By way of example, he cites reimbursement for a colonoscopy by the state's Medicaid program. Eight years ago, the payer reimbursed $400 for the procedure. Today, it pays about $90. Meanwhile, Owens faces another common dilemma. To stay competitive, the center must invest in the latest and greatest imaging equipment-while continually upgrading its storage. The medical center's PACS long-term imaging archive, for example, stands at 58 terabytes, a massive amount of data which must be replicated in a back-up storage system for safety. "You're only protected if you have two copies," Owens says.
Faced with this across-the-board economic crunch, radiology practices across the nation have taken a variety of steps to stay afloat financially. Following are seven strategies.
Strategy #1: Streamline Referrals
Steve Fischer, the CIO at the Minneapolis-based Center for Diagnostic Imaging, describes the modern radiology practice as "a capacity game. You need to drive more volume. You are put into a sales environment-how do you get more orders coming through the door?"
The center-which owns more than 60 imaging facilities nationwide-functions as a management services organization for some 200 radiologists, dispersed among 10 otherwise independent group practices, who provide reading services. For its own centers, CDI performs about 500,000 annual studies, with even more work coming from other hospitals that contract with it.
To streamline orders from the primarily ambulatory group practices that serve as its referral base, the center, whose radiology information system, or RIS, is from Merge Healthcare, has built a direct interface to a number of EHRs. "We get orders directly from about 15 ambulatory EHRs, including NextGen, Epic and GE Centricity," says Fischer. "It's the advantage of having a single RIS." (For more on the interplay between EHRs and radiology, see story, page 44). Only about 10 percent of the orders come in via direct interface, but Fischer says the portion is growing steadily. Results flow back automatically to the EHR as well, thus eliminating the need for fax. "We are starting to see a groundswell," he says. For practices without an EHR, orders can be placed via a referring practice portal, which enables order tracking and results retrieval.
The portal is not used much, as practices find it easier to fax in their orders. But Fischer says it's critical to offer referring practices the best service possible. That's why CDI is beginning to function as a care coordinator for certain patients. "We go beyond the screening mammogram," he says. If a negative finding occurs, CDI will initiate conversations with its referring physicians, and promptly schedule additional imaging. "The primary care physicians say 'give us some help,'" he says. "This is not their area of expertise."
Strategy #2: Boost Network Speed
Imaging Associates of North Mississippi Magnolia has a long name-and an equally broad technology footprint. Based in Tupelo, the 10-radiologist group practice serves four local hospitals with on-site physicians and two more remote facilities via teleradiology, says Cavett Otis, I.T. director. The group provides more than 150,000 annual studies. During the regular work week, its on-site physicians rely on the local hospital's picture archiving and communications systems (PACS), which vary at each location. Imaging Associates loops all of its physicians to the remote hospitals using a wide area network and a common viewing platform, from Merge Healthcare. During the off-hours, rotating physicians on duty use the wide area network (WAN) to retrieve and read images from its core hospitals as well.
To connect to the local hospitals, the group uses a cluster of six T-1 lines, high-speed connection that delivers images quickly. Connecting to the remote hospitals, which have limited broadband availability, proved to be more problematic, Otis says. Two minutes were required to transmit a single X-ray image.
To remedy the situation, Otis turned to Circadence, a software vendor offering network optimization technology. Its software essentially repackages data packets and uses available bandwidth to its maximum capacity. Now an X-ray can traverse the network in 17 seconds. Since about 20 percent of Imaging Associates' reading work flows across the WAN, the improvement represented a major productivity boost. The software also pre-empted the need to add additional T-1 capacity to the outlying hospitals.
Now physicians can retrieve images promptly regardless of their source. And the practice is considering expanding its staff by hiring some contract physicians who could tap into the network remotely. It toyed with that model last year, bringing on some temporary physicians who were finishing fellowships in other states. Otis is also trying to persuade one of his hospital sites to deploy the network-enhancement software for its own PACS set-up, which involves a shared system with yet another hospital. A system upgrade there has resulted in more sluggish response times, the anathema of the modern radiology practice, Otis says. "Everybody wants results right now," he says.
Strategy #3: Embrace the Cloud
When it comes to managing a radiology practice, Rick Jennings is all about technology-and productivity. Jennings serves as chief technology officer at vRad, an Eden Prairie, Minn.-based company that doubles as both radiology group practice and software vendor. On the group practice side, vRad spans 421 physicians, who practice across the United States with major clusters in New York and Philadelphia. The physicians all use vRad's software, a commercially available product that is based on the hosted, cloud computing model. About 1,000 radiologists use the commercial product, which combines PACS/RIS functionality, Jennings adds.
Regardless of where they work, vRad physicians can access images via the cloud set-up, in which the guts of the program reside on vRad's servers, not on local hardware. Images from the local hospital PACS feed to vRad's data center, which in turn distributes them to its physicians. "The case is routed to the doctor best able to read it," Jennings says. He says that vRad clients have been able to boost their reading rates by up to 20 percent after implementing the technology, which enables radiologists to read images without the constraint of being tethered to a single hospital's PACS. "You don't have to be where the hospital is," he says. "You can do case distribution in seconds."
