Olivia Bobrowsky

Healthcare reform may be shaking up the medical imaging community in every which way, but according to Jef Williams, vice president of Ascendian Healthcare Consulting, there are just four main tenets of healthcare that are really driving the change.

In this video, Williams boils the list down to electronic health records, health information exchanges, accountable care organizations (ACOs) and declining reimbursements.

Still, the combined impact of these four forces is considerable.

“It’s requiring the imaging specialists, the leaders in healthcare, in imaging, to step outside of their comfort zones and get outside of their departments, get outside of their silos,” he said, “and look at ways to work collaboratively.”

Videos

VIDEO - Consultant Jef Williams details the four areas driving change in healthcare for radiologists.

The Four Forces Driving Healthcare Change

Consolidation may be the name of the game in medical imaging today, but what’s really behind all the mergers and acquisitions? 

Brian Baker, president of Regents Health Resources, offered up a few explanations, including the price disparity between how much outpatient providers and hospital providers get paid for the same services.

“MedPAC has realized this, and so they’re recommending that those two rates be brought in line with each other,” Baker said, referring to the Medicare Payment Advisory Commission which advises Congress on Medicare issues. “And I would guess you can bank on the fact that they’re not going to raise outpatient medical imaging rates to match hospital rates. They’re going to bring hospital rates down.”

So now there’s this short window where hospitals can take advantage of this rate disparity by buying outpatient centers, he said, speaking in a video interview at the recent AHRA 2013 meeting.

What’s more, Baker said, it’s not just about the buyer making a profit – the businesses being sold can benefit from the acquisition as well. In this video, Baker explains why, and whether that’s always the way to go.

VIDEO: What’s behind the imaging operations mergers and acquisitions? Brian Baker discusses the why and what to do about medical imaging consolidation.

Why Radiology Operations are Consolidating

As reimbursements decline and imaging facilities look at new profit models, an emphasis on patient satisfaction is on the rise.

“We have to focus and really put an effort in to deliver an experience for our patients,” said Jamie Verkamp, managing partner at (e)Merge Medical Marketing Consultants. It’s especially important to consider patient satisfaction now that reimbursements are tied to patient satisfaction scores, she added in an interview at the recent AHRA 2013 annual conference.

To boost those scores, Verkamp said facilities should start by examining the behaviors of patient-facing employees. She stressed the importance of ensuring imaging centers employ the right people with the right characteristics in the right positions.

“Skills can be taught,” she said, “but behaviors are hard to change.”

In this video, Verkamp shares what she considers to be the top three qualities of patient-facing employees, along with some advice for leaders on how to cultivate those behaviors.

VIDEO: Radiology facilities are increasing their focus on patient satisfaction. Consultant Jamie Verkamp discusses qualities of patient-facing employees.

Key Behaviors of Patient-facing Employees

From dose management systems to wireless DR detectors to high-tech displays, several new and exciting products were on display at the AHRA 2013 exhibit hall. Here’s a small sample.Did we miss a product that caught your eye? Tell us about it in the comments section below.And here’s where to go for more information on each product listed:1. Canon’s RadPRO D2-50RF Dynamic Digital RF System2. Sectra DoseTrack3. Hitachi’s Noblus4. Philips’s IntelliSpace PACS Anywhere5. Sony’s LMD-DM30 and LMD-DM50 Radiology Displays6. Hologic’s Horizon DXA7. Konica Minolta’s AeroDR8.Â  Kubtec’s XPERT 409. Del Medical’s EV800 Elevating, Four-Way Float Top Table10. Carestream’s DRX-Revolution Mobile

Slideshows

10 New Tools from AHRA 2013

MINNEAPOLIS - As the landscape of medical imaging changes and the future looks uncertain, there is at least one piece of the puzzle that radiology facilities can and should control: strategic marketing.

“You can absolutely impact your referral value, and you can increase your market share by having a strategic marketing plan,” said Nicole Faucher, vice president of sales and marketing at MedQuest Associates, speaking this week at the 

It doesn’t matter whether the organization is a hospital or an imaging center, and it doesn’t matter whether it employs physician liaisons, sales representatives, or none at all, said Allison Arant, the area marketing manager at MedQuest. A thorough marketing strategy is about how organizations develop a plan, how they decide to leverage whatever resources they have, and how they measure their outcomes.

But it’s not always clear to a radiology facility, she said, what its strategic plan should be.

“We do what we do every day in the department. We understand so well how that works,” Arant said. “But we may not always understand so well what happens outside our walls, and what really impacts what comes inside our facilities.”

Arant recalled a hospital she once worked with that had built a state-of-the-art outpatient facility. And then no one showed up.

“They were doing maybe one MRI a day,” she said. “We started talking about the bigger picture. You have this beautiful facility, you have these billboards, but what else can you leverage?”

