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How To Be The Perfect Radiology Group


The perfect radiology group has no concerns.

You have reimbursement woes. You worry about your billing practices. You wonder if you’re doing the right things to demonstrate your value to partner hospitals. The daily stresses can be nearly overwhelming – but, if you were a perfect radiology group, these worries wouldn’t exist.

The perfect radiology group has tweaked its day-to-day activities. Their streamlined coding process ensures proper payment. Their targeted marketing attracts more referring physicians, and personnel tactics secure a seat at the administrative decision-making table. Every day, for the perfect radiology group, operations are smooth.

But, is the perfect radiology group really attainable? Not really, industry experts acknowledge, but it’s possible for you to get close. Later this year, the American College of Radiology (ACR) will release a road map for creating your “optimal” radiology practice or department. In it, according to Mark Bernardy, MD, chair of the ACR Managed Care Committee, you’ll find a list of best practices that were tested at the ground level, and can help you on your way. Consider it an expansion of ACR’s Imaging 3.0.

“Imaging 3.0 has laudable big picture ideas. Everyone nods their head that it sounds good and right. But, then, exactly what is it that you want me to do?” said Bernardy, who is also a practicing Georgia-based radiologist. “There’s a big gap. I thought it would be useful to go through the exercise of writing down what it is we mean when we say, ‘This is what the perfect radiology group looks like.’”

As a compilation of best practices gathered from large medical centers and small private practices nationwide, it will be a living document, open to modification with new, effective ideas, he said.

What Perfect Radiology Offers
Overall, the perfect radiology group outline breaks down into three parts. The goal, Bernardy said, is to make it accessible to all providers, regardless of location or group size.

“It’s written so that if you’re the owner of a radiology practice or a physician sitting on a board, someone could hand you the document a few days before any meeting and ask you to look at it for a discussion,” he said. “There will be enough details so you could go down the list of things and decide what sounds good or not and identify things you’d never thought of. There will be enough there so you can understand the principles to get started, and, then, discover more things on your own.”[[{"type":"media","view_mode":"media_crop","fid":"32165","attributes":{"alt":"Perfect score","class":"media-image media-image-right","id":"media_crop_336047990442","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3401","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":"height: 188px; width: 251px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©iluistrator/Shutterstock.com","typeof":"foaf:Image"}}]]

First, it asks radiologists to identify the clinical value they bring to patients and their health care environment as a whole, as well as what benefit they offer to their referring physicians. Second, he said, it discusses various billing practices, including analyzing revenue cycle management data, and facility and business management, such as creating marketing plans. It also touches on financial strategies, including developing and implementing capital budgets and assessing risks. More examples of human resource, risk management, office governance, and leadership tactics are available from the Radiology Business Management Association (RBMA).

The last third focuses on bringing radiology to the forefront of health care.

“It’s about leadership at the local level in hospital systems and in communities,” said Bernardy, who is also the ACR representative to the RBMA. “It, then, takes on leadership in statewide and nationwide organizations, whether they’re medical or other groups. It’s designed to help radiologists show their value to customers, partners, and patients.”

At its core, he said, the document is a compilation of the best ideas out there – the best practices of radiologists from both clinical leadership and patient care standpoints.

One Group’s Best Practice
For example, a radiology group in Columbus, Ga., launched a calling service to solve their communication problems with referring physicians. Providers had difficulty finding time to deliver unexpected or critical results, so they hired two employees to coordinate convenient times for the referring physician and radiologist to talk.

The system has worked so well that, over time, referring physicians have begun to rely on the call service for both radiological and non-radiological needs. In one case, the call service helped a physician who had forgotten at which hospital he needed to visit a patient for a consultation. The employee was able to look up the patient’s information and provide his location.

It’s these types of fixes that are making concrete changes and improvements to daily practice, Bernardy said.

“The innovative things that some groups do may be relatively pedestrian approaches to fairly simple problems, such as getting referring doctors on the phone,” he said. “But, they mushroom over time into invaluable resources for the whole medical community. Those things are happening out there.”

Currently, leadership for both ACR and RBMA are examining the document for approval.

But Nothing’s Perfect – What Can You Do?
Operating a radiology practice where everything is perfect and runs like clockwork isn’t going to happen, but improvement is possible. According to Michael Bruno, MD, radiology and medicine professor and quality management and patient safety director for the Penn State Milton S. Hershey Medical Center, enhancing your reporting is low-hanging fruit. Without it, a radiologist can face significant problems.

“A poorly organized, confusing, or internally inconsistent report with misspellings and typos can erode patient confidence in their provider’s work and even their institution,” Bruno wrote in a Journal of the American College of Radiology op-ed. “By extension, sloppy reports may render radiologists economically vulnerable in competitive markets.”

The most important thing to remember, he said in a recent presentation, is that your referring physicians read very little of your overall report. In fact, only 50% read more than the impression. Keep your reports short, avoid hedging or recommending unnecessary follow-ups, always answer the clinical question asked, and use structured response formats without abbreviations. And, don’t shy away from saying a finding is normal if that’s the case.

Global healthcare consulting firm The Advisory Board Group also polled hospital and radiology group leaders to set progressive benchmarks for several measures that point to improved radiology service. According to their 2012 analysis, radiology departments and groups should push for under-30 minute turnaround times to emergency departments and under-4 hour turnarounds for inpatient and outpatient services. They should also strive to provide critical finding reads within 30 minutes.

Changing the way you provide call service can also make a difference. Provide 24-hour coverage and don’t outsource any off-hour readings. If you must outsource a read, spread the cost evenly within your practice or department rather than passing the cost along to your referring physicians. Absorbing the fee is a way to demonstrate the value you provide, the report said.

Ultimately, though, your practice or group will be able to cherry pick which strategies work best for you. If you’re satisfied with your clinical performance, you would select tactics to improve how you market your business. Or, Bernardy said, you could opt to choose measures that augment your quality performance. No matter what you pick, it’s important to remember not to take on too much at any given time.

“The idea is the ultimate pie in the sky because there’s no such thing as a perfect radiology group. It’s a complete fictitious thing,” Bernardy said. “I don’t imagine there will ever be an idea that will work for every practice or group. That would be like going to a smorgasbord and eating everything. It just won’t happen.”

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