately comprehensible: “If you have a Microsoft Excel spreadsheet with 150,000 CPT codes on it, you will not be able to make heads or tails of it. These data have to be in a concise format that is usable, so the physicians can make better decisions,” he explains. Agile decision making matters to radiologists on both personal and professional levels, Peterson continues. “The speed of access is a big part of what has changed, with regard to these data,” he notes. “We used to have access to the data, but nobody cared—what do RVUs matter, until Medicare becomes 50% of your payor mix? Now, radiologists want to know if they stand to make $20,000 less next year if Medicare changes the RVU weighting in their reimbursement equation. This information is key to making decisions, not just on the practice-health side, but individually, in their personal lives.” For these reasons, practice-management software must be carefully evaluated to ensure that it meets the scope of the practice’s needs, Peterson concludes. “In today’s radiology market, there are definitely going to be winners and losers,” he says. “The physicians who embrace this and change their business model accordingly—the ones who look at these data and make proactive decisions based on them—are going to be the winners.” Cat Vasko is editor of and associate editor of Radiology Business Journal.