Radiologists who take the time to understand their team’s processes are better equipped to make their practices more efficient and effective.
While many radiologists count notable achievements through individual efforts, the success of their practices (and ultimately the well-being of their patients) can wither if they do not understand how the collective healthcare imaging chain functions. Knowing how the imaging process works — from scheduling to interpreting to follow-up treatment — is critical to maximizing quality, efficiency, profitability, and patient satisfaction. The radiologist’s value as a physician becomes less clear when he or she doesn’t identify as being a member of a team.
The Imaging Contingent
“While we’re now seeing the best trained clinical radiologists that we’ve ever seen, most radiologists don’t understand team building or even what a radiology team is,” says Lawrence R. Muroff, MD, FACR, CEO and president of Imaging Consultants, Inc., in Tampa, Fla.
A radiology team might include the radiologist, technologists, peer specialists, coders, front office staff, and others. However, knowing what each team member actually does — and how each role serves a larger purpose — escapes many radiologists.
“I think it’s fair to say that when you look at the process of how an order is placed, to how an image exam is scheduled, to how it’s coded, to actually bringing a patient in and performing the exam, to the images being sent to a work station — the nuts and bolts of the processes are poorly understood,” says C. Matthew Hawkins, MD, director of pediatric IR at Children’s Healthcare of Atlanta at Egleston. All the moving parts of the imaging value chain potentially impact revenue, timely patient care, the quality of procedural documentation, and the accuracy of exams ordered, Hawkins notes.
Taking time to learn the workflow of the entire department can reduce waste, Hawkins says. “There’s no way, for example, you can actually understand what’s happening in your MRI department unless you get up and go there and spend time with the MRI technologists to find out how they do things,” Hawkins points out. “It gives you a sense of the complexity of their job, it tells you how you might more accurately schedule, and it usually reveals opportunities to reduce waste.”
For example, technologists might be doing things they were taught a long time ago that no one has taken the time to tell them may be unnecessary. “So if you don’t take the time, that waste is going to continue,” says Hawkins. Being successful in radiology today, he says, relies on finding efficiencies. The large financial margins radiologists enjoyed twenty years ago may have fed some sloppy business practices they can no longer afford, Hawkins says.
Being attentive to patient needs and meeting the demands of referring physicians are critically important to a smooth-running practice, says Muroff. “But to get a radiologist’s attention quickly, demonstrate to them that failure to pay attention to what’s happening around them in a practice can have a direct impact on their livelihood.”
He shares an example of a young radiologist who noticed what she perceived to be a discrepancy between the work being done and the compensation the group was receiving. She asked for permission to review some back-office processes and found that several million dollars were “falling through the cracks” annually. “This practice had, to the outside observer, a pretty competent business operation,” Muroff says. “If I told you that by just paying attention to certain things around you — beyond devoting time to clinical work — you might make such a finding, I’d probably get your attention.”
Knowing how the practice operates is not only about finding revenue, Muroff adds. “Once you get an understanding of all of the moving parts, you can make a practice more efficient, more effective, and more patientfriendly,” he says. That means knowing the details behind scheduling and being responsive to referring physicians. Taking ownership of operations can determine the degree of quality at which that operation functions.
“It really comes down to whether you’re going to be an owner or a shift worker,” Muroff says. “There is a tremendous difference between the mindset of an owner and that of somebody who just comes in and punches a clock. We in radiology haven’t really stressed the importance of understanding that difference to new trainees. Some new hires don’t fully grasp the importance of being a part of something larger than they are.”
A radiologist’s behavior can have a direct impact on how the rest of staff performs. And that’s tough to identify sometimes because the implementation of PACS has changed radiology. “There’s not as much direct feedback anymore, less mentoring, and little interaction between radiologists and technologists,” says Jeffrey Atkin, MBA, CEO of Reston Radiology Consultants in Virginia.
