Reorganizing for the Future

Group members at odds over the implementation of Imaging 3.0TM? It may be time to restructure.


February 2015

This is a non-breaking news alert: radiology is changing from a volume- to a value-focused model of care. In response, the ACR has developed Imaging 3.0™, an initiative that encourages radiologists to add value by engaging closely with patients and other members of the health care team.

While some radiology practices have already begun adopting Imaging 3.0 principles, the road to truly value-based care is fraught with hurdles, including misaligned incentives and resistance to change. To overcome these obstacles, radiologists say that practices must do one thing: overhaul their organizational structures. 

Representing a monumental cultural shift, Imaging 3.0 guides radiologists out of their reading rooms and encourages them to interact directly with referring physicians and patients as consultants in care. "Imaging 3.0 proposes earthquake-level changes in the day-to-day activities of the average radiologist in private practice," says David F. Hayes,MD, consulting senior associate at Windsong Radiology Group in Williamsville, N.Y., who has authored an ebook on the business of medicine and written multiple journal articles on the subject. "But as difficult as those changes are, Imaging 3.0 is the only way radiologists can save their deteriorating business and add value to the health care system."

While Imaging 3.0 is designed to help radiologists thrive in the new health care paradigm, many radiology groups have been reluctant to adopt its principles. One reason is that reimbursements currently cover only imaging exams, not the time radiologists spend in consultation with referring physicians and patients. Another reason is that some radiologists simply don't want to change the way they practice. "For generations, radiologists have been trained to sit in our reading rooms and interpret images," explains Howard B. Fleishon, MD, MMM, FACR, chief of medicine at John C. Lincoln North Mountain Department of Radiology in Phoenix. "To adapt to a more outcomes-based or patient-centered environment, we really need cultural changes within our practice."

Group members must evolve from individual professionals who see themselves as equal partners to defined management teams that make decisions for the group. — Dieter R. Enzmann, MD


Chain of Command

For those changes to occur, radiology groups must acknowledge two important shifts in the marketplace. First, hospitals and patients have new expectations about the quality of care that radiologists provide. And second, many private practices are being consolidated into larger health care systems. In fact, a 2013 report shows that nearly 50 percent of physicians are already employed by hospitals and health systems. "Radiology groups are increasing in size, complexity, and, in many cases, geographical reach," says Dieter R. Enzmann, MD, Leo G. Rigler Chair and Professor in the University of California, Los Angeles radiological sciences department. "As these groups expand, radiologists must manage not only their own professional activities but also the activities of the technologists, nurses, and staff who make it possible for them to actually generate and interpret images."

As radiologists take responsibility for the broader imaging enterprise, groups must restructure themselves to better manage those activities and usher everyone toward value-based care, Enzmann says. Currently, most private practices function democratically, with each partner having an equal say about the group's operations. But Enzmann maintains that groups should transition to more traditional management teams to guide the changes outlined in Imaging 3.0. "Group members must evolve from individual professionals who see themselves as equal partners to defined management teams that make decisions for the group," he says. "That means having less of a partnership and more of an organizational structure with defined leadership roles and accountability. The radiologists still have input, but the management team is vested with the decision-making powers for the group."

Hayes agrees that groups must revamp their organizational structures to achieve the goals of Imaging 3.0. He says that groups should abandon the democratic structure and instead appoint "knowledgeable and accountable" chief executive officers who have the authority to make decisions for their groups. The corporate-style structure, Hayes says, will eliminate the conflicts that arise when, inevitably, some partners refuse to advance the principles of Imaging 3.0. "It will be the CEO's responsibility to learn about the problems facing the group and define the best solutions to overcome those challenges and achieve success in the future," he explains. "As a result, the partners will no longer have the capacity to vote on significant issues; rather, the CEO will make those decisions. Once that happens, the partners will hold the CEO accountable for outcomes."

"Individuals who embrace this philosophy can have big impacts while their groups are contemplating how to fully implement Imaging 3.0." —Howard B. Fleishon, MD, MMM, FACR


Stimulating Change

While not all independent radiology groups are prepared to relinquish authority to a management team or CEO, Hayes predicts that more groups will make the transition once radiologists look beyond their next paychecks and recognize that their customers' expectations are changing. "If radiologists can get over the blindness of their current successes and understand that what they are doing now will not work in the future, they will accept this new way of operating," he says. "These changes will bring accountability for everyone — the CEO is accountable for leading the group, and the members are accountable for providing services for the group."

Still, management teams or CEOs may need to convince some radiologists why it is necessary to meet the objectives of Imaging 3.0. One way they might do that is by holding radiologists accountable in the same way business managers outside of medicine hold their employees accountable, Hayes says. For instance, corporate employees who ignore company protocols risk losing their jobs. Hayes says that if radiologists face similar pressure, they will be motivated to make the cultural changes necessary to move their groups into the future. Enzmann predicts that once a few members of a group embrace Imaging 3.0, the other members will follow. "It will be a challenge for the management or leadership team to get everyone on board, but, in many instances, once a small segment of a group is motivated to make the changes, other people will come along when they see that the changes are successful or necessary," he says.

While management teams and CEOs may ultimately lead groups in the implementation of Imaging 3.0, individual radiologists can also help spur the changes. Fleishon says that his group has slowly begun to adopt Imaging 3.0 concepts thanks to members who have spearheaded quality-assurance and radiation-safety initiatives. "Individuals who embrace this philosophy can have big impacts while their groups are contemplating how to fully implement Imaging 3.0," Fleishon says. During that time, radiologists should also consider taking management courses to learn how to function in larger groups. "The most beneficial thing that radiologists can do is to learn how to manage and organize themselves to make decisions as part of a hospital or radiology group," Enzmann says. "Doing so will ensure that they are prepared once the time comes to make the tough decisions necessary to achieve effective solutions and meet the new marketplace demands."


The Road to Value-Based Care

Learn the ins and outs of Imaging 3.0TM at ACR 2015.

While the transition from volume- to value-based care will be at the center of discussion throughout the ACR 2015 annual meeting, stop by the session "New Payment Systems and Strategies to Cope: Imaging 3.0 and Other Initiatives" to focus specifically on Imaging 3.0 and the steps radiologists should take to deliver added value and become consultants in patient care. Bibb Allen Jr., MD, FACR, and Geraldine B. McGinty, MD, MBA, FACR, will headline the session. Attendees will explore how radiologists can leverage information technology tools, workflow, and management processes to drive value-based imaging. Allen and McGinty will also describe how Imaging 3.0 can enhance information systems, leading to better patient engagement, increased consultation and communication with referring physicians, and more appropriate evidence-based imaging recommendations. "Health care payments are shifting from a focus on volume to an emphasis on the value delivered," says McGinty. "This session will offer radiologists strategies for success during this transition and beyond."

By Jenny Jones, freelance writer for the ACR Bulletin

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