We’ve all heard the cost of health care is increasing. Employers are moving more of the costs to employees in their employee benefits packages to help mitigate those costs. And with unemployment currently at 9.2% (June 2011 data) compared to the 4.5% rate of 2006, less patients are insured and subsequently covered for the same imaging studies they were covered for in 2006. Reimbursements are diving. There is also the now highly publicized risk of unnecessarily overexposing patients to radiation that has also slowed the referring physicians from ordering as many studies as they used to.

These changes in the market have more of the effect of 1000 paper cuts on your imaging business, rather than one giant crashing anvil that is easy to see coming. However, without an effective plan of action, death by paper cuts or by anvil is inevitable.

So what will be your plan of action? Do you ever get into the imaging center in the morning and say to yourself, “Things just aren’t ‘humming’ like they used to.”? Do you look at the schedule and see enough space or openings to make you uneasy?

All of these marketplace forces and mechanisms have exceedingly shifted imaging marketplace supply and demand. The supply and demand paradigm in imaging has consequently restructured and reorganized the imaging provider market in most locales across the nation. Hospitals are purchasing imaging centers or entering into joint ventures and turning those centers into their outpatient imaging centers. Stand-alone imaging centers are being purchased by conglomerates, closing their doors or selling to the hospitals in their communities. Physician groups and their members are referring only to the facilities that their groups are affiliated with or that they own.

In all of this, we find that many imaging center operators and owners (hospital-owned, privately owned and radiologist-owned) are continuing to run their businesses as they did in 2006. What’s hurting all of them is all of the recent paper cuts. We work to help clients keep up with their always changing imaging center markets by offering them uncommon information that helps them quickly and effectively make decisions about their imaging businesses. It’s in these partnerships that we ask and help them answer the following questions:

When was the last time you assessed your marketplace, or your Imaging Service Area?

Has your patient demand changed?

What does your current market capitalization look like?

Have you addressed outdated and unnecessary patient pursuit costs?

What are your competitors doing?

How will what your competitors are doing (buying, selling, gaining capacity, etc.) affect what your center does?

Will your specific volume growth strategy need to change based on the answers to the questions above?

Stop the paper cuts by designing a strategy around them. Obtaining knowledge on your ever-changing imaging market can help you effectively target the referring providers, patients and niche markets that you may otherwise be missing.

Then you can stop asking, “Where have all the patients gone?”, and instead start asking, “Where have all the openings on the schedule gone?”

There are many vendors that provide supplies for our imaging needs. I doubt that any of them would object to accepting more money from you if you are willing to pay. The task lies within you and your organization to find the savings. Remember that the cost of items will change over the course of time. You should make the effort to perform a yearly review of all of your supply costs and look for opportunities to reduce them whenever possible.

There are many possibilities that ultimately depend on the structure of your business. The most obvious opportunity is to identify a GPO that you can participate with that will offer you the most savings for your business type. Many of these organizations will even work with you to compare products and pricing. They may offer suggestions for substitutes that provide more savings. The GPO will also offer the contact information for the vendors that accept their discounts and will help you to structure your relationship with said vendors.

Other opportunities lie within bidding out your supplies, such as isotopes. By seeking quotes from several vendors, you will ensure that you are receiving a cost-effective rate. You can also have a direct comparison to the other items that affect the cost of the supplies such as delivery charges, markups, emergency calls, returns etc. By working directly with your radiologists and technologists, you may also identify an alternate product that will offer the same quality image at a reduced cost.

Some opportunities may be less obvious to you such as purchasing items and supplies. This example will require input from your staff. Historically, imaging staff did not think twice about which supplies they grab during their busy day. In our current environment, fiscal responsibility is critical to the success of any operation. Sharing this concern with your staff, and expecting buy-in from them is the key. Take some time to talk with the people using the products that you are purchasing. Find out if there may be opportunities to consume less. Ask the staff if a more cost efficient product would offer a similar result in their work flow. Have information on alternate examples for them to review and share with them the savings that might be appreciated. Remember that there may be a bit of trial and error in this approach, so when substituting items, don’t buy the farm. Purchase a small sample of the substitute first, so that the staff can evaluate it before making a large purchase.

