Building a Better Radiology Group

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Howard Kessler, MDWhat will the radiology group look like in five years, and how can today’s groups position themselves not only to survive, but to thrive? These are the key questions on the imaging industry’s mind as reimbursement rates continue to decline, regulatory changes create enhanced oversight, and the pressure to capture business mounts. Howard Kessler, MD, of Union Imaging Center in Union, New Jersey, takes the optimistic view: He predicts that five years down the road, groups that make intelligent, strategic decisions now will see ample returns. “Groups will do well if they look at emerging opportunities as ways they can achieve more efficiency and greater productivity,” he says. Locke Barber, DOKessler is not alone in envisioning substantial opportunities for traditional radiology groups—if they can evolve toward maximizing their resources. Improving productivity will be critical to groups’ survival, according to Locke Barber, DO, of Kennedy Health System, Voorhees, New Jersey. “More and more groups are moving toward a payment model based on productivity,” he notes. “People are comfortable in the way they always practiced radiology, but it’s not good enough anymore—other groups may come in offering better interpretations at reduced costs, and hospitals have good reason to be open to that.” Timothy Myers MDTimothy Myers, MD, an affiliated physician with Virtual Radiologic (vRad), a leading national practice, says, “If we look at what we’re seeing for the road ahead, groups are getting larger. Growth is always an iterative process—it’s never a nice, smooth curve. In order for groups to evolve, they’ll need to find innovative ways to optimize their resources.” The Business Balance Repositioning should not be approached lightly, Kessler cautions; instead, it should be driven by strategic decision making that anticipates the needs of the market, including better service, provable quality, and increased subspecialization. “Groups that are forward thinking and insightful will come up with methodologies to measure quality of care and quality of service,” he observes. Barber adds, “When we provide more subspecialty ability, hospitals can develop service lines around that, or we can support service lines they’re developing. That’s a way to maintain current contracts and get other contracts: be indispensable.” The imperative to evolve presents a fresh set of challenges, Myers notes; prime among them is adding subspecialty ability as needed by new clients, not as available within the group. “Groups may not immediately have the kind of subspecialty expertise they need, or they may have it, but be unable to access it immediately; their new imaging-center client may want to add orthopedic MRI, but their current musculoskeletal radiologist may be fully occupied,” he says. Kessler observes that groups in evolution take on a significant administrative and governance-related burden—one for which it is critical to be prepared. “Groups will have to take a long, hard look at themselves, taking a very critical approach to trimming the fat from their system,” he says. “Very few people consider how time consuming and costly this can be, and how much due diligence and effort they will put into this. If it’s not well thought out and properly executed, it will become a distraction to the performance of radiology.” Barber adds that it’s vital for groups to maintain their existing relationships throughout the process. “I think the key is to be as diversified and as open minded to the potential for change as possible,” he says. “Groups need to keep good relationships with their hospitals and stay on their toes.” Building a Better Group To position themselves for the changes to come, groups should consider aligning themselves more closely with payors, Kessler suggests. “The holy grail for practices is developing meaningful relationships with payors—and that’s not just based on size or geographic coverage, but the metrics and methodology for demonstrating quality,” he says. “If practices don’t do this, radiology benefit managers or other third parties will. There has to be a healthy dialogue.” Relationships with companies providing value-added services for radiology can also help build a foundation for the future, he adds. “Groups will have to dedicate time and resources to looking into these new opportunities,” he says. “The groups that don’t do well will be the ones that either bury their heads in the sand or rush into things at breakneck speed. These changes always create opportunities, and that can translate into a better lifestyle for groups: more money, greater stability, and the ability to diversify.” Groups trying to solve the seemingly insoluble equation—building their businesses while maintaining their existing relationships and improving service—should consider new solutions, such as working with a teleradiology provider like vRad, as part of a resource-optimization strategy, Myers says. “In today’s marketplace, it’s a struggle for groups to grow on their own, but if we can help them by providing the subspecialty coverage they’re missing, that allows them to play at a higher level,” he adds. “We can free the group that wants to be more aggressive from having to be concerned about providing difficult or uneconomical coverage, and we have the ability to work more closely (and in a more integrated approach) with groups.” He adds that groups must select their partners intelligently, seeking those “with the right strength, stability, and ability to get the job done. Partnering with the group across town, or in the same part of the state, doesn’t necessarily give you the strength you need to make sure everything is covered appropriately,” he says. “We can supply—on a dial-up, dial-down basis—whatever extra coverage a growing group needs. That’s our greatest strength.” Kessler concludes that groups must remain nimble in the coming years, adapting themselves to their environment as quickly as it changes. “Groups should have both short-term goals and long-term expectations,” he says. “Radiology can’t bury its head in the sand; it has to evolve.”