Distributed Imaging Unified Workflow Brings Better Outcomes


November 4, 2015

Any distributed workflow solution worth its salt helps radiologists work at the top of their clinical skill set, maximize their productivity and fully integrate their workflow with that of the rest of their practice—and, ultimately, with the workflow of the ordering physician, practice or provider organization. Read More

Collaboration Series Part II: Improvement in Quality

By Keith Chew, MHA, CMPE, Managing Director of Strategic Positioning and Consulting Services

In last month’s installment of the Collaboration Series, we discussed the evolving, varied business models of radiology group collaborations, partnerships, affiliations and acquisitions. This month, we will be focusing on using the collaborative model to improve the quality of care radiology groups provide.

In the pursuit of cost-effective, high-quality services, the healthcare industry today is experiencing tremendous change. Consolidation, in particular, has been particularly brisk in recent months, as firms look to build scale, cut costs, expand service lines and gain market share.

So it’s easy to see why hospital leaders now are paying particularly close attention to radiology. According to the American Academy of Orthopedic Surgeons (AAOS), “the annual spending on diagnostic imaging in the United States is $100 billion, making imaging the second-largest and the fastest-growing item for healthcare payors.” The medical organization estimates that $30 billion of this total outlay is spent unnecessarily, due to the inappropriate utilization of imaging or duplication of studies.

With so much opportunity for increased efficiency in radiology departments, what can radiologists do to ensure they remain a valuable partner to hospitals, payers and patients? They can come together. Radiology group collaboration is a proven strategy for improving quality, lowering costs and increasing efficiency. Here are three reasons why:

Subspecialty Access

Access to the appropriate subspecialists is a key component of improving quality within radiology practices. It is critical to have access to the most qualified specialist with the greatest knowledge and experience in the specific area of diagnostic imaging being utilized. This will decrease the likelihood of additional diagnostics being ordered, which can put strain on a facility’s time and resources.

Subspecialty access can also help to reduce clinical errors in radiology readings. According to the American College of Radiology (ACR), the average error rate of radiologists is nearly 30 percent, with 70 percent of the errors due to an unperceived, or “missed,” abnormality in the reading. If radiology groups form a collaborative and become interconnected remotely with subspecialists throughout their community, state or even region, they immediately become empowered to work toward meeting the goals of the Image Wisely campaign of supplying the right diagnostic test to the right patient at the right time. This can be brought about through better clinical decisions that will ultimately improve the quality of care and patient safety.

Workflow Technology

By combining resources, collaborative radiology groups can utilize key imaging workflow technologies that address operational inefficiencies, limited capacities and workflow integration. This technology can provide radiologists comprehensive, detailed patient clinical history to use when interpreting studies. The more specific the clinical information at hand, the more actionable that diagnostic interpretation can be. This provides added value for the referring provider to develop an effective treatment plan for the patient.

At IRP, we make available to our Regional Radiology Group Networks (RRGNs) a customized imaging workflow management software that features a unified work list, enhanced voice recognition capabilities, advanced performance reporting, automated peer review and critical results notification. All of these elements are specifically designed to enable greater operational and clinical efficiency in an era of value-based care. Practices can optimize their performance and better position themselves for success in the market by pooling resources and investing in sophisticated technology solutions.

Cutting Costs

Radiology groups that collaborate with other like-minded practices reap the reward of cost-savings in a variety of areas. One example includes medical malpractice insurance; groups involved in IRP’s collaborative model can save an average of 15 to 20 percent on their annual malpractice insurance costs initially. That savings can also increase as analytics are applied to the risk management functions of the practice or network. By focusing on cutting unnecessary costs, radiology groups can target their resources on quality improvement initiatives.

As the industry continues to move toward a value-based care model, radiology practices and imaging centers will increasingly need to demonstrate and deliver their value proposition. Advanced data and analytics capabilities will play a key role in proving a practice’s value.