Because many radiology practices are already at maximum productivity, radiologists don’t make the time to cultivate the relationships that are crucial to, for example, keeping your hospital contract or nurturing referrals, says Muroff. “There is a limit to how productive you can be, so you must turn your attention to this other side of the equation — the practice as a whole,” says Muroff.
With a good business practice and a better understanding of the whole imaging cycle, “you discover things that could potentially drive new business,” Hawkins says. Your entire staff should have a general understanding of the revenue cycle, he says. “Not everyone in the practice has to have intricate knowledge of how radiologists get paid, but they do need to know that it’s a process,” he says.
“Once you get an understanding of all of the moving parts, you can make a practice more efficient, you can make it more effective, and you can make it more patient-friendly.” – Lawrence R. Muroff, MD, FACR
Learn what your front office staff does. “If you can rely on your front office staff to communicate clearly with patients, providing transparent pricing information and being attentive to scheduling, that’s obviously an incredible driver of business,” says Hawkins.
And the patient experience can also affect your referring physicians’ satisfaction. If patients have a negative experience or deal with long wait times, referring physicians will likely hear about it. “If you’re not constantly taking a look at how you’re doing things and finding ways to improve processes in your operation, patients will end up less satisfied,” says Hawkins.
It would be a mistake, Muroff suggests, for radiologists to assume that their business operations are so efficient that they can dedicate all of their time to clinical work. “If your reimbursement drops, there are only two ways you can compensate — increase your productivity or become far more efficient and attentive to detail in order to capture the work that needs to be captured,” he says.
“Some radiologists are really interested in learning what’s going on in their practice,” says Atkin. “Others don’t want to know about anything until a problem arises. It’s usually those who don’t understand how one area’s failure can completely disrupt the entire process flow.”
In addition to interpreting images, an informed radiologist will be interacting with technologists, talking to referring physicians, examining scheduling practices, and taking a personal interest in follow-up care for patients, Atkin asserts. He also credits the feedback that radiologists at his facility provide to referring physicians with strong referral patterns.
“Our radiologists take the time to verify certain exams with the referring physicians,” notes Atkin. “Just because an exam is ordered doesn’t mean it should be done if it’s going to be bad for the patients (in terms of high-deductibles), bad for the referring physicians, bad for the accountable care organizations. It has got to lead to the right diagnosis.” Atkin notes that this communication between radiologist and referring physician has improved patient care, positively impacted revenue, and been valuable from an appropriate use standpoint.
Atkin also credits his group’s radiologists for being involved with the day-to-day workings of the practice. According to Atkin, the radiologists who take the time to understand their practice’s processes are better equipped to continually adjust and solve problems. “Processes must be adapted for everything from federal regulations to insurance company policies to daily quality control by monitoring technologists’ performance,” Atkin says. “If they don’t understand all the parts of the process, they can’t help the practice adapt.”
The bottom line is radiologists need to be more involved in the mentoring of their staff, Atkin says. “If they can give immediate feedback, then bad habits won’t be allowed to continue,” he says. His group encourages faceto- face discussions, but also regularly distributes emails to staff explaining policies and procedures and asking for feedback. “I try to empower my staff and my team and to constantly educate them whenever possible,” Atkin says. “If radiologists don’t like the way something is done, we try to bring them into the workflow so they understand why it’s necessary.”
Both Muroff and Atkin believe that spotting problems and addressing challenges before they get out of control are key to a practice’s success. “Radiologists need to communicate clearly with the practice managers,” says Atkin. “If the practice managers don’t know the problem, then they can’t help.” Muroff agrees: “Challenges in radiology affect us all and the best course of action is better communication and more effective management. It’s a team effort.”
1. Liebscher LA, Fleishon HB. Radiology Is a Team Sport. J Am Coll Radiol 2015;12(10):1118. Available at bit.ly/JACR_Team. Accessed on Jan. 24, 2018.
By Chad Hudnall, senior writer, ACR Press