Richard Woodcock, MD

I have heard frustration from oncologic practices regarding radiology reports. Here are a few ways we can help improve radiologic-oncology care.

I frequently consider what value I add to patient care, and how I can improve it. Here are the criteria one of my nonradiology colleagues recently told me she looks for in a good radiologist.

In an environment where competition is increasing, branding your practice can be very useful. Here's how.

Unhealthy referral relationships can drag on in radiology, but there are often valid reasons to dissolve the partnership.

We are practicing radiology in an ever more competitive environment. That pressure makes me ever more aware of what value I can offer that is unique. I've talked about building relationships before but there are a few unique ways we can accomplish that.

Starting a new member of a practice on a good foot requires planning, organization and preparation. A good practice will not put a new employee behind the eight ball by being disorganized. Worse yet, a good practice will not risk a new radiologist being unprepared for her duties, being distracted by administrative work, or not being credentialed when it's time to start. How do we avoid this? By creating a list of what needs to be done in advance and following through with it.

Several months ago, we were considering our eligibility to participate in the federal government’s electronic health record (EHR) incentive program that pays cash incentives to eligible healthcare professionals who make “meaningful use” of certified EHR systems. I mentioned some of our considerations at that time. Now it’s time to look a little closer at some of the details in enrolling.

Whenever there is anticipated change to your bottom line, it is good for the practice leaders to ask the business office for a "damage report." In other words, find out what the real facts are regarding the impact might have been for the last fiscal year. At least this will give you a little financial perspective to share with everyone.

We’ve considered several options to deal with variability of staffing and variability of workflow. One is leveraging teleradiology services; a second is employing part-time staff. But which is more cost-effective? It really depends on your model.

Clearly, it would be great to have all patients done on the most state-of-the-art systems. But there are other perspectives that are important. In a world where our resources may be more tightly allocated it is good to consider those.

Radiologists need a great working relationship with their facilities. But all too often this relationship, in practice, is adversarial at times. So, how do you build a good relationship? Here are a few steps to keep in mind, even when you may feel at odds with the facility.

Mistakes are unavoidable, despite our best efforts. As a mentor of mine used to say, radiology is the most humbling of all specialties. The question is not will you make an error or oversight. You will. And it isn't whether others point it out. They will. What you do from there is what is critical.

Overall documentation is for everyone's interest. Certainly it is helpful legally. But most importantly it improves the patient's health care delivery and increases overall patient safety.

When economic pressure is applied, it is not time to cut service and reduce time spent consulting or reviewing clinical data. It is time to increase those value added services and more.

Like many others, we are now exploring how radiologists may benefit from the EHR incentive program. Our interest is sparked by the fact that for all physicians, CMS will pay cash incentives to eligible health care professionals who make “meaningful use” of certified EHRs. But maybe even more eye-opening is the fact that those who are eligible but don’t meet the requirements will find CMS payments reduced starting in 2015.

My radiology colleagues often bristle when I mention having uniform reports. They seem to think this means uniformity of thought. But that is far from the intent of using templates for dictation.

Lack of uniformity negatively impacts the quality of your care most importantly. It will cost patients time, and cost the practice time, possibly you personally. It also makes the practice appear haphazard and un-professional.

Radiologists are in a unique position to enter into the fray on healthcare spending and utilization. We should be doing so aggressively at the highest levels of policy. Is it possible we don't because over-use doesn't hurt our business in a tangible way? In the end, day to day, we need to be true to our calling and to ourselves. That is, we need to help make local policy and everyday decisions.

As imagers, our patients are not present in front of us, and that sometimes challenges us to remain care focused. Especially when it is busy.

Yes, part of radiology service is accommodating what seem like demanding requests sometimes. But each call, be it from physician or patient, needs to be handled professionally, quickly and efficiently.

Our practice recently changed its leadership. That’s a challenge for any business, but radiology has some unique problems.

Quality is in the eye of the beholder. Clinical image interpretation is paramount as we’ve talked about before. But there are other aspects to demonstrating quality for your partners.

We’ve considered how the competitive nature of the marketplace has influenced practice behavior, or should. Chiefly, what sets you apart? That is, what value do you add? And how do you make sure your practice is of high quality?

Efficiency can be eroded in subtle ways - that’s the bad news. The good news is that if it can be easily eroded, it can be easily improved.

We deal with the same headaches all radiologists do: tracking down other busy professionals to make sure that they get the information they need and, sometimes, demand.

Everyone I know, radiologist or otherwise, looks forward to getting their paycheck. And most of them want to look at it as soon as it arrives. It is therefore a powerful tool for delivering information, since it commands attention. So what information can be conveyed? Metrics of several types are a good option.

Much of the effort in pay-for-performance programs seems cryptic to radiologists and doctors in general. For now that’s because it is not impacting our bottom line very much. That said, if you can get ahead of the curve now, you'll make things easier later when they mean more to you financially.

Physicians are not always the first adopters of new technology, and the use of Web content is no exception. Of course, most of our business has no direct correlation with information from the Web, but that does not mean that having a Web site is not a great addition to the practice.

A significant decision regarding these standards looms over us now - how to incentivize or discourage certain behavior. There is not a right or wrong answer to this. The group needs to decide when and how hard the rubber meets the road. In our minds, our options include publication of statistics either anonymously or openly, hoping for behavior modification; escalation of punishment for failure to meet a standard, by financial or other penalties; or incentives for those performing best.

The most common complaint amongst physicians in our practice is that someone is working harder than someone else. It’s a contest no one wins.