Stay tuned for the final installment of the Collaboration Series, when we will discuss the different ways data analytics and quality metrics can be built into collaborative practice models in order to demonstrate, prove and even improve their value proposition.

Collaboration Series Part I: Evolving Business Models

Within the past ten years, physician leaders and hospital executives have seen more consolidation in the healthcare industry than ever before. As the industry transitions to a value-based care model, efforts are underway by leaders across the board to reduce costs, improve results and increase hospital-physician alignment. A recent report by Deloitte, “2015 Health Care Providers Outlook United States,” states:

As patient rolls lengthen and networks narrow, providers may need to adapt to this realignment of market forces. Smaller players (e.g., single hospitals, independent physician groups) may be in danger of exclusion from more narrow networks. In contrast, market-dominant players are likely to be immune from exclusion and can negotiate from a position of strength. Dominance comes partly from being big, and the need to be big is driving sector consolidation. (3)

Changes in regulation, technological innovation and financial pressures are all contributing to this push toward market consolidation—toward “being big” in order to survive.

But it is important to examine physician practices’ options in today’s rapidly changing environment. The multitude of possible models that lie on the spectrum of consolidation prove that there is no one way to align with hospitals and become a stronger market player. On one end of the spectrum lies traditional merger and acquisition (M&A) activity, while beyond that exist joint venture models, clinical integration networks (CINs), affiliations and collaborations as potential solutions to avoid sacrificing practices’ independence.

Below are three examples of the different options available to radiology groups in the current landscape:

Collaboration of Large Groups

Collaborations of large practices are becoming more popular in the specialty of radiology. An example is

Strategic Radiology, which strives to provide its network of 1,300 radiologists shared access to data, clinical information and certain consolidated expenses in a collaboration-based model. Although its goal is to deliver higher quality, cost-effective care, Strategic Radiology focuses on practices with fifty or more providers, essentially ignoring smaller regional players. Though collaboration provides the tools necessary to succeed in such a model, it is an exclusive model which has not focused on the independence and survival of smaller groups across the U.S.

Acquisition by Management Company

Single-specialty and multi-specialty national management companies are also on the move within the radiology market (see MEDNAX’s acquisition of vRad spring of 2015). One example is Radiology Partners (RadPartners). The group’s approach resembles the traditional M&A model of acquiring practices to join its expansive network of over 100 locations. Though it positions its services as “partnering” with radiology practices, RadPartners primarily acquires local groups and promises health systems greater stability. This corporate-sponsored management company has over 200 radiologists who share technology, quality data metrics and economies of scale in order to hope to succeed in the era of consolidation, yet simultaneously cede to this trend as they lose their independence.

IRP’s Model of Small Group Collaboration

At IRP, our collaborative model is built to support regional radiology practices’ sustained independence. We provide radiology groups of all sizes the resources they need to survive in the age of value-based care. IRP’s model helps transform practices into more nimble organizations that allow for faster, more efficient decision-making in a rapidly moving market. We prepare our collaborations for the future of healthcare; for example, as CMS moves its 2018 Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) initiative forward, we equip our groups with the data submission capability and metrics necessary to evaluate the assumption of greater risk as these models come to fruition.

It is critical for radiology leaders to examine the emerging and evolving practice models and make an informed decision regarding their practice’s future. As the current regulatory environment fuels increased demands and pressure on physician practices around the country, what is your plan to solidify your independence and ensure your success?

–By Keith Chew, MHA, CMPE, Managing Director of Strategic Positioning and Consulting Services

Stay tuned for part two of the collaboration series next month, where we will discuss the various benefits a collaborative model brings to radiology practices nationwide.

Radiology ICD-10 Readiness

August 31, 2015

Oct. 1 is rapidly approaching, and no medical specialty, including radiology, will be exempt from ICD-10’s industry-wide overhaul. Read More–>

Radiology ICD-10 Readiness

By Robert Kebbekus, President & COO

Oct. 1 is rapidly approaching, and no medical specialty, including radiology, will be exempt from ICD-10’s industry-wide overhaul.