One step to creating a successful strategic marketing plan, Arant said, is to identify and target areas of potential volume growth. That could mean focusing on maintenance if business is already strong, or pinpointing where referrals should be coming from if they’re lacking in a certain specialty.

It’s also important to establish core messages based on provider needs and departmental goals. Of course, that starts with identifying those goals.

“Communication has to happen two ways,” Arant said. “It’s not just us going out into the market, telling people how great our facility is, but it’s also bringing information from the market back into our walls to talk about what we can do differently or better. Maybe you learn that the referral pad is microscopic and they can’t see it, and that’s fine on our end because we know where the checkboxes are, but they can’t see it at all. Or we may realize that they’ve been waiting on hold for 22 minutes when they call our centralized scheduling line, and what can we do about that?”

The point, Faucher said, is to make the process as easy as possible for the referring physicians and then to help educate them on the process. Maybe, she said, physicians are requesting scans with and without contrast, when all they really need is without.

These are often just simple tweaks, and they could go a long way.

“Your impact is huge,” Faucher said, “And you have a lot of leverage in what you’re doing.”

Articles

Radiology groups can boost referral value and market share by having a comprehensive marketing plan. Here’s how.

How to Create a Strategic Marketing Plan to Drive Growth

MINNEAPOLIS - You’re on a first date, and it’s going well. To get that second date, you hand over a brochure about yourself, along with a business card and a referral pad.

According to Martin Farrell, the founder of Arista Medical Imaging, an open MRI facility, if that’s not what you would do to win over a love interest, it’s not what a medical imaging company should do to score referrals.

“We get so caught up in the technology side of things,” said Farrell, speaking this week at the 

. “We oftentimes forget we’re dealing with people. So we need a meaningful way to engage in conversation with a referring office and patients.”

The way to do that, he said, is simple: Ask questions. Get clients talking about themselves. And eventually they’ll start asking questions about your organization.

Farrell said he still sees the value in entering a referring office with marketing materials in hand. He likened it to holding a drink on a dance floor: It may not make much sense, but it helps to fit in and it provides a sense of security. So he worked with his team to figure out a way to create a handout that would spark a conversation, but still give his sales representatives the security of having a physical document to reference.

And the documents are a little out of the ordinary. The idea came about when Farrell heard that an employee at one of his referring offices said his facility had “the weakest magnet in the marketplace.” He was watching Mad Men at the time, and inspired by the character Don Draper’s quote, “If you don’t like what’s being said, then change the conversation,” he decided to do just that.

He contracted with a design firm and created his first in a series of monthly brochures. This one said “The Weakest Magnet in the Valley,” in a big, bold typeface on the front cover. He said he was going for shock value. He wanted to get people talking. The tongue-in-cheek brochure then went on to explain the misconceptions surrounding MRIs in smaller text.

Farrell loved it. But his sales reps wouldn’t hand them out. “I, as the leader, hadn’t engaged my own staff in my focus,” he said.

The next time around, he involved his staff in the creative development of the marketing materials, and he said his employees got on board with the strategy. The results he’s seeing now, Farrell said, include increased sales activity and better conversations with patients and referring offices.

The brochures still have splashy text on the front cover, but now they each have a theme that ties in with the current month - think love in February, New Years resolutions in January, the beach in July. The insides of the handouts feature quizzes and infographics related to the theme: What’s your love language? What kind of beach are you? A “chilly beach”? A “diva beach”? Farrell said his team distributes about half of the brochures to referring offices and the other half to patients. Then they keep records of their clients’ answers to the quizzes on file.

“Now we know who these people are and it helps us better have a conversation with them,” he said.

Here’s how one imaging facility took a less traditional approach to market its practice with bold and creative brochures.

A Twist on the Traditional Imaging Marketing Strategy

MINNEAPOLIS - Say good-bye to the straightforward model of volume-based reimbursement. A value-based model is becoming the new reality, and imaging facilities still need to figure out how to make that profitable. 

“At the end of the day, the real change here is there’s not necessarily going to be a direct relationship between what you collect and the number of exams you do,” said consultant David Smith, BAA, MPA, FACMPE, speaking this week at the 

. “You have to focus on where your organization can excel in terms of value.”

The industry is just on the cusp of this transformation to an emphasis on quality, Smith said, and the contracts involved in this new model are still being written. That’s why it’s imperative that radiology organizations work with patients, third-party payers and other business partners to negotiate agreements and drive the conversation regarding what “value” means and how to quantify it.

“The challenge is going to be if you have 15 different payers in your market and 15 different models, and they each have 10 different things that they’re measuring,” Smith said. “You want those 10 to be fairly consistent across all those payers, or else it’s just going to be totally unmanageable.”

