Practice–Health-system Alignment in Developing the Outpatient Imaging Network
michael_morelandWhen Saint Thomas Health (Nashville, Tennessee), a member of Ascension Health, decided to collaborate with locally headquartered practice Optimal Radiology Partners (ORP) on an outpatient joint venture, its primary motivation was providing more convenient service to patients and physicians, and, therefore, growing market share, according to Tom Blankenship, chief development officer for the partnership. “We also did our ambulatory surgical centers through joint ventures with physician partners,” he notes. “If you can find a partner who’s better at something than you’ve been able to be, that makes more sense than competing with it.” The success of that partnership inspired a similar arrangement between Optimal Radiology Partners and another Ascension Health member: St Vincent’s HealthCare (Jacksonville, Florida). Michael Moreland, vice president of ORP, says, “A lot of health systems and hospitals are seeking their own aligned outpatient-imaging networks. Utilization is only going to continue to increase, and many of those studies are most appropriately done in an outpatient setting.” For radiology groups, joint ventures for outpatient imaging allows health-system alignment without loss of independence: a win–win situation, in today’s evolving health-care markets. Chad Calendine, MD, CMO of ORP, explains, “As a practice, we know the health systems are going to be thriving in the future. We need partnership with them for long-term survival. The health system needs touchpoints throughout the community in order to grow, and this is a good strategy for developing an outpatient imaging network.” Partnering for Optimal Care Gretchen Guess is director of the ambulatory-care service line for St Vincent’s HealthCare; in her previous role, she oversaw two imaging joint ventures between the health system for which she worked and its radiology groups, and she is well aware of the advantages of this approach. “We don’t need to own everything ourselves,” she says. “We’re always looking for partnerships with the right providers who want to serve the community. We know that in trying to care for our patients in the best manner possible (providing the most efficient care, with highest quality), we need to provide care across the continuum.” In the cases of both Saint Thomas Health and St Vincent’s HealthCare, the health systems saw an advantage in making full use of independent radiology-practice expertise with stand-alone imaging. “In the experience of Saint Thomas Health, it was only able to offer outpatients other imaging services inside its hospitals, which were usually large, congested, and inconvenient,” Blankenship recalls. “That meant losing market share. It needed to identify some type of more convenient alternative to meet the needs of both patients and medical staffs.” Guess concurs, underscoring the distinction between hospital-based and standalone imaging. “At my previous job, we had both: a standalone independent diagnostic testing facility (IDTF) that we were running, and one that the radiologists were running,” she says. “I’ve seen both management models. Both hospitals and radiologists can run them, but they should understand that standalone facilities need to be run in a different, more retail-like manner.” Business Ramifications The business advantages of these partnerships for health systems can be substantial, especially as consumerism becomes a growing factor in patients’ health-care decisions. “Some of the advantages are purely logistical, but they really make a difference to patients,” Guess notes. “Stand-alone imaging centers often can be more nimble for the customer because their underlying structure is not to serve the hospital.” For health systems, the key question should be whether they feel that they can manage an outpatient imaging network as efficiently and effectively as a radiology group can, Guess says. “Radiologists are in a small group of physician types that we can legally do business with, and every health system tries to determine whether owning or partnering is the right path to take, based on the economics of its market,” she says. “For some health systems, the answer is owning the whole continuum of care. As our health system grows, we’re open to multiple ways of partnering and affiliating.” Guess expects the more customer-centered approach to outpatient imaging services made possible by the joint venture to enable the health system’s network to grow. “We’re here to serve people when they need to be served, but that can throw off our operating-room and imaging schedules—and thus, timing and customer service,” Guess says. “Stand-alone imaging, on the other hand, has the nimbleness needed to meet the evolving needs of our community.” Moreland also highlights the fact that—depending on the local market’s dynamics—partnership with a radiology group can eliminate competition for the health system. “Groups that own their own outpatient imaging may be in conflict with the hospitals,” he says. “Alignment eliminates that problem and turns a competitive advantage for the radiology group into a competitive advantage for the hospital.” Guess observes that relationships between radiology groups and health systems break down longstanding silos between providers, meeting one of the most prominent goals of health-care reform. “As hospitals evolve into health systems, we want to be able to partner with our radiologists, so that our employed physicians have specialists they can collaborate with,” she says. “We’re all trying to move beyond the stovepipe system we’ve had in the past. Our approach is to let everyone do what he or she does best.” Cat Vasko is editor of and associate editor of Radiology Business Journal.