eMed Technologies
Radiology practices today must secure and extend a decade's worth of hard-won gains in productivity and imaging volume. Unfortunately, many of the easy fixes for coping with declining reimbursement have been tapped. Difficult tasks remain, such as the need to improve and connect disparate imaging and information systems, communicate a coherent brand identity, and maintain physician-referral bases. Some market analysts believe the Internet offers solutions to many of these challenges.
The reimbursement crisis
Faced with a crisis of declining reimbursement rates from managed care and U.S. government healthcare programs in the 1990s, radiology groups and imaging centers had no choice but to implement three overlapping strategies:
- Reduce costs through staff reduction, supplier cost reductions, centralizing, and outsourcing functional areas.
- Improve productivity by asking radiologists to work harder, faster, and longer, and implement technology solutions such as automated fax reports, miniPACS, local area networks, and information systems.
- Increase exam volume to offset lower reimbursement and create negotiating leverage with payors through mergers, geographic and service offering expansion.
Continuing strategies for success
In the aftermath of this response to the 1990s reimbursement crisis, radiology groups and imaging centers are serving increasingly larger areas. These groups employ more radiologists, more of whom are subspecialists, and they interact with a greater variety of institutions and management structures -- at hospital chains, tertiary hospitals, local community hospitals, and freestanding imaging centers.
Although the strategy of cutting costs while raising productivity and volume have worked well for many radiology groups and imaging centers, even the most successful find the situation to be somewhat precarious. While pressure from payors continues unabated, most, if not all, of the easy fixes have been expended. Recognizing the need to consolidate newly won market advantages and avoid slippage, imaging businesses must address some remaining and challenging tasks.
Creating brand identity
The creation of a brand identity projects the practice's values and credentials to hospitals, physicians, and patients. Focused on expanding volume, many imaging groups have not worried much about how the marketplace perceives them. But a stronger, more consistent identity could serve as a competitive barrier to prevent volume erosion.
The threat to volume is constant, and it comes from competitive local groups, private imaging entrepreneurs, teleradiology businesses located around the country, and even an increasing challenge from local referring or non-referring specialists. The issue of identity has an internal as well as an external face.
As imaging businesses increased staff size, management complications inevitably followed. Working hard to align employee compensation with business goals, many have neglected to articulate core values concerning quality of care, relationships, and service inside and outside the organization.
Embracing the clientele
Another critical component of success is embracing the clientele -- referring physicians. But relationships with referring physicians can deteriorate simply as a consequence of increased volume. At best, focusing on imaging volume without a corresponding focus on clinical value risks reducing radiologists to image readers rather than doctors.
The framework for clinical consultation in radiology is under assault today, not just by cost pressures, but also by technologies that enable radiologists to interpret images for physicians with whom they have absolutely no working relationship. To counter the threat of commoditization, there must be a rededication to clinical consultation and relationship building. For the sake of the profession as a whole, radiologists can no longer afford to minimize the importance of their interaction with other physicians and their own contributions to patient management.
The digital answer
With the hard-driven business strategy reaching exhaustion, most radiology groups and imaging centers are implementing a digital infrastructure to improve workflow. The ability to route filmless images and RIS data throughout the radiology enterprise should, by definition, help radiologists work smarter. But this solution comes with its own obstacles.
Most radiology businesses provide professional services under different contractual arrangements to organizations -- including hospitals, imaging centers, and nursing homes -- with varying digital infrastructures and often little motivation to invest in new digital equipment and software. When imaging groups attempt to make radiology filmless, they start out with a conglomeration of different information technology (IT) committees, corporate structures, legacy hardware and software systems, and service contracts.
They must patiently make improvements bit by bit, byte by byte. In this struggle, the ability to connect disparate systems together in a unified, coherent, and smart network is a key advantage.
The power of the Web: improving workflow integration
By giving referring physicians online procedure scheduling and communications tools, as well as secure access to imaging exam results, the Web can enhance both productivity and relationships. For such a service to be successful, however, images and reports should be posted automatically to a secure server after interpretation. Referring physicians can then access reports and images wherever and whenever they need them.
With faster access to completed examinations and receipt of images and reports, the Web can improve workflow integration between radiologists and referring physicians, which, in turn, improves the quality of care. But a Web service only brings value when physicians are using it, and such a service must be combined with a marketing and execution strategy for success.
Physicians must be encouraged to use the service through comprehensive marketing programs. Elements to consider include pre-launch surveys to determine key early adopters; open houses and events to launch the Web service to the physician community; training programs to promote ease of use; and reminder cards to encourage ongoing use. All of these activities serve a dual purpose. Not only is the Web service promoted, but the practice is also positioned in the physician community as an innovative leader.
