Strategic Imaging

A North Carolina radiology practice has developed a regional imaging strategy around advanced IT solutions.strategic imaging2

When reimbursement cuts began about a decade ago, Greensboro Radiology, a private practice in Greensboro, N.C., knew health care was evolving. And the practice's leaders recognized that to survive in the era of value-based care, they'd have to evolve, too.

To position itself as a leader in the changing paradigm, Greensboro Radiology began instituting a regional imaging strategy to deliver innovative IT solutions that benefit both the practice and the health systems it serves. Since then, the group has earned a reputation as a committed partner in care and has secured contracts with two accountable care organizations (ACOs).

Established in 1998, when two radiology practices merged with a total of about 25 radiologists, Greensboro Radiology has grown to include more than 60 radiologists who serve four hospital systems and over 50 outpatient facilities, in addition to the two ACOs. The group has also formed a spin-off management services company called Canopy Partners.

Worth Saunders, MHA, Greensboro Radiology's CEO, attributes the group's growth to calculated risks that have delivered added value to the health care enterprise. "For the past 10 years, practice leaders have been very progressive and very visionary, pushing the group to try new things and to make long-term investments, particularly in technology," he says.

Building Relationships

Initiating the imaging strategy took years. Greensboro Radiology began by encouraging its radiologists to attend tumor boards, conferences, and committee meetings, where they could interact with referring clinicians and hospital administrators. "Our radiologists have developed credibility by being outside of the reading room and engaging in the clinical decision-making process rather than just producing reports," Saunders explains.

Once it gained the trust of referring providers and hospital administrators, the group launched the next phase of its strategy: delivering advanced IT solutions, including voice recognition services and a comprehensive PACS regional imaging timeline (an archive of imaging studies from disparate health systems), and working with its health system partners to integrate the solutions for improved patient care.

Initiating IT Solutions

Greensboro Radiology began dabbling in advanced IT solutions in 2007, with the emergence of voice recognition software. The practice purchased software and licenses from a voice recognition company and began approaching its health system partners about managing their imaging voice recognition systems for a per-report fee.

"We saw it as an opportunity to define voice recognition the way we wanted, rather than having all of the hospitals hand us different voice recognition systems," says Eric A. Mansell, MD, PhD, president of Greensboro Radiology and its affiliated management services company, Canopy Partners.

One of the first hospital systems Greensboro approach was Cone Health. Although purchasing IT solutions from a radiology group was unorthodox, Cone Health liked Greensboro's proposal. "They owned the process, offered better daily operational management than a traditional vendor, and were highly accountable, with skin in the game," says Steven C. Shanaberger, Cone Health's executive director of imaging services. Cone Health administrators knew they had made the right decision as turnaround times and quality of the reports immediately improved, he says.

As its confidence in delivering quality voice recognition grew, Greensboro Radiology incrementally expanded its service to other hospital partners. "We did it with our main system first; then we went to the next hospital and said, 'It's working great at this hospital. Let us show you this business model,'" Mansell recalls.

Building a PACS Integration

With its voice recognition service taking off, Greensboro Radiology began working on a comprehensive PACS regional imaging timeline. The practice hired expert developers to build an integration solution to aggregate imaging studies from a variety of health systems into a single off-the-shelf PACS, without requiring significant effort from integrating partners.

"We developed the PACS timeline so we could access all of a patient's historical imaging from disparate facilities in one place, allowing us to easily compare studies to determine whether a disease process has remained stable or gotten better or worse over time," Mansell explains.

Once the integration solution was ready, Greensboro Radiology began inviting its affiliated hospitals and health systems to join the timeline. Some institutions adopted it as their permanent imaging archive, while others purchased an overlay version, giving Greensboro access to their imaging studies without permanently archiving them.

Cone Health invested a full integration. "The radiologists demonstrated and articulated the value of their owning the PACS process, including more conclusive diagnoses and closer collaboration with referring clinicians," Shanaberger says.

Before the timeline, Greensboro's radiologists and referring physicians had no way to immediately access a patient's historical imaging studies from unrelated health systems. With the solution, they can directly access a patient's entire imaging history for easier comparisons and fewer repeat studies.

Impacting Patient Care

In 2011, as it incrementally integrated all of its partners into its PACS timeline, Greensboro Radiology realized that it had developed significant expertise beyond radiology. This is where Canopy Partners is originated. Greensboro decided to spin off this portion of its business as a separate management services company.

The move allowed Greensboro Radiology to conduct more accurate cost accounting and gave Canopy Partners more flexibility to expand its IT offerings. Canopy Partners has since become successful management services company, with a staff of nearly 170 and $17 million in revenue in 2015.

It's this approach that also helped Greensboro Radiology earn two ACO contracts. The group became a founding member of the physician-led Triad HealthCare Network in 2011, and in 2013, it won a contract with Cornerstone Health Care through a request-for-proposals process. Since then, Greensboro has received a portion of the annual shared costs savings realized by Triad, while Cornerstone pays the group on a contract basis.

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Thomas Wall, MD, chief clinical officer of Triad HealthCare Network, says Greensboro's PACS timeline and other advanced IT solutions have made it a leader in the ACO. "Greensboro Radiology is already doing what we want all of our physicians to do, and that is to be connected electronically and to make resources available so that we make better, safer, and more financially sound decisions at the point of care," Wall says.

And the results are real. Cornerstone Health Care has reported that its advanced imaging utilization has decreased by 9 percent during the past year and a half thanks to Greensboro's PACS timeline and other solutions.

Now Greensboro is working with its hospitals and ACO partners to implement clinical decision support systems, lung cancer screening programs, and other solutions. "We're adding value by proactively bringing solutions to our imaging partners rather than these organizations having to come to us or to implement these solutions on their own," Mansell says.


By Jenny Jones, Imaging 3.0® content specialist

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