Smith said the kind of metrics that drive value differ somewhat depending on the kind of value-based model being used. Various models include fee-for-service (FFS) reimbursement, tiered FFS systems, purely value metrics, or FFS combined with bonuses if certain goals are met.  

Consider the value of maximizing patient access, for example. Smith said that strategy has a high reward for traditional fee-for-service models, but for the other models it would depend on how the incentives are set and how the model is set up.

“That’s something you want to work on in the front end in terms of negotiation to drive the metrics in your favor to make them as compatible as possible with the business you already have,” he said.

Still, some priorities are universal no matter what model is in play, he said, such as price transparency. Price information is becoming more easily accessible on the Internet, and high deductible healthcare plans give consumers a bigger incentive to go digging for those numbers.  

“Patients have more skin in the game,” Smith said. “They’re going to want to know in advance what something is going to cost. … You’ve got to look at it more like having your goods on a shelf in a store.”

Other factors of value in imaging include patient and ordering provider satisfaction, service differentiation and appropriateness.

“There’s a real opportunity there in terms of making sure the right study gets done the first time,” Smith said. “And we’re not just doing things by rote automatically because it increases our volume.”

Volume-based reimbursements are being replaced by models emphasizing value. But what does that mean and how can this shift be profitable?

Navigating the Shift to Value-based Reimbursements 

MINNEAPOLIS - It’s no secret that the medical imaging industry must adapt with the onset of accountable care organizations. The question is whether radiology administrators are changing their strategic planning discussions in the face of such reforms.

“The strategic planning process itself probably hasn’t changed for the last 30 or 40 years,” said Bob Maier, CPA, CEO of Regents Health Resources, speaking this week at the 

. “And what we need to recognize is that our organizations are changing. So the strategic plans that we developed three or four years ago, or five years ago, or just before the great recession, are no longer valid.”

The planning process starts with gathering the facts: What’s important to an organization and where is it going? Who are the stakeholders? Such questions may have once been easily answerable, but not anymore. If an organization isn’t participating in an ACO today, Maier said, it might be six months from now. And if radiology administrators aren’t yet involved in payer contract negotations, they may be soon.

Next comes what’s known as a SWOT analysis, where leaders evaluate their facilities’ strengths, weaknesses, opportunities and threats. Most important, Maier said, is the considerations of weaknesses and how to fix them.

[[{"type":"media","view_mode":"media_crop","fid":"12351","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_1270133987785","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"847","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; margin: 5px; height: 131px; width: 120px;","title":"Bob Maier, CPA","typeof":"foaf:Image"}}]]“Sometimes we don’t understand what those opportunities are in the marketplace,” Maier said. He asked that radiology administrators take an active interest in the market and encourage their radiologists to do so as well. The physicians, he said, tend to get caught up in the bubble of their hospital. “Every day we see changes where one practice is taking over for another, a hospital is buying an outpatient imaging center, hospitals are buying physician practices. We need to know ahead of time what’s going on.”

Once the opportunities are evaluated, Maier said leaders should narrow in on what is most deserving of their attention and then define the strategies to get them to their end goals. Ideally those goals would be sustainable for the “foreseeable future,” Maier said, but given today’s landscape, that’s not always possible.

“It’s pretty tough to define what that foreseeable future is today,” he said. “Ten years ago it may have been a five-year horizon. Today it’s probably less than a year. So this is a process that we have to continuously revisit and come back to and say, ‘Are our assumptions still valid? Are the inputs still valid, and are our goals still valid, and are we doing everything we can to achieve those goals?’”

And those goals should be a short-list of two or three objectives that are consistently adjusted and reviewed. If a facility has a list of 10 to achieve, the other seven or eight goals can wait until the first ones are crossed off, Maier said.

He added, “Making goals achievable is up to you as an administrator to say, ‘How do I put together the right team to get these done?’”

A radiology facility’s old strategic plan likely is no longer viable for the evolving healthcare landscape. Here’s how to update and adapt your plan.

Adapting Your Strategic Plan in an Era of Change

MINNEAPOLIS - You’ve heard the acronyms: CERT, MAC, ZPIC, RAC. The terminology of Medicare auditing may sound like gibberish, but as healthcare providers nationwide face increasing threats of audits, it’s a language all radiology practices should learn to speak.

“It’s possible to win these cases,” said Jessica Gustafson,  an attorney and partner with The Health Law Partners PC who devotes a majority of her practice to pursuing Medicare audit appeals. “Just because a CMS contractor … says a claim is medically unnecessary or improperly billed, that doesn’t mean they’re right. And often times they aren’t.”

If a radiology facility faces a Medicare audit and is considering appealing, it’s first important to understand the different kind of auditors. 

