Because there are not enough radiologists available to meet demand, practices must learn to make the most of radiologists’ available time, according to a paper presented in Chicago at RSNA 2008: Personal Learning in the Global Community. On December 3, Tracking Physician Productivity: Is It Necessary and How Should It Be Done? was presented by Fred Gaschen, MBA, CHE, executive vice president, Radiological Associates of Sacramento, Calif; Stephen Chan, MD, assistant professor of radiology at Columbia University, New York; and Richard Duszak, Jr, MD, a diagnostic and interventional radiologist with Mid-South Imaging, Memphis, Tenn.
The need for efficiency in radiology, they note, is only going to grow, primarily because the need for radiologists will continue to increase. Population growth, the ongoing introduction of new imaging technologies (with broader applications for established technologies), and the aging of the population are some of the factors indicating that demand for radiologists will continue to outstrip supply for the foreseeable future.
Reasons to Measure
The process of measuring productivity is typically undertaken, the presenters say, because radiology practices need some way to compare their output, either as an average (compared with other practices) or among the radiologists within the practice. Some practices may need comparative productivity figures in order to justify recruiting more radiologists to handle the existing or projected workload; for example, showing that the practice’s radiologists are already more productive than expected strengthens the case that adding radiologists would be better than increasing each radiologist’s current workload.
Some groups might simply need a way to track their productivity improvements over time, partially to reassure the radiologists that they are performing at a high level, but also to monitor the effects, over time, of changes in operational methods or information technologies that can enhance or reduce radiologists’ productivity. Other practices may want access to individual productivity figures so that they can push underproducing partners to put in more hours, boost their efficiency, or make greater efforts to increase their productivity.
Of course, measuring and comparing productivity are not simple tasks. Radiologists work under circumstances that can vary widely by setting, practice type, subspecialty, patient population, information and imaging technologies in use, customer expectations, and even regional lifestyles. If identical circumstances exist for comparison, productivity still changes over time, so comparisons may no longer be valid if a few years have passed. Over the past several years, for example, many radiology practices and individual radiologists have responded to financial pressures by improving their productivity levels.
The presenters identify four primary measurement sets that can serve to quantify work, as a starting point in productivity assessment. These sets cover procedures, revenue, time, and RVUs, and practices have used them singly or in various combinations.
Measuring procedures is direct and fairly straightforward, and correlates well with services actually provided. CPT® codes are relatively easy to use for this purpose. There are a few drawbacks, however, to using this method alone. It presumes that all services are equal in complexity, thereby giving radiologists an incentive to boost their productivity ratings by concentrating on low-complexity procedures such as reading chest radiographs. Clearly, this work is not the equivalent of stereotactic breast biopsy or interventional radiology, the presenters note.
The most easily measured indicator of productivity is revenue generated. Dollars show a radiologist’s financial effect on the practice directly, but the difference between gross charges and net revenues must be evaluated carefully in order to avoid mistaken impressions. Conducting studies for patients with better insurance coverage may produce more dollars without representing higher actual productivity, for example. Relying on revenue measurement alone can also create an incentive to focus on expensive procedures; the presenters say that radiologists in a practice that tracks only dollars could leave for last the same stacks of chest radiographs that would be first to be completed in a practice that measures only total procedures.
Time is readily measured as hours worked, but the