A recent article in the Radiology Business Journal warns physicians to “brace themselves,” citing a Journal of American College of Radiology study which predicts a 6-fold increase in the number of codes used by radiologists.

“As the conversion from ICD-9 to ICD-10 will require acquiring and documenting even more detailed clinical information than is currently required for billing purposes—information that remains difficult for many radiology practices to adequately capture—that transition is perceived as a particularly daunting task for facilities, physicians, administrators, and coders alike,” Dr. Margaret Fleming from the department of radiology and imaging sciences at the Emory University School of Medicine reported.

Although the conversion to ICD-10 is a daunting task, there are many things radiologists can do to “brace themselves” for Oct 1st. Let’s examine what radiology leaders should do to prepare for this challenging transition and avoid any cash flow or productivity-related disruptions:

Confirm Medical Necessity

Confirming and documenting medical necessity for encounters is problematic in today’s reimbursement environment, but this process will become even more of a nuisance come Oct. 1. Add to that, over 40% of radiology studies result in no finding. In these cases, radiology groups are completely dependent on the referring doctor to provide detailed presenting conditions in order to get paid. Put another way, it is not how prepared your group is but how prepared each and every referring practice is for ICD-10. We recommend practices start tracking referring doctor and practices’ poor documentation of patients’ symptoms and condition. In addition, groups should contact their primary referring practices and confirm their ICD-10 readiness.

Please see last month’s blog post for more information.

Alter Findings Dictation

Findings from the reading must be dictated with a greater level of specificity than ever before required. For example, in scoliosis cases, radiologists must now be able to answer when exactly it began, is it acquired or congenital, along with the specific area of the spine affected. Without these key pieces of information, radiologists may face a significant increase in claim denials and a host of other reimbursement and compliance issues.

Medical Economics cites: “Of the ICD-10 codes that do not have ICD-9 counterparts, about half are related to laterality (left, right and bilateral indications), AHIMA says. Another big chunk of ICD-10 codes consists of ‘external cause reporting’ codes, such as what caused a particular injury.” The article continues to describe additional codes radiologists must support with documentation, including those related to linked conditions such as hypertension and heart disease as well as musculoskeletal conditions such as bone fractures. Familiarizing yourself with the codes most relevant to your practice as well as the required information associated with those conditions will ensure appropriate reimbursement and an uninterrupted workflow.

The top five areas radiologists will need to provide additional documentation in their reports are:

1) Fractures:  Radiologists will need to expand their documentation; laterality, type of fracture as well as encounter, is the fracture open or closed, is the fracture pathological or traumatic and in what stage of healing is the fracture.

2) Limb pain: Radiologists will need to document the specific limb and laterality.

3) Abdomen pain:  Radiologists will need to document the specific location of the pain in the abdomen.

4) Congestive heart failure: Radiologists will need to document the type of heart failure, and if it is acute, chronic, or acute on chronic.

5) Osteoarthritis: Radiologists will need to document the specific location and laterality.

Learn the Most Relevant Codes

ICD-10’s addition of 56,000 codes and change in code structure is overwhelming for any physician to absorb. Although all practices will have to do some preparation for and education around these new codes, it is important to narrow in on which codes are most relevant to the practice’s patient population.

According to an RBMA ICD-10 resource, this new system affects diagnosis codes in different ways. For example, the ICD-9 code for headache, 784.0, is only broken into two ICD-10 codes (G44.1 Vascular headache, not elsewhere classified, and R51 Headache). Other diagnoses, however, present a more alarming picture; ICD-10 breaks down ICD-9’s 786.09 Respiratory abnormal NEC into five different diagnosis codes, and ICD-9’s 729.5 Pain in Limb code into no fewer than 30! Many billing groups are looking for simple translations from ICD-9 to ICD-10; although there are many codes for which this will be possible, to address the vast majority of codes in this manner would lead to improper coding and negatively impact both compliance and reimbursement.

