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For years, radiologists and their partnering hospitals have operated on separate tracks. With the advent of RIS and PACS, radiologists have generally interacted less directly with referring physicians, hospital administrators, and patients than in the past. This “hands-off” model has led to the view among many in health care that radiologists are peripheral to the delivery of high-quality patient care.
But radiologists are beginning to push back against this perception. By asserting their importance as imaging experts, they are reaffirming their central role in health care. One such practice is Radiology Associates of Canton, Inc. (RAC), located in Canton, Ohio.
RAC, which has contracted with Aultman Hospital since 1971 when the practice was founded, recently entered into a “co-management” relationship with the hospital. The practice and Aultman have established a shared governance structure in which radiologists and hospital administrators make both operational and strategic decisions together, drawing radiologists out of the reading room and into the board room.
Syed F. Zaidi, MD, discusses an image with a physician colleague.
In the past, referring physicians at the hospital often made clinical care decisions without considering radiologists’ reports, notes Syed F. Zaidi, MD, president and CEO of RAC. “That led to mistakes in patient care,” he says. “We have worked on that and changed our relationship with the referring physicians. Co-management means that we now make patient-care decisions together with hospital administrators in a formal structure.” According to Zaidi, the staff at RAC has been working on streamlining inpatient interventional radiology procedures so that patients are treated more efficiently, thereby reducing length of stay and increasing patient satisfaction.
Another example of the shared decision-making process involves equipment purchases. “Previously, the hospital did not need our formal approval before buying equipment for the radiology department,” explains Zaidi. “Now they do need to get our input and approval because patient care improvements are related to how we use the equipment.” According to Zaidi, equipment decisions have a bearing on issues such as coordination of patient workflow and improvements in the department’s efficiency. “In return,” he notes, “we also are more responsive to their needs.”
One of the hospital’s most pressing needs is to reduce turnaround time for inpatient, outpatient, and emergency room studies. “We are streamlining our imaging protocols to improve both quality and efficiency so that the hospital costs are reduced,” Zaidi states. In particular, he says, “We are meeting clinicians and working with them to change ordering patterns so that there is appropriate utilization of inpatient studies.”
This team approach is a big departure from how the two entities engaged in the past, according to Christine Donato, executive director of imaging services for Aultman Hospital. “Our relationship was one of a vendor/customer arrangement. We were somewhat separated into independent silos. We met monthly and discussed operational issues and patient volumes, but there was no transparency and little trust between the radiologists and the administration.”
Although change is never easy, when Zaidi became CEO of RAC in 2010, he began looking for a new way to do business. “There is a shift happening in medicine from volume to value. Already the volume was flattening, and we knew we provided high-quality radiology services, including internal 24/7 services and our own onsite nighthawk services. So we had to find ways to get recognition for that in our business model.”
Zaidi’s first order of business was reaching out to the hospital administration to enhance the profile of radiology at Aultman. He and Allen J. Rovner, MD, past president of the group, met with Chris Remark, CEO of Aultman, to explore refashioning their relationship. Along with Donato, they developed and applied the concept of co-management to radiology.
Their outreach effort included setting up regular meetings between the radiologists and hospital administration. Notes Donato, “Dr. Zaidi and I meet weekly about quality review issues, project updates, marketing, and financial updates. I also meet weekly with the radiology department chairman to discuss the operational, day-to-day issues.” In addition, Zaidi and Donato participate in a monthly operations meeting with Aultman’s CIO, the executive director of imaging services, the executive director of information systems, and a range of other hospital administrators, along with any radiologists who would like to attend. The staff also meets quarterly with Remark and engages in regular meetings with key physician leaders in other departments such as ER, oncology, surgery, and others. Such meetings allow RAC radiologists to be proactive about responding to other departments’ needs.
“These meetings allow for much more communication, transparency, and trust between the radiologists and the hospital,” concludes Donato. “The meetings have agendas; expectations are met on both sides; and goals and projects are tracked, reviewed, and updated.” One important goal the department monitors is physician satisfaction, while examples of projects include appropriateness of orders and efficiency of protocols.
R. to L.: Allen J. Rovner, MD, Syed F. Zaidi, MD, Chris Remark, and
Working closely with radiologists will help Aultman navigate the tricky waters occasioned by the Affordable Care Act. With the legislation’s emphasis on quality health care, it will become more important than ever for radiologists to take a prominent role in patient care, according to Remark. He says that through its new co-management relationship with RAC, Aultman will work with the radiologists “to identify opportunities to curb utilization and ensure patients are receiving the right test, at the right time, in the right environment” during the transition from volume to value.
In pursuit of quality care, Donato said meetings between radiologists and administrators include discussions about key performance indicators. The measures, which include areas such as turn-around times for exams and reports, “provide us with information to see areas of opportunity and make appropriate changes. These meetings help keep us moving forward and track our progress. We look at quality, performance measures, and patient satisfaction scores” to assess if there is room for improvement.
Zaidi notes that the data is measured and tracked monthly and reported not only to the radiologists, but also to the hospital’s administrators. “Every month we discuss our progress, opportunities for improvement, and how that can be achieved,” he explains. “We are now working on a ‘radiology dashboard’ that will provide real-time data about turnaround time and productivity, so that the radiologists can get quicker feedback.” He asserts that these data will allow the radiologists to self-regulate without having to wait for the monthly report.
Satisfying key performance indicators is one of many ways in which radiologists at RAC have ensured their value as members of Aultman’s care team. The relationship benefits the hospital as well, since it will require the expertise of its physicians to navigate the shifting tides of health care reform.
“Health care reform is leading to a value-based payment methodology, which requires a big change in the way hospitals and physicians practice medicine,” says Zaidi. “And that is where co-management allows both the hospital and our radiology practice to navigate the changing landscape more effectively than ever before.”