Feature | September 17, 2009

Four Key Success Factors to Operating in the Post-DRA Era

Imaging centers leverage IT to recreate business, build success.

It began in 2006 with dramatic reductions in reimbursements for outpatient imaging procedures brought about by the Deficit Reduction Act (DRA.) Some believed the end of outpatient facilities was at hand. Yet in working with imaging centers nationwide for more than 15 years, I’ve seen organizations that have not only survived, but actually thrived through changes brought about by the DRA. A common thread among these success stories has been the pragmatic leveraging of IT as an essential business tool in order to adapt to a changing business environment.
Imaging centers that have had the most success since DRA have been pleasantly surprised to find out how technology has actually helped them. Today, these entities are facing new challenges. The credit crisis has hindered big projects, the influence of radiology benefit management companies (RBMs) is increasing across the country, and legislation continues to focus on imaging reimbursement cuts. However, when an IT solution is applied with foresight and common sense in an imaging practice, it can be used to strategically improve business.
To help offset DRA reimbursement reductions, practices focused on two obvious business levers: reducing operational costs and increasing study volumes. By reviewing and refining the use of information technology, an important first step was taken. Simply put, centers who quickly revised their IT strategies were in a far better position to handle DRA than those who put it off. When presented with a system or technology that was capable of meeting specific goals, the value and benefits far outweighed the initial cost.
Today, imaging organizations across the United States are re-evaluating business needs and aligning information technologyto focus on four critical areas in order to run a profitable business — especially in today’s climate of declining reimbursement.
Business Analytics
If you can’t measure it, you won’t be able to improve it. Whether your IT solution is on-site or hosted, it should deliver tools that transform raw data into meaningful information, including the ability to drill down to detailed data (i.e. location, radiologists, rooms, insurance carrier, referring physicians, procedures, turn times, fees, etc.). Sometimes, organizations are unaware this capability exists or they may have not fully implemented their solution to optimize this functionality.
• Data Capture and Analysis – When tracking, interpreting and using unbiased data, you can proactively recognize changing business conditions, and use this information to guide efforts to adjust or realign tactics in order to meet business goals. A robust analytics solution should enable you to establish key metrics for tracking and comparing your performance against referring physician expectations, industry standards or competitors. Systems that can chart data are especially helpful, as the information is presented in an easy-to-understand format, even for executives without business analytics expertise.
• Operational Efficiency – Most imaging centers grapple with a difficult operational challenge: identifying how much time to allot per exam. Schedule too much time, and you lose out on potential additional exams that day. Schedule too little time and you have unhappy patients crowding your waiting room. Many of today’s progressive practices are implementing more robust RIS systems (either on-site or hosted.) These solutions can capture and organize key metrics that help optimize per-exam time allocation. Moving away from block scheduling on the hour or half-hour can help practices improve room utilization and keep waiting room capacity to a minimum.
• Expansion Decisions – As your practice grows, you will hopefully face the “good problem” of adding modalities and/or sites. A robust business analytics system can capture the data necessary for benchmarking and ongoing monitoring that will help you decide when and how to expand.
Referring Physician Satisfaction
Stay ahead of your competition by giving your referring doctors a convenient way to interact with your office and secure information. Flexibility and communication are critical.
• Accessibility – Portal technology is replacing the manual processes involved with report generation and distribution. By offering a portal, you give referring physicians and their staff members secure, online access to patient-specific reports and images directly from your system. The number of calls a referrer makes to request reports is dramatically reduced (and satisfaction increased) when reports are viewable at a workstation — whether in the office, at home or in the palm of the referring doctor’s hand.
• EMR interfacing – HL7 brokering automates report delivery directly into the EMR of referring physicians without phone calls or faxes. Consider the value of being the first in your market to offer this convenience. It is a proven way to attract new referrers and keep your current referrers loyal.

Revenue Cycle Management
Today’s practices understand the importance of collecting the highest percentage possible of eligible revenues. Based upon legacy practice management principles and inefficient use of technology, many billing and collection departments are overstaffed, even among centers that contract out for services.
• Clean Claims – Are your current data entry procedures flexible, yet rigid enough to ensure all necessary billing information is being appropriately collected? Are controls in place to ensure pertinent information is not missing or erroneously entered? With current technology, claim rejection is quickly becoming a thing of the past.
• Don’t Repeat: If you use separate RIS and billing/AR systems, do you enter data twice? This is time-consuming (and thus costly) and often results in errors. Consider an interface between your systems, or source a new solution that automatically prepares claim information for billing.
• Code It Right – Improper coding results in millions of dollars annually in rejected claims. Does your system provide a method of ensuring proper diagnosis and exam coding? Without this system of checks and balances, significant review and rework is often necessary. Overtime fees can really add up!
Notably, a practice’s most expensive assets are indeed, human. Solutions that increase the efficiency of the radiologist, the technician and/or the referring physician can help increase study volume and report turnaround time, provide clinicians greater convenience and satisfaction, and improve clinical quality.
Overall, this can translate into increased volumes without increased staffing — and boost your bottom line.
• Patient Status — Does your system provide worklists for technologists indicating which patients have arrived? This can reduce the time technologists spend calling or visiting the front desk.
• Modality Worklist — Efficiency is gained if your modalities are networked to your information system and a modality worklist is populated. The time it once took technicians to manually re-enter information into modalities can be freed up for other tasks. Because modality worklists are auto-updated, data entry mistakes and mismatched studies are reduced.
• PACS Tools — The newest PACS functionality can help radiologists automate numerous tasks involved with reading and comparing images. Seek opportunities and easy-to-use applications that help your radiologist read more studies in the same amount of time, without sacrificing quality. Minimizing even a few clicks of the mouse for each read can have significant impact.
• Document Access and Report Delivery — Instant access to digital documentation and electronic signatures saves valuable time. If you’ve not already done so, eliminate the need for your staff to manually move reports from transcription to radiologist. Also consider the savings of having reports automatically delivered to an online portal immediately upon electronic signature of the radiologist — rather than faxing these reports to referring physicians. Portal technology is an essential communication tool for your referring doctors – for both relationship- building and efficiency.
While many businesses adjust their operations on an as-needed basis, it is critically important to take time to define processes and goals when considering a new workflow solution. With many elements to examine, a health IT expert should be able to help you evaluate your business, and then offer a solution and workflow improvements that are best suited to your long-term plan.
Whatever the size or scope of today’s post-DRA diagnostic imaging business, it is becoming increasingly important to establish and achieve a workflow that reduces operational costs and increases business. If you think newer, more efficient imaging informatics technology is just too costly or unnecessary, the question you need to ask yourself next is, “Can I afford not to make such an investment for my future?”
Author: Jeff Schmidt has a master’s degree in computer engineering and a bachelor’s degree in electrical engineering, and is an executive vice president with Merge Healthcare’s Fusion Division.

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