Comprehensive Error Rate Testing (CERT) audits measure improper payments in the Medicare fee-for-service program. If a CERT contractor identifies an overpayment, providers can appeal the finding, said Gustafson, who spoke this week at the 

Gustafson said it’s especially critical to appeal questionable CERT claim findings, because other auditors use the results of the CERT audits to identify vulnerabilities within the Medicare program.

“If the CERT auditor finds there’s a very high error rate in radiation oncology, for example, then other auditors may focus their auditing efforts on that particular type of service,” she said.

Medicare Administrative Contractor (MAC) audits are those that target problem areas identified by CERT contractors. MACs actually have the ability to withhold funding from a practice until the facility submits the documentation required by the audit.

Zone Program Integrity Contractor (ZPIC) audits focus on the investigation of fraud and abuse, and Recovery Audit Contractor (RAC) audits deal with improper payments, including incorrectly coded services or duplicate services.

Auditing activity across the board is on the rise, due to factors such as the use of electronic health records and the upcoming implementation of ICD-10, a new, more detailed medical coding system.

Adrienne Dresevic, an attorney and founding partner of The Health Law Partners PC who focuses on Stark law and fraud and abuse, said she once had a client who had to go through three levels of the appeals process because the signatures failed to show up on the printed-out electronic records.

Dresevic suggested radiology facilities prepare for increased claims scrutiny by naming a point person responsible for communicating with CMS contractors, responding to records requests and monitoring areas that may be subject to review. Areas that are at a high-risk for a 

CERT, MAC, ZPIC, RAC: Radiology groups need to know these Medicare auditing terms and how to prepare their practice.

What Radiology Facilities Need to Know about Medicare Audits

MINNEAPOLIS - Only a fraction of the Johns Hopkins Radiology Department’s employees serve in formal leadership positions, but those managers know their organization depends on the leadership abilities of everyone on staff.

“You don’t have to be a supervisor to use leadership skills,” said Alison Ramos, MBA, CNMT, technical manager of Johns Hopkins’ division of nuclear medicine, speaking this week at the 

Johns Hopkins’ radiology leadership decided that widespread leadership training is especially crucial given their growing number of employees reaching retirement, Ramos said. They asked themselves: “How are we going to mentor and grow that next set of informal leaders?”

The answer lay in the creation of the Future Leaders program, an initiative that launched in 2006 and eventually developed into a formal developmental program within the radiology department.

Future Leaders is a 10-month program where members meet once a month for a full day of lectures and workshops. Participants learn practical leadership skills, such as how to facilitate meetings, deliver effective presentations and conduct behavioral interviews. Other topics focus on building leadership characteristics and values.

“When you have an employee whose values are aligned with your department’s core values, you have a highly engaged employee,” said Elyce Wolfgang, RT (R), a co-chair who also serves as the pediatric technical manager in the radiology department.

Wolfgang suggested other institutions should try creating a similar program. She recommended that anyone from a large, academic hospital who’s interested should meet with senior leadership to kick off a full-fledged program. Smaller hospitals or imaging centers may find it easier to focus on smaller, shorter workshops, she said, or it might help to team up with sister ancillary services, like a laboratory.

“All of these workshops have nothing to do with radiology specifically,” Wolfgang said. “They translate to any group of leaders.”

In that spirit, Future Leaders participants are not just culled from the Johns Hopkins staff of radiologists. “We get transport, IT, nursing, all of the imaging modalities, our call service, our customer service reps, and even the university and our imaging sites participate,” Wolfgang said.

Launching such a program does take some investment, Woflgang said. Consider the time it takes to arrange speakers and develop a curriculum, and the nominal costs associated with reserving meeting space if necessary.

Institutions and facilities must also consider the logistics of employees missing work. The co-chairs of the program present employees’ managers with the schedule well in advance so they can ensure they’ll be able to take the day once a month to focus on leadership.

“We do pay them as if they were working in the work area,” Wolfgang said. “Senior leadership supports that because they know that the one eight-hour shift that we’re paying them for that day to be out of the work area. They’re still going to give back to us at some point, because we’re developing them.”

Johns Hopkins leadership is so confident of the benefits of Future Leaders, Wolfgang said, that when the organization was ramping up two years ago to move into a new building, they refused to let the program slide off their priority list.

When planning Future Leaders that year, Wolfgang said the three co-chairs had been nervous that the program’s schedule would clash with key dates associated with the move.

“So we decided to go to our radiology leadership and pose the question to them,” Wolfgang said. “What do you guys think? Do you think we can do this? Because we were thinking they would want all their staff and their clinical areas to do all the prep work for moving. And they said without a doubt [that] we have to do the Future Leaders program this year. We need these future leaders to help us through the change.”

The Johns Hopkins radiology department developed a program to foster and train leaders in their growing institution. Other institutions should do the same.