Redefining the Radiology Group: New Approaches and Roles

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Chad CalendineMichael MorelandAt the 2013 annual meeting of the AHRA, held in Minneapolis, Minnesota, Chad Calendine, MD, CMO of Optimal Radiology Partners, presented “Radiologist As the Chief Marketing Officer” on July 28. The focus of his session was how radiology groups can enhance their value and visibility to the rest of the health-care continuum; Calendine believes that radiologists should more aggressively market themselves to stakeholders ranging from patients and referring clinicians to hospital administration. “Radiology groups need a climate of dissatisfaction,” he says. “We tend to settle in and think the way we do things is the way it should be done. A climate of dissatisfaction means not remaining in the status quo and never missing a chance to build value.” Calendine observes that many radiology groups know that this kind of change is necessary, but have trouble “closing the gap between knowing and doing: turning potential energy into kinetic energy,” he says. To do so, he adds, groups need to develop concrete plans of action for the management of staff, of referring-physician relationships, and of hospital/health-system expectations. New Management Approaches To begin with, groups need “high expectations of the marketing role for all radiologists,” Calendine says. He emphasizes that no group’s position in its hospital is guaranteed, going forward, and he says that groups should assume that they are vulnerable at all times. “Do not underestimate the risk of inaction,” he says. “Look for ways to position your group for the future.” Critical aspects of that positioning are adding and demonstrating value. “In the future, there is going to be greater accountability,” he notes. “We want the best radiology experience possible for every patient. It’s going to affect where the patients want to go—and where their referring physicians want them to go. We have to improve our services to grow market share.” To that end, Calendine recommends that groups take steps such as making courtesy more important than efficiency and decentralizing the authority needed to make changes that improve patient care. “Patient satisfaction is fool’s gold,” he notes. “We have to go beyond it and aim for loyalty, not just satisfaction. Loyalty is born out of caring and compassion, not accuracy, new equipment, or decreased turnaround times. Competence is assumed.” Groups also need to give their radiologists incentives to develop collaborative relationships with other members of the care team—everyone from front-desk staff to technologists, nurses, and referring physicians. “Establishing good referring relationships has always been incumbent on the radiologist,” Calendine notes. “We need to increase our involvement through reporting of critical findings and unexpected nonemergency findings, as well as appropriateness consultations.” In short, radiologists need to view themselves as small-business owners—which, Calendine notes, is what they are. “Radiologists need to understand that this is part of the job,” he says. “Business isn’t as difficult as neuroanatomy. Just get out there, be a good person, understand how you make your money, and work hard to maintain relationships.” Emerging Roles To achieve true partnership with hospitals while maintaining independence, Calendine says, groups should be open to assuming new roles—both for individual radiologists and as whole entities. For instance, Optimal Radiology Partners is in the process of negotiating with one of its hospitals to take over radiology-department management. “The current proposal is to take over management entirely, and the reasons are twofold,” Calendine says. “One: I think we can do it more efficiently and save the hospital money. Two: We can generate additional revenue for the radiology group.” Under the terms of the deal, Optimal Radiology Partners would assume responsibility for managing the radiology department’s technologists, would work to streamline the patient-transport process, and would double down on decision support and clinical appropriateness. “These make for a better work environment for the radiologists and lead to more referring-clinician satisfaction,” he says. Michael Moreland, senior vice president of Optimal Radiology Partners, adds that taking on a managerial role emphasizes the radiology group’s commitment to partnership with the hospital. “A lot of hospital-based groups, historically, have made a very comfortable living just sitting back in their franchises and making money. Their attitude is that the hospital is there to serve them,” he says. “In the future, that will be a disadvantage. Radiology groups need to be ambassadors, helping their hospitals save money and achieve greater accountability.” Accountability is the byword of the Optimal Radiology Partners proposal, in which the group assumes the risk of bringing the radiology department in below the hospital’s anticipated expenditure level. “We will be paid whatever the hospital’s expense was minus a percentage, and we’ll provide metric-driven performance and service levels—no risk, no reward,” Calendine explains. Those measurements will include order-to-performance times and availability of services; one day, they might include initiatives with a more global scope, Calendine says. “The hospital has to feel comfortable that it is getting the service that it expects; then, we can look at lengths of stay and other initiatives that matter to the hospital, in terms of value-based purchasing,” he says. “We want to be able to tell the hospital that we can help it get wherever it needs to go.” By working hand in hand with hospitals to improve profitability (while enhancing quality), radiology groups can maintain independence and establish a more secure future, Calendine concludes. “We may lose money in the short term, but we have to take a longer view,” he says. “The dynamic between the hospital and the radiology group should be to ask, ‘What can we do together?’ If you act like a partner, you’ll be treated like one.” Cat Vasko is editor of and associate editor of Radiology Business Journal.