How medical imaging is conducted and delivered is changing. To be successful under new quality and payment models for healthcare such as accountable care, radiologists need to be prepared, according to a presentation given at last week's AHRA 2013 meeting in Minneapolis.
Healthcare providers are transforming into new interconnected systems, and the old relationships that drove patient referrals in the past may no longer work, said Bob Maier, president and CEO of Franklin, TN-based Regents Health Resources, a healthcare consulting firm that provides services to hospitals and physician practices.
"Reimbursement is morphing from fee-for-service to population-based managed care models and risk-based bundled payments," Maier told attendees at the AHRA session. "It's crucial that medical imaging maintain a defining role in improving patient care quality and outcomes."
How? Through strategic planning, or the process of defining an organization's direction and making decisions to move in that direction, he said. Strategic planning for medical imaging must support the overall goals of the parent organization, whether it's a hospital, health system, imaging center, or physician practice.
What is accountable care?
The current iteration of healthcare reform is focused on cost-effectiveness and shared information, Maier told the session attendees. The emphasis is on cost control, pricing transparency, and service value, as exemplified by the presence of accountable care organizations (ACOs).
"What's different about accountable care is that it's patient-centric, and it's focused on cost accountability, performance metrics, and utilization management," he said. "Although payors are still firmly entrenched in the fee-for-service model, they are preparing for capitation and population health models -- ACO management of healthcare."
ACOs are transforming healthcare as hospitals acquire physician practices at unprecedented rates, physician practices merge or form coalitions, and insurers form relationships with ACOs in numerous markets, according to Maier.
Accountability in medical imaging means timely access to clinical data and ongoing review of the appropriateness and cost-effectiveness of exams, but it also means providing measurable outcomes and, of course, quality images. It's important to keep in mind the difference between quality and outcomes.
"Quality is the subjective measure of the service you provide: how it compares to competitors," Maier said. "Outcome is the measure of the effectiveness of that service: the resulting effect on the health of the patient."
Radiologists can measure quality in several ways:
- Using automated appropriateness evaluations
- Performing the correct tests the first time, every time
- Communicating appropriately with referring physicians and patients
- Making previous images available for comparison from any location
They can measure outcomes by making the cost of the exam clear, transmitting diagnoses immediately, and offering interpretations early and accurately.
"Imaging quality will be measured via physician and patient satisfaction, whether imaging reduced a patient's hospital stay, whether the most effective and least expensive exam was used, and postexam analysis of the results," he said.
Radiologists' participation in the healthcare enterprise will change, requiring more time planning, better financial and operational tracking, a focus on throughput and efficiency, and regular, real-time reviews of the practice's capacity, productivity, and use of resources.
"More and more, radiologists are expected to participate in the ACO planning process, to communicate well with their hospitals, and to provide proactive decision support," he said.
The strategic planning process consists of a number of parts, including gathering facts, SWOT analysis (strengths, weaknesses, opportunities, and threats), reviewing facts, defining strategies and addressing SWOT data, and final review and adjustment, Maier said. He listed a number of factors that could fall under the SWOT category:
- Continued reimbursement reductions for radiologists, hospitals, and imaging centers
- Hospital/system employment of radiologists
- Commoditization of radiology services
- Increasing pressure on appropriate utilization management
- Radiation dose management and tracking requirements
- ACO consolidation of practices and services
- Practice consolidation into regional groups
- Emergence of national practice management companies and alliances
- Aging imaging technology and service cost increases
- Consumerism trends: demand for cost-effective care and ease of access to patient information
"SWOT analysis identifies areas that contribute or detract from your ability to achieve your goals," Maier said. "Determine what your internal strengths and weaknesses are, and what are your external opportunities and threats."
Internal issues include a practice's access to capital, expertise, management skills, and organizational ability to focus on strategic and tactical goals. External issues include traditional and nontraditional competition, market and reimbursement changes, the expansion of the insured population base, and payor-enforced controls such as preauthorization.
How can radiologists implement a strategic plan? There are many practical actions to take, Maier said, including the following:
- Identify two to three critical goals
- Develop milestones, tasks, and responsibilities
- Assign tasks
- Set weekly meetings
- Monitor performance indicators: finances, operations, quality, and outcomes
In any case, strategic planning is no longer a luxury but a mandate, Maier concluded.
"Times are changing for all healthcare providers, including imaging," he said. "And strategic planning is critical to prepare for a changing payor and service environment. Your preparation can mean the difference between continuing to be profitable or not."