When contract renegotiations roll around, is your practice anxious or confident? When a referring physician or hospital administrator asks to meet with practice leaders, do you expect good news or bad? The answers to these questions might reveal a lot about the state of your relationship with your hospital or referring physicians — whether it’s flourishing or floundering.
In order for the two sides to interact effectively, radiologists, hospitals, and referring physicians must keep sight of their common, overarching goal: caring for their patients. “We’re a team in that experience,” says Ed Yoder, administrative director of medical imaging and radiation oncology at Winter Haven Hospital in Winter Haven, Florida. “And radiologists are just as involved as anyone else at the hospital.” Joseph P. Finizio, MD, president and CEO of Radiology Imaging Associates, in Maryland and Virginia, agrees. “We’re all trying to accomplish the same thing,” he says. Here are eight ways radiologists can work with hospitals and referring physicians to care for patients and nurture this important business relationship.
1. Communicate clearly and often.
“One of the main things that radiology groups can do to maintain good relationships with their hospital is to establish an open line of bi-directional communication,” says Cynthia S. Sherry, MD, FACR, of Southwest Diagnostic Imaging Center in Dallas. “And that doesn’t mean coming together only when there’s a problem. We need to come together at regular intervals and talk over the status of things — and do so in a mutually respectful way.”
Not only does effective communication help processes to run more smoothly, but it prevents small hiccups from snowballing into bigger, contract-endangering issues. “It won’t solve every problem that occurs,” Sherry cautions, “but it will sure give you a heads up if there is a problem.”
2. Advocate for quality.
“Hospitals have to conform to quality metrics, on which radiologists often take a leadership role,” explains Geraldine B. McGinty, MD, MBA, chair of the ACR Commission on Economics. To effectively establish these metrics, “you have to draw a line in the sand on quality,” she says. More importantly, in addition to developing and preserving these standards for the hospital and its referring physicians, radiologists who emphasize the value of quality demonstrate their commitment to providing the best care to patients.
The ACR’s 2010 Task Force on Relationships Between Radiology Groups and Hospitals and Other Healthcare Entities, chaired by Sherry, pointed to various ACR programs that can aid radiologists in establishing and maintaining quality metrics. “The development and expansion of the ACR accreditation programs are vital tools for radiologists and radiation oncologists striving to optimize patient care,” the task force noted. For example, “RADPEER™ is a means for our members to demonstrate their commitment to the quality assurance and quality improvement processes.”1
3. Look at the numbers.
It’s difficult to demonstrate a practice’s value without supporting data. “We need to show the service that we provide,” says Ricardo C. Cury, MD, chairman and CEO of Radiology Associates of South Florida in Miami, Fla. “And the more data that we provide, the better.” Cury’s group collects data that includes patient satisfaction, referring physician satisfaction, and average turnaround time. This information is used in negotiations with hospitals and appears in an annual report chronicling the practice’s achievements and metrics for the year. “[In the report,] we highlight all of our activities, the quality benchmarks, the subspecialty areas, and the ongoing mission and future initiatives that the group is working on,” he says. The group views this document as a marketing tool for both new and existing contracts and uses the information to negotiate metrics-based bonuses with hospitals.
4. Stop looking at the numbers.
While metrics are invaluable tools in a group’s arsenal, many practice-sustaining efforts are not directly measurable. “Believe me, I’ve been on a lot of committees over the years,” says Finizio, pointing to the benefits of looking at issues from a wider perspective. “A lot of times, there’s resistance from radiologists to do things because they don’t have the full lay of the land. They don’t understand the stresses that the hospitals are dealing with,” he says.
In addition to providing a more holistic view of the medical environment, being involved can also keep groups plugged into the hospital grapevine. When a hospital cancels its contract, says Sherry, “it seems to radiology groups that it just happens abruptly, when in fact these kinds of relationships take a long time to fall apart. There are things going on that the radiologists aren’t aware of because they haven’t weaved themselves into the fabric of the hospital and the medical staff.” The task force suggested opportunities for radiologists to get involved, such as by making it a priority to attend medical staff meetings, serving on hospital committees, and participating in medical societies.
By focusing on activities that strengthen their relationships with referring physicians, whether billable or not, and carving out a place for themselves in the framework of their hospitals, radiologists make themselves indispensable and show that they are not simply commodities to be traded for the lowest price.
5. Be visible.
While much of a radiologist’s work takes place behind the scenes, many practices are finding creative ways to get out of the dark room and increase their visibility. Cury’s practice instituted radiology rounds, in which a radiologist takes 30 minutes each day to go on rounds with referring physicians in different departments. The radiologist takes an iPad to share images with patients, participates in treatment discussions, and answers questions. “We realized that this small portion of our time can have a significant impact on educating referring physicians and patients,” says Cury. As a result, “we were able to see an increase in patient and referring physician satisfaction.”
Cury’s practice also organized an imaging summit to bring together hospital CEOs, corporate committee members, and radiologists to provide a snapshot of the radiology department’s initiatives and vision for the future. “During the summit, we were able to highlight ways that we are being proactive and supporting the growth of the hospital,” says Cury. “And that was very beneficial to lay the foundation [for a positive relationship], not only through meeting together but also allowing us to brainstorm about where imaging is heading and the challenges that we are facing.”
6. Accentuate the positive.
McGinty emphasizes the importance of creating a positive culture and attitude. “Focus on every single interaction you have with anyone you run into, whether it’s patients, other hospital employees, or hospital leadership,” she says. “The perception of you as a radiologist throughout the hospital is an opportunity for you to demonstrate your value.”
It is particularly important to interact effectively with technologists. “The practice’s relationship with the technologists affects the relationship with the hospital,” says Cury. “A lot what the techs say can make it up to the administration.” He suggests nurturing this relationship by having protocols that improve over time, minimizing radiation exposure, valuing input, and introducing new techniques.
7. Share your knowledge.
When it comes to their specialty, radiologists need to present themselves as the experts that they are, Finzio believes. “We need to demonstrate that we have the expertise technically to know not only what is the best test at the best time, but we also need to show that we really know how this equipment works,” he says. “Our role is clearly to educate the patient, the referring physicians, and our colleagues in other specialties.”
By engaging referring physicians in a tactful, constructive way, radiologists can help their colleagues take full advantage of their imaging options and increase knowledge about the value of radiology.
8. Never stop improving.
Whether your relationship with your referring physicians or hospitals is going strong or on the rocks, there’s always room to grow. If your relationship is struggling, there’s no time to waste. “Go on a massive PR blitz,” advises McGinty. “Go to the hospital directly and find out what their main issues are and how you can help and what you can contribute to value and patient care.” If things are going well, why not take steps to remind your referring physicians or hospitals why they work with you in the first place? //
1. Sherry C, et al. “ACR Task Force Report: Relations Between Hospitals and Other Health Care Organizations.” JACR 2010;7:410–18.
Lyndsee Cordes is a staff writer for the ACR Bulletin