It is critical to understand which of these conditions occur most frequently in the radiology practice or imaging center to appropriately allocate ICD-10 preparation time and funds. Radiologists do not need to learn all 68,000 codes, but they will certainly have to familiarize themselves with the additional codes that will affect them the most. Our findings indicate that less than 4 percent of the ICD-10 codes will be used in radiology. In addition, the top 62 ICD-10 codes will cover as much as 65 percent of a radiologist’s primary findings. Physicians need to know not only these top codes, but also what to document in order to provide the specificity required to properly assign these codes. Talk to your coders and find your top ICD-10 codes.

If there is a “silver lining” to ICD-10 for radiologists, it is that the required additional information from the referring doctors for ICD-10 should provide a much clearer picture of what’s actually going on with the patient. Thus, radiologists can more accurately address the presenting conditions of the patient.

Please click here for additional, radiology-specific ICD-10 resources.

Affiliation Is The Answer To Consolidation, Now More Than Ever


July 19, 2015

We’re only halfway through the current calendar year, and already radiology practice in the U.S. has been jolted by not one but two major transactions. In January, Sheridan, the multispecialty physician-services division of AmSurg Corp, purchased Radisphere Radiology for an undisclosed amount. In May, Mednax Inc., the $2 billion health-services company mostly focused on neonatal, pediatric and anesthesia services, snapped up Virtual Radiologic (vRad) for $500 million.  READ MORE

Independent Radiology Practice, it’s 2015. Do you know how your hospital sees you?


July 19, 2015

The question in the headline is not open-ended and philosophical. It is multiple-choice and strategic, as any given hospital or multi-hospital system now inevitably perceives its contracted radiology practices as occupying ground in one of only three possible capacities. READ MORE

Patient Empowerment Part III: Responding to Patient Choice

July 7, 2015


In last month’s installment of the Patient Empowerment series, we discussed how the rise of the new patient-consumer directly affects radiologists. Part III of this series will provide insight into what radiology practice leaders can do to not only adapt to this trend, but capitalize upon it to better serve their health systems and patients. Read More 

Patient Empowerment Part III: Responding to Patient Choice

July 7, 2015


In last month’s installment of the Patient Empowerment series, we discussed how the rise of the new patient-consumer directly affects radiologists. Part III of this series will provide insight into what radiology practice leaders can do to not only adapt to this trend, but capitalize upon it to better serve their health systems and patients.

The healthcare industry’s transition from a wholesale to retail business model has inevitably altered health systems’ priorities, which now include patient acquisition via patient experience improvements. These industry-wide changes have directly impacted the radiology department; according to an article from RSNA, “…various market forces—from the growth of teleradiology and non-radiologists performing imaging exams to changing reimbursement models and healthcare reform—present both a threat and an opportunity within the specialty. As a result, experts say it is more critical than ever for radiologists to prioritize patient satisfaction and strengthen relationships with referring physicians, hospital administrators and insurers.”

The following are three ways radiologists can respond to the rise of patient choice and assist their hospital in attracting patients and gaining valuable market share:


Self-Assessments and Satisfaction Surveys

Conducting regular assessments to test the efficiency and quality of the practice’s care as well as patient and staff satisfaction levels is a key step in increasing a radiologist’s visibility and contribution to the overall patient experience. Dr. William Thorwath Jr. of Catawba Radiological Associates and RSNA Board Liaison for Publications and Communications states: “We need to be seen as we actually are: active participants in patient care.”

Dr. Thorwath continues: “We need to be continually asking, ‘What are we doing well? Where do we need to improve?’…Every radiologist knows the value of making the patient experience more positive, from convenient parking to a comfortable waiting area to easy and timely access to results.” With consistent surveying of both staff and patients to better improve practice efficiencies and operations, radiology leaders are continually increasing the value they add to their community and the health systems they serve.


