The health of relationships between hospitals and radiology departments has long been a concern in the industry with many organizations and task forces addressing this issue. But unless both sides take steps toward greater cooperation, it’s possible these associations could deteriorate further, experts said.
By eliminating the barriers that hamper clear communication and improving leadership skills from within, radiology departments can proactively improve how well they work with hospitals and hospital administrators. Making these changes offers both financial and professional culture benefits.
Radiology is fighting for survival on an ever-growing number of fronts. Plummeting reimbursement, competing teleradiology companies, and the specter of bundled payments has the industry constantly trying to promote the value it brings to healthcare. There are, however, many challenges to successfully delivering that message.
The biggest roadblock to smooth hospital-radiology relationships is the breakdown in understanding expectations, said Cynthia Sherry, MD, chair of Texas Health Dallas Presbyterian Hospital’s radiology department.
“Radiology departments aren’t meeting the service expectations of hospitals, administrators, or referring medical staff. That’s, in part, because it was really hard for hospitals to replace their radiologists in the past,” said Sherry. “Now, if a radiology department isn’t providing the necessary service level, the hospital has the option to replace them — and they can and will do it.”
Sherry also led the American College of Radiology’s 10-member Task Force on Relationships Between Radiologists and Hospitals and Other Healthcare Organizations. This group published a report in the June 2010 Journal of the American College of Radiology that looked the main challenges facing these departments and offered potential solutions.
Inadequate radiology department leadership has also been a problem, putting radiologists increasingly at odds with their home facilities. Without strong guidance, hospital-based practices are more apt to take on outside business that directly competes with hospital interests, Sherry said, and doing so makes them obstructionists rather than good partners.
“Radiology departments haven’t really developed good leaders who can interact with hospital administrators in a meaningful and effective way,” she said. “In some cases, radiology leaders are not congenial, choosing to drive a stake into the ground rather than cooperate on things. Other times, the leader might be on the hospital’s side, but the department will not fall in line and support the leader’s efforts.”
Shifting priorities among younger radiologists can also make it difficult to foster amiable relationships. Many younger radiologists place greater emphasis on the work-family balance rather than on taking the extra steps to meet hospital needs. This type of focus often creates tension, said Peter Angood, MD, chief executive officer of the American College of Physician Executives.
“Radiology is a good example of this inherent tension between hospital administration and hospital-based services,” Angood said. “In many cases, radiologists want to run their practice and service themselves rather than be primarily focused on the hospital and serving its priorities.”
The onus of improving relationships doesn’t lie solely with radiology, however. It’s also incumbent upon hospital administrators to actively invest in these partnerships, Angood said, by assigning a liaison to the radiology department who can open communication channels and broker collaborations. As healthcare moves rapidly toward an accountable care organization (ACO) model, hospitals and radiology departments would both benefit from having existing collegial relationships in place.
“These individuals would be in place to ensure both sides of the equation have their expectations managed appropriately,” he said. “In these cases, there would be no gaps, and everyone would learn about how to satisfy the other party’s unmet needs.”
What Radiology Departments Can Do
Despite these challenges, it is possible for radiologists to positively impact their relationships with hospitals.
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According to Jason Itri, MD, PhD, a radiologist at the University of Pennsylvania Hospital, practices should take advantage of the existing patient satisfaction and quality surveys linked to reimbursement, such as Hospital Care Quality Information for the Consumer Perspective (HCAHPS) for inpatients, to gather new ideas for improving service. This feedback can be used to improve reporting, staffing, and appointment availability.
Given that many departments are now actively competing with teleradiology companies — and potentially grappling with them to reclaim lost business — it could also be helpful research and understand these outside providers’ missions and product offerings, Itri said. Additionally, practices should analyze their internal financial situations and stay abreast of new technology and standard-of-care advancements.
It’s important, however, he said, to not take on too many challenges. Focus on a few changes, such as streamlining department governance or securing a place on hospital boards, and do them well rather than trying to address every concern from outside parties. But even selecting a few goals will require a shift in industry culture during a time when the healthcare field faces significant financial challenges.
“All of us, hospitals and physicians, are under increasing financial pressures. Reimbursement is declining, and those kinds of pressures affect all of us,” Sherry said. “Making our relationships with facilities and administration better means changing the score sheet a bit in this environment.”
Radiologists should be prepared to spend more hours onsite during the day, including reclaiming night and weekend read times, she said, as well as beef up the level of subspecialty care and consulting services offered to referring physicians. It’s also imperative to take on responsibilities outside of designing protocols and reading studies. Radiologists must be part of decisions dealing with equipment purchases, safety, and performance measures.
Radiologists can no longer stay cloistered in the reading room and ignore phone calls. That’s a recipe for the industry to lose control over its future, Sherry said. As a group, radiologists cannot hand decision-making authority to other practitioners who neither have radiological expertise nor the specialty’s best interest in mind.
“We’re at a pivotal point now with all of these [accountable care organization]-like projects getting started. It’s time for us, as radiologists, to assert ourselves and get into positions of influence,” Sherry said. “If we do it in a meaningful way, the future is bright.”