Radiology groups are losing hospital contracts in record numbers as imaging services have become increasingly commoditized -- especially with the advent of teleradiology, which gives groups a break from night call but also exposes them to the threat of replacement.
There are strategies, however, that radiologists can use to align their practices more closely to the goals of the hospitals they serve, thus making themselves less disposable, according to a presentation at the recent AHRA meeting in Grapevine, TX.
Cordial, innovative, and mutually profitable relationships between radiologists and their hospitals can be win-win situations for both parties, yet they aren't so easy to forge, said presenter Dr. Lawrence Muroff, CEO and president of Imaging Consultants in Tampa, FL, and clinical professor of radiology at both the University of Florida and University of South Florida Colleges of Medicine.
"The essential conundrum is this: Most radiologists are, from their perspective, extremely loyal to the hospitals they serve," Muroff told session attendees. "But on the other hand, hospitals have legitimate concerns about coverage, quality, and service, and sometimes the views of each party on these basic issues seem to be polar opposites."
It doesn't help that radiologists tend to believe a number of urban legends that keep them vulnerable to being replaced, such as "they can't replace us," "we're a big group," "there's a radiologist shortage," or "if we're good radiologists, nothing else matters; our contract will be safe," according to Muroff.
"At no time in my 35-plus years in radiology has there been a greater parting of radiologists from their hospitals," he said. "In some cases it is the radiology group that chooses to leave, but in the overwhelming majority of cases it is the hospital that terminates the radiology practice."
Common complaints
What complaints do hospitals tend to have about radiologists? Unfortunately, there are many, Muroff told session attendees:
- Rude, condescending, and/or inappropriate behavior
- Not being available when needed/when appropriate
- Not being helpful to technologists (i.e., radiologists don't know more about the study than the technologists -- and in some cases, know much less)
- Putting the technologists in difficult or professionally untenable situations
- Not consulting or practice-building
- Not educating referring physicians and/or technologists
- Competing with the hospital; not aligning goals with those of the hospital or the department
- Lack of empathy or compassion with patients
- Inattention to specific medical issues and/or allergies of patients
So how can radiology groups shape up? A good place to begin is with a review of the professional services agreement between the group and the hospital, Muroff said.
"The starting point to solving issues [between radiology groups and hospitals] is understanding the relationship of the group and the hospital in the first place," Muroff said. "That invariably means understanding the professional services agreement between the hospital and the radiology group."
In about 80% to 85% of cases, radiologists work in a hospital under an exclusive agreement, according to Muroff. This kind of contract gives radiologists protection, via access to an efficient work environment and reasonably predictable income, as well as the ability to optimize recruiting and retaining of new staff. As for the hospital, an exclusive agreement provides service to referring physicians, defined hours of coverage, theoretically fewer complaints and problems, and ensured technical expertise -- in other words, control.
"From a practical perspective, without the exclusive contractual arrangement, there could be demoralizing chaos in a department," Muroff said. "Such chaos is costly, it impacts service and quality, and it detracts from the efficient and effective operation of a successful radiology department."
So what is covered under the professional services agreement?
- Definition of radiology services and where they apply to the "exclusive" arrangement
- Organizational status
- How new services are allocated; how turf battles are resolved
- Responsibilities of each party to the department: teaching, hours of coverage, types and numbers of radiologists on site
- Length of term and means of termination
- Clean sweep or not
- Noncompete or not
- Permissible charges; third-party payor obligations
- Indemnification and insurance needs
Of course, each of these items provides opportunities for conflict, Muroff said. Although exclusive contracts do clarify radiologists' roles in hospital departments, they can also erode incentive for appropriate communication or alignment of goals and create mutual mistrust and, all too often, hostility between the practice and the hospital administration. In essence, hospitals are replacing their radiology groups because they can.
"These problems -- and others -- have led hospitals to strongly consider replacing their incumbent practices," he said. "Hospitals are tired of hearing complaints about service or behavior issues from referring physicians. They don't like radiology groups competing with them, or they don't like the radiologists themselves and aren't confident in their leadership capabilities. And some groups just aren't big enough to provide the 24/7 subspecialty expertise hospitals want."
Fighting back
What can radiology groups do to keep their contracts? First and foremost, remember that radiology is a service specialty, Muroff said. Radiologists should be part of the hospital's strategic planning, and the hospital administrators should understand the goals of their radiologists.
"A continuous dialogue should be occurring between radiologists, [hospital administrators], and referring physicians," he said.
Radiologists would do well to remember that most referring physicians would rather get superior service from average radiologists than lousy service from great radiologists, according to Muroff. Having a quality assurance/quality improvement program in place before it is needed and working with (that is, meeting with!) referring physicians to understand their needs and concerns is key.
The following are some key actions radiology groups can take to build long and happy relationships with hospitals:
- Maximize communications at multiple levels.
- Name "modality champions" -- individuals who are in charge of a given modality or subspecialty and work together to standardize and optimize procedures and protocols.
- Develop credible quality assurance/quality improvement.
- Establish periodic, scheduled educational sessions for technical personnel.
- Consciously try to align goals and understand the mutual needs and concerns.
- Conduct a facilitated retreat that includes key hospital administrative people and radiology practice members.
It all comes down to establishing presence, Muroff concluded.
"To maximize the opportunity for tenure in a hospital, radiology groups must integrate themselves into the medical, political, and social structures of their hospitals and their communities," he said.
