Feature | October 01, 2013 | Tony Gevo

The Perfect Storm

Today’s radiology groups face challenges through declining reimbursements, expanded patient access, increased quality demands and the emergence of competition from mega groups

According to many healthcare experts, radiology is facing a perfect storm. This situation has been brought about by a number of factors, all converging on this profession at the present time. The challenges that radiology groups face today are declining reimbursements, expanded patient access, increased quality demands and the emergence of competition from mega groups.

Declining Reimbursements

Declining reimbursements have put continued pressure on radiology groups ever since the Balanced Budget Act of 1997. This, in turn, set the stage for the Deficit Reduction Act of 2005 (DRA), which included several provisions affecting Medicare physician payment policies that have had a significant impact on radiologists. The impact on individual physicians varied substantially, depending on the extent of technical components and global billing, how much of the practices were devoted to Medicare, and the imaging modalities in which they specialized. 

This trend, which in the past focused primarily on driving costs down by reducing payments to physicians, is now being modified and accelerated by the Healthcare Reform Bill of 2010 and the Affordable Care Act. Under the provisions of these bills, not only will radiology groups face a continuing challenge to reduce costs, but groups will now have to contend with calls for expanded patient access and increased quality of care and reporting. Experts predict that the Healthcare Reform Bill has the potential of adding an additional 30 million patients to the system while also mandating that all patients be afforded equal, high-quality care regardless of where they’re being treated. This is designed to address patients in rural areas who have limited access to specialized physicians and the unequal geographical/time distribution of specialists within urban areas. 

Add the emergence of competition from regional and national mega groups to these factors, and it is no wonder that many clinicians have serious concerns for the future of their practices and even their profession. In addition to the factors already in play regarding reducing costs, expanding access and improving quality, there are a number of technical issues that must be addressed if groups are going to compete with these encroaching practices and grow today: 

How to manage multiple contracts?

How to distribute work efficiently?

How to deal with multiple systems?

How to ensure acceptable income levels and
quality of life for radiologists?

The real question that results from a consideration of these factors is this: How can my group compete in this marketplace?

Finding Solutions

At conference after conference, radiology experts addressing this perfect storm state that although most radiology practices are not equipped to address these challenges today, the solutions are available and ready to be implemented. Instead of looking at the current set of issues as a death knell, practices should consider this time as an opportunity to use technology to move forward toward the inevitable electronic radiology practice. The experts also noted that advancements in radiology-oriented technology, coupled with affordable and readily available networking bandwidth, have placed systems that were once only available to the largest groups now well within the grasp of even start-up radiology practices.  

In conjunction with specialized radiology software and affordable bandwidth, they also noted the benefits of utilizing cloud technology. This eliminates both geographical and time-based constraints that prevent radiologists from providing the best care at the right time at an efficient rate. Groups can receive orders, images and supporting documentation from any site, and the radiologist can then read those orders and provide the interpretive report from any location where a suitable workstation is available, such as their office or home. 

The goal of such technology is relatively straightforward and fully supports the goals of the electronic radiology practice: efficient workflow, high-quality care and profitability. Specifically, the working goal of such an implementation is to provide the radiologist with a single workstation that provides:

Auto-launching of appropriate viewers;

Auto-launching of appropriate reporting systems;

Unified, intelligent worklists with flexible workload assignments; and

Expanded radiologist support through an
integrated tool set.

From a group practice management viewpoint, the capabilities of the electronic radiology practice should include tools to:

Easily administer contracts, facilities and personnel;

Know the status of every order and get alerts automatically;

Monitor quality, service levels and productivity;

Provide interface and connectivity tools and alerts;

Provide practice operational data as a by-product of radiologists reading; and

Be Web-based, not requiring client software or cumbersome updates.

The benefits to a group implementing the electronic radiology practice are far-reaching, helping them to meet today’s challenges and equipping them to be a viable enterprise in the future. With the right vision and leadership, any group can utilize the tools presently available to:

Expand patient accessibility;

Provide increased quality to patients;

Help staff operate more efficiently and balance workload;

Reduce costs;

Enhance quality of life; and

Grow and maintain profitability.

