A shift in the radiology practice model

December 3, 2010
Richard Woodcock, MD

Our business has changed substantially in recent years. Ours was a practice that was primarily hospital-based. However, it underwent a paradigm shift, and the group has added a substantial amount of teleradiology and non-hospital based business. In so doing we have made several philosophical decisions and must continue to consider those.

Our business has changed substantially in recent years. Ours was a practice that was primarily hospital-based. However, it underwent a paradigm shift, and the group has added a substantial amount of teleradiology and non-hospital based business. In so doing we have made several philosophical decisions and must continue to consider those. 

Amongst those decisions is how fast we want to grow, and if at all, that we need to slow the pace of expansion to allow for reorganization. While a mature business might be able to manage both tasks, it is a common problem of small organizations that they outstrip their organizational structure as they grow.

For example, our hospital-based practice had needed only basic billing and office business support. Our teleradiology practice requires additional management services. With increased in-house information technology needs we need someone to manage our subcontracted relationships. With ownership of the totality of the reading process, we need continual analysis of process and efficiency. On the same tact, we also need to continually look for new systems and options to improve or replace our existing services.

Perhaps most importantly, the development of our own relationships means we need to have those nurtured and cultivated, while we look for new opportunities. Determining the point at which these needs are handled in house or outsourced is a central challenge facing any radiology practice that seeks to diversify its business model.

An additional choice now is how we attract business. In looking for new business we essentially sell ourselves to the clients and must offer something as a starting point for them to try us, much as commodities are offered for initial discounts until they prove themselves. One philosophy in the group has been that by offering stat and call services we will add business faster and more robustly, i.e. pay to play.

In other words we accept the work at hours that are more challenging but are able to then gain daytime cross-sectional business. That proposition is one that should be revisited regularly. At least annually, we need to analyze the trends of what modalities each of our clients sends to us and how they’ve changed. What volume is being sent during off- and on-hours?

The consideration of these issues has brought us yet another philosophical choice. Should we consider nonphysician business leadership, or allow for more dedicated physician administrative time? One option requires relinquishing power, the other giving up productivity. Why is this choice at hand for us?

With a simpler model and fewer business needs, we have been a physician-run operation. Specifically, our business office has been reactive or responsive to the requests and direction of the physicians. There is nothing wrong with that model. Yet, if the physician leadership has clinical responsibilities, the complexity of the business may quickly outstrip the skills, knowledge, and time available from the physicians. Only with dedicated and proactive leadership can a diverse business model continue to thrive.

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