Face-to-Face Interaction

Though not a traditional element in radiologic care, both RSNA and the American College of Radiology (ACR) suggest incorporating and increasing face-to-face time with patients. The ACR conducted a study to examine radiology’s role in patients’ overall health and the value a radiologist can bring to the continuum of care. The results were astounding; 93% of patients were more motivated to improve their health and diet after reviewing their images in a consultation with the radiologist. 86% were more motivated to exercise, while 100% were more motivated to quit smoking after the consultation. Moreover, 100% of patients preferred to repeat the experience and meet with a radiologist again in the future. This ultimately proves the significant and lasting impact radiologists can have on their patients’ health and the value they bring to the health systems they serve.


Patient (and Practice) Education

After Dr. Jennifer Kemp received a patient’s-eye view of her profession, she became the head of RSNA’s Radiology Cares committee to “optimize the patient experience in radiology.” Dr. Kemp espouses the importance the providing educational materials to patients to aid them in a better understanding of their results and/or condition. Radiology Cares offers a suite of downloadable patient-centered communication materials for radiologists to share and review with their patients. But the focus extends beyond the patient; Radiology Cares recognizes that this first must start with the practice leaders themselves. Therefore, the committee also offers a downloadable “Educational Toolkit” as well as a “Presentation Toolkit” to educate physicians on the importance of patient-centered care and how their practice can adapt to these industry changes.


To learn more about the rise of the patient-consumer and what radiology groups can do to respond to this industry-wide trend, please email us at ContactIRP@integratedRP.com.

Patient Empowerment Part II: The Rise of Patient Choice

June 16, 2015


In April’s first installment of the Patient Empowerment series, we discussed how increased patient responsibility and widespread use of technology has led to the creation of the new patient-consumer. Part II of this series asks the question: So what? Read More 

Patient Empowerment Part II: The Rise of Patient Choice


June 16, 2015


In April’s first installment of the Patient Empowerment series, we discussed how increased patient responsibility and widespread use of technology has led to the creation of the new patient-consumer. Part II of this series asks the question: So what?


The rise of patient empowerment has given way to a startling amount of autonomy when it comes to healthcare information and decisions; the Pew Internet and American Life Project found that 83% of Americans look online to research health and medical information as well as physician providers.

The patient-consumer’s ability and tendency to research both medical information and providers has dramatically altered the traditional pattern of physician referral. Although physician referrals previously accounted for over 51% of patients’ providers source, this number has fallen to about 30% in recent years. Instead, patients choosing a provider on their own has risen from 24% to 60%, with 80% of high margin procedures such as orthopedic surgery sourcing back to patient choice, rather than physician referral.

The following are two primary ways this change in referral pattern has impacted radiologists and the imaging centers and hospitals they serve:


Hospital Marketing Spend

As a result of this interrupted referral pattern, hospitals have had to become proactive in both attracting and engaging patient-consumers. According to an article by National Public Radio, hospitals’ spend on marketing and communications doubled between 2000 and 2009. A 2012 study by UBM Medica cites that a bulk of the hospitals’ digital marketing budget is used to improve the hospital’s and its physicians’ rankings on digital search engines.
And this is not surprising, considering, as HP Social Media Solutions’ whitepaper “Social Media in Healthcare” states, “whole sites—RateMDs.com, Healthgrades.com, Vitals.com, and others—are dedicated to patient reviews of physicians and hospitals.”

This is crucial as hospitals are becoming increasingly focused on gaining market share and increasing their value. Providing high quality readings and offering subspecialty access such as interventional radiology have become some of the most significant ways radiologists can serve their hospitals and imaging centers. Maintaining a progressive online presence through communication of expanded service offerings and positive patient experience is now a primary way health systems and associated radiologists attract patients and provide added value to their community. A negative presence has the ability to seriously affect a radiologist’s encounter numbers and thus productivity, decreasing his or her value in the eyes of the hospital and/or imaging center.


