Protecting your radiology contract: Quality from the hospital’s perspective

This article is the second in a series reviewing why and how radiology practices set themselves up to lose long-held professional services agreements, how hospitals view “quality” from a business perspective, and what steps groups can take to turn an adversarial relationship to a collaborative partnership. Included is a challenge to change how we conduct business, with the goal of long-term success for everyone involved.


If you talk to any radiologist or practice manager about what makes his or her group unique, the answer is consistently “the quality of our physicians.” Groups typically seek to recruit from the top radiology programs in the country and many place a premium on subspecialty skills and training, often carefully crafting a service offering that meets a desired need for clinical excellence.

Not to diminish the physician emphasis on quality, but if you step back to look from the viewpoint of radiology’s customers, competent physicians are an assumed component. Hospital professional services agreements and/or credentialing requirements usually specify board-certified radiologists, and the expectation of highly competent physicians exists until evidence to the contrary emerges. Referring physicians and patients anticipate top clinical quality as well, so again, this is an assumed baseline.

How then, does a hospital measure quality? The answer is likely to be right there in most professional service agreements, providing they have been dusted off and updated within the past 10 years or so. And even if they are not addressed in the hospital contract, quality concerns are defined on a fairly regular basis by hospital administration—although these expectations are often interpreted as trivial griping and, therefore, frequently dismissed. In other words, there are specific service elements important to our hospital customers, some of them defined by accreditation bodies such as the Joint Commission, some by regulatory requirements, and others as an attempt to prevail in a competitive marketplace.

While the priority list may vary from one healthcare entity to another, there is some consistency and it’s reasonable to assume the following issues will be included:

Radiologist reporting. The issue of “critical results reporting” is a Joint Commission mandate and involves not only the prompt turnaround of written radiology reports, but calling results when indicated. The hospital will include an emphasis on getting final reports signed and will frequently have standards against which performance is measured. Hospital complaints in this area are usually associated with only a few physicians in the group who are chronic offenders.

Quality assurance reporting. A Q/A overread program may be a requirement of both accreditation organizations and hospital bylaws. There is always an expectation that the hospital will demonstrate an active and effective Q/A program, including a method to follow up on problem cases. The criticism of hospital administrators often has to do with inconsistent participation from all members of the group (rather than whether a program exists). And, once again, it’s likely only a few physicians in the group place the entire practice in the spotlight.

Working and playing well with others. Every group in the country can probably identify the radiologist the techs and staff avoid or who is most likely to say, “I’m too busy, take it to Dr. X.” Over time, such behavior adds up in the negative, especially as it impacts department throughput and staff morale. Everyone will react to stress from time to time (and be forgiven), so this is more about group culture and attitudes toward nonphysician personnel. It is easy for a group to ignore the results of referring physician, internal (emergency department for example), and staff surveys as just another nuisance activity. But rude behavior and resistance to administrative processes are ultimately detrimental. The tendency to ignore bad behavior is common and these situations are unpleasant to resolve, but more groups now recognize the liability associated with failure to correct problems that involve a small minority of physicians.

Participation on medical staff committees. It takes only a few conversations with hospital administrative staff to learn their perception of radiologists is that too often the only meetings they show up for are capital budget meetings, where they then expect to receive most of the available funding for new equipment. Failure to participate in hospital initiatives and on committees is seldom the primary reason for hospital dissatisfaction but will be listed when the litany of “service issues” ultimately hits the fan.

Other administrative/medical director duties. If you haven’t pulled the professional services agreement from the file in some time, it would be worth reviewing other administrative expectations. They may include developing joint process-improvement initiatives, participating in the implementation of new technology, conducting educational sessions for technologists and medical staff, or assisting with marketing/business development activities. Too often these activities get lip service for a year or so and are thereafter ignored.

The saddest thing about this dilemma is that a highly competent radiology practice, one with “quality” radiologists, can lose a contract over basic service issues, nonphysician interpersonal relationships, or other common administrative expectations. And it cannot be overstressed that the behavior of only a few physicians in the group can jeopardize the stability of an entire practice. You probably know their names.

If the hospital moves from being perceived as a golden goose to being considered the practice’s largest customer, what changes would we make to ensure a long, mutually successful business relationship?


Next: What does it mean to partner with your hospital in practical, operational terms? Previous article: Protecting your radiology contract: How did we get here anyway?


Ms. Kroken is a consultant and principal in Healthcare Resource Providers. She can be reached by e-mail at pkroken@comcast.net.