The Evolving Radiologist-hospital Relationship

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It was the contract termination heard ‘round the world when Florida Radiology Associates (FRA) ended its 40-year relationship with Florida Hospital last year. Negotiation of a new contract barely got off the ground before the hospital formed its own in-house radiology group, poaching the majority of FRA’s staff. The incident raised eyebrows in the imaging community, highlighting tensions between hospitals and radiologists that have simmered for years as teleradiology groups increasingly displace local radiologists and hospitals attempt to streamline operations by bringing radiology in-house.

For Richard Helsper, MBA, bringing radiology in-house has been a boon to imaging operations. Helsper is vice president of operations for Clarian Health Partners, Indianapolis, and he oversees the health system’s 13 outpatient imaging centers, which are staffed by an 85-member radiology group that is a wholly owned subsidiary of Clarian.

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Bill Pugh, CFO

“The group became a wholly owned subsidiary in 2003,” Helsper says. “We saw that within a single hospital with multiple facilities, there was competition between the two radiology groups for business. By putting them on a shared-governance process, we’ve been able to expand internally.” This shared-governance model has allowed the application to radiology of quality and safety metrics determined not only internally by the managerial team, but also by referring clinicians and patients.

“We focus on four pillars of quality: what we do, people development, fiduciary responsibilities, and service,” Helsper explains. Clarian measures its success using physician, staff, and patient surveys.

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Richard Helsper, MBA

The consolidation has also enabled Clarian’s radiologists to serve multiple locations, streamlining the staffing process for a rapidly expanding health system. “Clarian now has affiliations with or owns 18 hospitals in Indiana, and in six years, we’ve opened three new hospitals, expanded at University Hospital, Indianapolis; started working on a Tower expansion at Riley Hospital for Children, Indianapolis; and acquired several other hospitals,” Helsper says. “Our radiology group was staffing five Clarian hospitals, and it added a sixth on July 1.” It also has a relationship with a seventh hospital to provide night coverage. Helsper continues, “For community-based hospitals, it’s comforting to know that if they needed to, they could make a phone call and have a subspecialist take a look at a case.”

The results have been increased volumes, revenues that Helsper estimates have risen 240% in six years, and nearly twice the RVUs. “It’s enabled us to grow aggressively, and at the same time, our service expectations are up, and our quality expectations are up,” he says. “Because of Clarian’s purchasing power, combined with the physicians in the Indiana University School of Medicine, we’ve been able to be very creative, resulting in Clarian being a technological leader.”

Bill Pugh, CFO of Pinnacle Health, Harrisburg, Pennsylvania, does not have an in-house radiology group, but his idea of an ideal relationship between Pinnacle and its radiologists sounds much like the Clarian model. “The payment reform coming down the pike is going to require all hospital-based physicians to work more closely with the sponsoring hospitals,” he says. “My only concern about the future involves those radiology groups who see their autonomy as being more important than a long-term relationship.”

Pugh says that he would consider bringing imaging in-house in the future. “I think we’d be interested in an employed radiology group,” he says. “It’s all about developing a more cooperative relationship, having economic alignment going forward, and being on the same page in terms of the risk involved with investing in a new technology in this area.”

Helsper characterizes Clarian’s relationship with its radiologists as collaborative and friendly—and the shared-governance model has been so well received that Clarian is now bringing all its subspecialists under the umbrella of a new group called Indiana Clinic. “This is really a step in the direction of a truly integrated health plan,” he says. “We’ll remove all the economic drivers so that our focus will truly be on patient quality standards. Radiology was one of the early adoptees, and one could argue that the Indiana Clinic is partially inspired by the success we’ve had as a result.”