By Lena Kauffman, AuntMinnie.com contributing writer

June 12, 2015 -- Healthcare as an industry is under pressure. Decelerating price growth, continuing cost pressure, a shifting payor mix with more Medicare and Medicaid, and more elderly and chronically ill patients are pushing hospitals and health systems to embark on a period of rapid strategic change.

In this new paradigm, independent radiology practices need to understand how their hospital and health system partners really view them in order to remain viable, explained Keith Chew, outgoing president of the Radiology Business Management Association (RBMA), and William Pickart, CEO of Integrated Medical Partners (IMP), in a June 8 presentation at RBMA's Radiology Summit.

Chew, who is also senior vice president of Integrated Radiology Partners (IRP), and Pickart together have more than 60 years of experience in healthcare. Based on their history of working with independent radiology practices, they believe that hospitals and health systems typically view such practices in three ways: as competitors, valued partners, or invisible.

Competitor practices

A competitor practice is doing things that bump up against the strategies of the system itself, Pickart explained.

The following characteristics are common in this type of practice:

  • The medical staff and referring providers it works with are alienated and actively dislike dealing with the practice.
  • The practice steers patients to its own imaging facilities over those of the hospital or system.
  • The practice physicians do not participate in medical staff activities.
  • The practice does not work toward improving service or clinical quality and may actually belittle hospital or system staff and administration.

Pickart and Chew said they see this situation most often when the practice owns an independent imaging center that competes with the hospital or health system's own outpatient imaging.

"It is frequently the most contentious element of the relationship, and despite all those things that can be done by the practice to position itself as a valued partner, that always gets in the way," Pickart said.

Invisible practices

Most often, though, practices Pickart and Chew work with are not seen as competitors -- they are not seen at all.

"An invisible practice is one that may do excellent clinical work and support the hospital, but given the massive shift in what the hospitals are looking for in support from the group, being invisible doesn't work," Pickart said. "It means that you are not at the table for any kind of strategic initiative with the hospital, and therefore the concerns of the practice are not going to be heard."

In general, invisible practices share the following characteristics:

  • They are minimally or not proactive in any interactions with the hospital or system.
  • They respond or act only when it is an absolute necessity to do so.
  • They do not engage in supportive or coercive acts of any kind.
  • They do not demonstrate their value and assume that if they do good work, the hospital or system will see this and not need it pointed out to them.

Valued partners

Practices that serve as valued partners are different. They actively give hospitals or systems what they want and need to succeed, and they treat the hospital or system the way they would want to be treated.

"[Hospitals and systems] are under severe competitive pressure themselves, and they are looking for ways to differentiate their systems in the eyes of employers, referring physicians, and patients," Pickart said.

As they try to figure this out, health systems are also looking to control their costs. They know that payors are moving toward making them more responsible for the overall cost of care and stemming patient leakage, because in a population health scenario, they need to "capture lives" to also capture the cost savings of good preventive care services they provide, Chew explained.

Furthermore, there are various government quality initiatives that require health systems to raise patient and provider satisfaction, along with improving outcomes and adhering to best practices. It is a tall order; the hospitals and health systems know they can't do this alone, and they need valued partners who will help them reach their strategic goals.

To become that valued partner, Chew and Pickart advise the following:

  • Work with the hospital and system to control costs by decreasing overutilization of imaging, providing ordering guidance to referring physicians, and assisting with the implementation of clinical decision support.
  • Improve clinical and service quality by doing a better job of matching up subspecialized expertise with the procedure being done.
  • Bring forth innovations in protocol across the system. "Just coming together is not going to get you anything," Chew said. "You have to bring something to the table."
  • Have high peer-review and quality-control standards, and tell the system or hospital what you are doing, since they will not know otherwise.
  • Invest radiologist time in educating referring physicians about incidental findings, appropriateness criteria, and ordering guidance.
  • Partner on initiatives to raise patient satisfaction without confusing it with quality. "The problem with patient satisfaction is that it is based on patient expectations, and we've done a poor job as an industry in setting patient expectations," Chew said.
  • Demonstrate quality improvement and improved outcomes with surveys and data.
  • Improve referring provider satisfaction and hospital administration satisfaction on internal surveys.
  • Take the lead in population health management initiatives by working with the hospital or health system on standardization of protocols, procedures, equipment, staff training, reporting, and peer review.
  • Help the hospital or health system avoid patients leaving the system due to poor relationships with referring physicians, and get referring physicians who currently send you some of their patients to send you every possible patient. "You start doing that, and your hospital or health system will love you because that is more volume into their system," Chew said.
  • Initiate data analytics and business intelligence to make you and the hospital or system better.

"What I keep telling groups when we talk about being a valued partner is that it is a 'raise all ships' philosophy," Chew said. "If you can make the hospital the highest value provider of medical services in their market, more people are going to come to that facility for services. If more people come to that facility where you are providing the professional services, what happens? You see more services as well. You can also negotiate better payment rates."

The Radiology Summit where Chew and Pickart presented was held from June 7 to 10 in Las Vegas. Learn more about RBMA's educational programs at www.rbma.org.

Disclosure notice: Lena Kauffman is a professional reporter and writer for the Radiology Business Management Association (RBMA), an organization comprised of more than 2,400 professionals who focus on the business of radiology.


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