Looking Forward and Looking Back: On 20 Years in Imaging

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Darrell HulseyMark TalleyThe radiology industry has seen its shares of ups and downs during the past two decades. “In 1993, health care was in a period of chaos much like the one we are experiencing right now,” Mark Talley, COO of Medical Management Professionals (MMP), says. “The biggest fear was that everything would move to capitation. As time went by and things settled down, there was a period of rapid growth in radiology, primarily driven by advances in imaging technology.” G. Darrell Hulsey, president and CEO of MMP, concurs. He says, “Clinically, radiology has made significant advances in the past two decades, all contributing to better and more streamlined care.” David StoneTogether with David Stone, Hulsey and Talley are cofounders of MMP, which was launched 20 years ago, in May 1993. Stone, who is executive vice president of MMP, notes, “At that time, there was the potential for disruptive change, in terms of alternative payment methods. We are right back there again—except this time, the disruption is really going to happen. What made people successful in the 1990s, and what will make them successful again, is the ability to change and adapt to emerging payment and delivery methods.” Adaptability and Survival Having observed 20 years of industry upheavals, the three cofounders of MMP all point to adaptability as a critical factor in surviving change. “A tumultuous market will not define a company’s character, but it absolutely will reveal it,” Hulsey says. “Any strategy that is going to work, in the long term, has to be based on finding the right people (with the right character and work ethic) and then empowering those people to make decisions, every day, that drive the company toward achieving its goals.” Talley says that this kind of fluidity has proved essential to MMP’s business as radiology groups’ billing and revenue-cycle–management needs have evolved. “In the first 10 years, there was high demand for doing billing locally, and if there is a client that still would like its billing done on a local basis, we can do that,” he says. “Since the DRA, however, practices have been squeezed on reimbursement; billing can be done less expensively out of larger, regional offices, so we have focused the majority of our recent growth into several larger regional service centers. The lesson is to assess the market, see what it is wanting, and offer it.” Stone notes that part of adaptability is evolving to stay close to the customer’s needs, even as the business expands in size—a critical concern for practices facing a consolidating market. “As you get larger, as a radiology practice or a billing company, how do you maintain that feeling of being small enough to be close to the customer?” he says. “With all this consolidation occurring, practices should be paying attention to how to stay local, even as they become part of bigger organizations. They will have to stay attuned and listen actively to their customers’ needs.” Data-driven Future As the health-care marketplace continues to evolve, the three cofounders point to data as the primary means through which radiology practices will be able to understand their customers’ needs and stay receptive to change. “Your typical radiology practice is coming off of a period in which all it took to succeed was to keep up with fee-for-service reimbursement,” Stone says. “They were boom times. With different payment methodologies on the horizon, however, when it comes to negotiating effectively with payors and hospitals, the practices with the best data will win.” Hulsey agrees. “Of the world’s data, 90% were created in the past two years,” he says. “Right now, in health care, the data are disparate, but eventually, someone will put them all together and create outcomes-based measurement. That will be a behavior change for health care, focusing on how to serve patients best and how to capture those data points.” Specifically, Talley predicts, radiology practices will face an imperative to measure factors related to patient satisfaction and to report on those factors to their various constituents, including hospitals, delivery systems, and payors. “Radiologists need to understand that their role has changed; they are not just scientists providing an unbelievable service,” he says. “They need to think about patient satisfaction: quick turnaround times for exams and giving screening results before patients leave the imaging center.” Strategic Imperatives As successful strategists themselves, the three cofounders see a few imperatives on the horizon for radiology practices. Stone cites relationship building as a critical concern. “Groups have to refocus on relationships with an expanded list of clients—not just referring physicians, but also hospitals, health systems, and patients,” he says. “That list may also expand to include other forms of organizations, such as accountable-care organizations, or combinations of hospitals and payors. Radiology practices have to understand the needs of those organizations, even as they change forms.” Talley points to the pending influx of newly insured patients and the productivity and efficiency that accommodating them will require. “Having 30 million new patients is the biggest change that is coming,” he says. “It will force groups to look closely at their own productivity, to be sure everyone is working hard and fully used. Once the newly insured are getting screening exams, other care will follow from that as well. Those patients are in the system now, and the system will have to change to be able to absorb them.” Hulsey observes that all the tactical planning in the world is meaningless without the right culture underpinning it. “Radiology groups have developed this entrepreneurial sense of independence, over the years, and the groups that have exhibited that spirit have typically been more successful,” he says. “That same independence, however, may not be conducive to success in the current environment. Groups need to create a culture of accountability to one another and to the people they serve—of doing the right thing, even when no one is watching.” Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.