The Electronic Age

This article has examined the current trends that are challenging radiology groups, all of which are under huge reimbursement pressures and are realizing the only remaining way to increase profitability is to increase practice efficiencies. The electronic radiology practice is the best way to increase productivity, utilizing a single intelligent worklist solution that streamlines the reading process, minimizes the number of systems radiologists must use and lets every member of the group contribute no matter where they are located. A continuing push for cost reductions, coupled with growing demands for equal patient access, increased quality through sub-specialty reading and increased competition from large groups has created what some would call a no-win scenario. Many experts, however, see this time as one of opportunity for groups that will embrace the tools currently available to move their businesses into the age of the electronic radiology practice.  

Tony Gevo is president of Gevo Associates, Inc., a consulting firm in Belleair Beach, Fla., providing customized services to healthcare vendors and provider organizations. The firm has worked with vendors like McKesson, Epic and GE over the past few years, as well as a number of hospitals and radiology groups. RSA is a radiology group headquartered in Williamsville, N.Y.


Case Study — Radiology Solutions Associates (RSA)

RSA is a 20-physician group based in Williamsville, N.Y. It currently provides interpretive services for a number of hospitals, clinics and imaging centers. It implemented Clario’s zVision in 2011, along with an existing central picture archiving and communication system (PACS) and new dictation system. The goals for the system were:

1. Increase radiologist efficiency;

2. Provide high-quality sub-specialty services; and

3. Enable growth without linear costs.

According to David Ludwig, M.D., PC, president, “We had become victims of our own success, in a sense. As we added more contracts we also had to add staff and systems to allow our radiologists to read. What this meant, in reality, is that we had reached a point where growth wasn’t worth it anymore — we couldn’t reach our profit goals with that model. In addition, we had problems getting orders to the right doctors, as well as fully utilizing on-site radiologists.”

RSA’s model is to place radiologists at their clients’ sites, which provides a high level of service and interaction with their clients’ physicians. That was the positive, according to Ludwig. The problems it created were multiple worklists for the doctors to monitor, multiple workstations to read from, order prioritization issues and very unbalanced workloads. Ludwig states that the impact of the new system was immediate. “With the efficiencies gained we’ve been able to combine two of our rotations into one, eliminating the need to hire additional radiologists to keep up with current growth,” he said. “This is very exciting as we are still expanding. Prior to this, our radiologists and support staff had to watch multiple PACS work lists, waiting for stat cases to pop up and hoping they were noticed it in a timely manner. We also had problems where lower priority cases would often go overlooked for extended periods of time until a physician’s office called looking for the report.

“With the global work list we have now, and its ability to track a report’s required turnaround time, we know immediately when stat cases arrive and we’ve all but eliminated the problem of cases becoming stagnant,” Ludwig continues. “Our group also integrated voice recognition into zVision, which allows the radiologists to dictate a completed final report to our referring physicians, emergency rooms and urgent care centers. This has allowed us to maintain a 20-minute report turnaround time. Our referring physicians and our respective hospital administrators are thrilled about the quick report time. By integrating zVision with voice recognition and a PACS, we now become more competitive in the marketplace. Whereas before we had multiple PACS and multiple RIS, we could not interface with other facilities’ systems and thus we could compete for contracts. A unified RIS/PACS allows us to easily interface with any system that allows us to gain market share. Additionally the system has also allowed us to fully utilize our sub-specialty trained radiologists, even if they’re working remotely.”  

Ludwig explained that previously, staff would run into situations where a sub-specialty radiologist was unavailable to the rest of the system because they were reading in a location not connected. “Our most valuable resource was, in reality, isolated. With the order assignment engine, we know what each radiologist’s RVU workload is at all times and the system automatically assigns orders to the correct doctors,” he said. “It also keeps track of each order’s contracted turnaround time and sends alerts when orders start aging. An added benefit is our ability to know where each order came from and launch the appropriate PACS viewer for each study. This is very important to us because our physicians read local studies on the site’s PACS and remote studies from our central PACS viewer; but we need all the reports and other data in our database. This is all automatic with the new system.”