Exploring the benefits of the web: Bay Imaging Consultants
Bay Imaging Consultants, a radiology group in the western U.S. has implemented Web-based distribution systems for images and reports. The group (an eMed Technologies customer) emerged in the 1990s as a larger group serving an ever-wider service area. It faced the challenge of projecting a unified identity and consolidating relationships with referring physicians.
Bay Imaging has 58 radiologists who work with more than 1,300 referring physicians. In addition to serving 12 area hospitals, the group provides services through a network of 12 freestanding outpatient imaging facilities -- including four MR sites, four CT sites, and numerous multimodality mammography, ultrasound, and general radiography clinics. For Bay Imaging, the shift to the Web offered a number of benefits:
A brand identity for referring physicians, patients, and employees. The creation of a Web site and service provided clarification for the group’s internal marketing needs.
"The Web site has not only improved the visibility of Bay Imaging; it enhanced our own self-image as well, which in turn has had a positive effect on every single member of our organization," said Dr. Robert Binder of Bay Imaging. "Moreover, it has created an environment in which every member of Bay Imaging has a heightened sense of Bay’s service ethos. In essence, the Web site, in its appearance and its function as a conduit for images and reports, is a symbol of the quality of service that Bay’s radiologists and staff -- and there are more than 230 employees -- want to live up to."
Practical service to referring physicians. CT and MR images are posted to the Web server as soon as the radiologist has signed off on a dictated report. While a paper copy is currently auto-faxed to the physician, the report will also soon be available on the Web server along with the images.
Standard turnaround time for image interpretation and reporting is less than 24 hours. If there is an urgent finding, the referring physician receives an immediate call.
"Referring physicians love the fact that they are able to view reports and images at their own convenience -- and immediately after the report is completed," Binder said. "They know that they can send a patient to us and in a reasonable amount of time have both the report and the images back. Clearly, with this type of convenience and certainty, physicians will be more likely to use our services again."
Radiologists also appreciate the capability to view images using a browser. "It is a tremendous convenience that in response to a telephone query about an image, I can be at my desk and use the browser on my personal computer to call up the case," commented Binder.
Emphasis on subspecialty services and quality of care. Bay Imaging uses the Web to distribute CT and MR images to appropriate subspecialists for reading, and the availability of these images on the radiology group’s Web site publicizes the availability of this expertise. CT and MR examinations have the highest reimbursement rates.
Reduction in film and chemical costs. The more referring physicians view images at the radiology group's Web site, the less often will they demand printed films. This transition means reduced costs.
For example, if the group conducts 300 MR and 300 CT studies per month and a third of its referring physicians sign up to review images by means of the Web site, the group’s potential annual cost savings is $98,604. Of course, the rate at which referring physicians opt for the transition to Web access is not the sole determinant of film cost savings, as some referring physicians are far heavier users of imaging services than others. Marketing the service is critical to boost the physician adoption process.
Interacting with referring physicians. The introduction of the group's Web service for distributing images and reports was an occasion for celebration. Referring physicians were invited to an open house to preview the system and sign up for access to images and reports. Flyers, postcards, press releases, and other support materials were created to announce the new distribution system to the referring base.
But each group also wisely involved referring physicians in the consultative process of setting up the Web site. One concern was that referring physicians might have had previous negative experiences with Web-based services; another was that the physicians’ own PC equipment could deter from the quality of images provided through the customized web distribution system. Fortunately, these fears turned out to be unfounded.
Ensuring security
The security features of a Web service should meet or exceed the proposed federal regulations under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Web service Bay Imaging selected uses secure channel technologies and post-event security. At the application level, security is maintained by three means: access control (who has permission to view images and reports); information selection control (what images and reports are visible to each individual who has access); and logging control (the record of who has logged on and what has been viewed).
To sign up for image and report access over the Web, the physician must fill out an application offline, for verification and approval by the radiology group. Once signed up, the physician may enter the physician portion of the group’s Web site and sign in by typing an ID and password. The radiology group also controls how much information referring physicians can access.
Usage reports help to monitor success and provide insight into which physicians are using the service. From this information, the radiology group can ascertain which physicians need additional marketing encouragement to use the service, and whether to provide confirmation that images and reports have been received.
By Susan WorthyAuntMinnie.com contributing writer
July 26, 2001
Susan Worthy is director of marketing at eMed Technologies of Lexington, MA. She can be reached at [email protected].
Copyright © 2001 AuntMinnie.com