Doctor-Patient Relationships

Widespread use of technology to not only research imaging centers and hospitals but also to check symptoms and seek medical advice has fundamentally changed the way patients interact with their radiologists. In its report titled “Doctor Innovation,” The Economist states: “Many initially saw the spread of medical information on the Internet as a nuisance or even a risk, although most have since come to see it as a way of enriching doctor-patient conversations.” Patient-consumers are no longer receivers of information from physicians, but rather collectors of information from friends, family, websites and social media channels. This therefore grants them a larger, more proactive role in their healthcare decisions.

An article featured in the NY Times last year, “Radiologists Reducing the Pain of Uncertainty,” touches on how this development impacts radiology: “…Patients are more and more insistent on knowing how and why doctors make decisions about their care. And more and more medical centers and doctors’ offices are allowing patients to log on and see their medical records, which can include reports on scans.” The article continues to explain initiatives taken by both the Radiological Society of North America and the American College of Radiology to demonstrate “how some radiologists have successfully managed to communicate with patients and by letting radiologists know this is something patients want.”

With the patient-consumer becoming increasingly accustomed to direct access to medical information and records online, radiologists are finding a greater need to adapt to this trend, developing positive relationships with patients built on trust and open communication.


In the third and final installment of the Patient Empowerment series next month, we will outline what steps radiology groups and imaging centers can take to proactively engage these patient-consumers and capitalize upon this new industry trend.

What the Acquisition of vRad Means for the Practice of Radiology


The entry of corporate management companies into radiology

May 19, 2015


On May 12, 2015, MEDNAX announced its official agreement to acquire Virtual Radiologic, commonly known as vRad, for $500 million. vRad is a leading outsourced radiology physician services company comprised of over 350 U.S. board-certified radiologists. It is also the largest corporate provider of national teleradiology services. Read more

Radiology: The Changing Competitive Landscape

Radiology: A Changing Competitive Landscape

By Keith Chew, Senior Vice President

May 18, 2015

Read more

Patient Empowerment Series: Part I


April 22, 2015


The changing healthcare landscape has directly affected providers, hospitals and medical staff, but it also has had a profound effect on patients. The increase in patient responsibility for healthcare costs paired with the ease of sharing information via technology has created a patient population that is more aware, knowledgeable and concerned regarding the healthcare industry and their interaction with it. Read more

Top tips on making joint ventures tip top


 April 15, 2015

While independence once held great value and autonomy, joint ventures (JVs) now allow radiology groups of all sizes to work smarter. Radiology practices benefit from the clinical and business intelligence and improved performance analytics JVs can bring, as well as the potential for predictive and prescriptive analytics, increased access to radiology capacity and sub-specialized radiology talent, benchmarking and economies of scale. Read More

Liftoff at last for JV many months in the making

Two independent radiology practices in New York’s Hudson Valley have finalized a plan, three years in the works, to form a joint venture and begin actively inviting other groups to climb aboard. Read More…

Radiology Leadership: Fulfilling the Hospitals’ New Needs


March 12, 2015

The needs of the hospital have dramatically changed as the healthcare industry transitions to a value-based model. These changes have required a greater level of hospital physician alignment than ever before. Read more

The ICD-10 Readiness Checklist: Are You Prepared?

February 26, 2015

Group collaboration is growing and evolving as an effective business model. But whether you are pursuing a collaborative practice or not, all physician leaders are having to address the impending ICD-10 deadline. Read more

Three words to the wise: ‘Get big fast’ Multispecialty outsourcing expert warns radiology of things to come

Change is coming to radiology in ways the profession could not have anticipated in a pre-Affordable Care Act world. The forces driving the change are many and varied—economic, regulatory, technology-enabled—but one common denominator has emerged as the “cardiopulmonary system” of the transformation: hospitals under intense pressure … Read whole article here

Taking our data to the next level in 2015: Q & A with Keith Chew

As senior vice president of Integrated Radiology Partners, (IRP) and also president of the Radiology Business Management Association, Keith Chew is a well-respected leader in our industry. He recently spent time with RadAnalytics to talk about his new role with IRP, the importance of applying analytics in radiology, and share his thoughts on radiology’s outlook for 2015. Read the whole article here.