We would all like to think that we are savage negotiators when it comes to pricing for our consumables, but in most cases, we are leaving money on the table. Methodically analyzing your costs and opportunities to cut them is a necessary part of good business practice. There are several organizations that can offer assistance with supplies and in most cases, having someone review your purchasing from a different perspective will render results in the form of cost savings. Just don’t wait too long, or you may be faced with the question of “Why didn’t we do this sooner?”

David Rushing, RT(R), MR, is operations manager for Medical Imaging Specialists. He has 19 years of experience specializing in radiology program development, implementation, and management. He has organized several mobile MRI programs for hospitals, served as hospital radiology department manager, and managed a full service free standing imaging center

For the consumer and employer groups, this strategy has proved to be attractive and lucrative. Passing more of the hard costs over to the patient has allowed the insured to remain insured – albeit with downstream consequences. More and more patients cannot pay their deductible at time of service, nor do not honor a mutual and reasonably negotiated payment plan. Additionally, today’s patient is not as concerned with unpaid medical bills as perhaps was a previous generation; the stigma of a credit report ding for an unpaid medical bill is not as penal as it was in the recent past.
From a provider’s viewpoint, this shift has created the need to better forecast the impact of the annual deductible – and anticipate the whole dollars related to year to year plan changes.

Many carriers (the Blues and the major commercial plans) have “product” managers that are well-versed in shifts among their demographics. They know who the major employer groups are and what changes are elected for the new fiscal year. The same information can be obtained for those with individual coverage. These changes are known in advance of the New Year.

It will serve you well to identify your major managed care payors and commercial plans; and, reach out to them to communicate (at least annually) on the changes they see within their beneficiary ranks. Once you have that knowledge in advance, you will be better equipped when the patient presents.

Beyond the traditional remedies – pay in full at time of service or develop a payment plan – you may wish to consider a billing hold for a reasonable period in order to not be the claim that absorbs all of the deductible.

Bill has 19 years of progressive management responsibilities in health care administration. For the past 6 years, Bill’s interest has been focused on the complex issues surrounding revenue cycle management in the radiology environment – both in the hospital based and free standing imaging center arenas. A graduate of the Fuqua School of Business at Duke University, Bill’s health care responsibilities were shaped and strengthened by 8 years of commercial banking experience while he managed the medical portfolio of a large national bank that is now owned by Wells Fargo Bank, N.A.

The referring physician office staff answers with fundamental responses (if they answer at all, and not necessarily in this order of importance):

1. Location of the imaging center
2. Patient Atmosphere, Comfort and Experience
3. Imaging Report Turnaround Times
4. Referring Physician Preference (image quality, radiologist’s reputation, report clarity)
5. Ease of scheduling
6. “They bring the best breakfast bagels/donuts, lunch trays, etc.”
7. Etcetera, Etcetera, Etcetera

When I see the “Marketing Person” start to take notes on what his/her competitors do best, I cringe.  If that “Marketing Person” is my client (titled a Referring Physician Relationship Manager if we’re working with them), I tell them to stop. 

Then I conduct an intervention.  An interruption.  A cease fire of pen to paper or finger to keyboard.  Stop it.

Any person can think of why a referring office might be using his/her competitor (see above, while not all-inclusive, it’s fundamental).   The question is: are The Physicians, The Office Managers, The Physician Assistants and The Schedulers all 100% satisfied with the current imaging provider?

Anything less than 100% is an opportunity.

Most “Marketing People” ask why their prospect likes his/her current imaging provider.  Most offices will answer very politely, one of the 7 reasons above or more, after all ….they have a job to do too, and answering your questions is not in his/her job description.

This is where I say stop asking those questions, which is the playbook of your competitors.  Look to your referring offices with compassion, empathy and a philosophy of help and start asking them different questions.

Find out who in the office actually determines the imaging center that they recommend to the patients.  Once you find those people, ask them some different questions. 

Ask them what gives them the biggest headache about their current imaging provider. 

Ask them what “they can’t STAND” that the current imaging center does.

If there is a group of schedulers that are responsible for scheduling all of their patients’ imaging studies, round them up for 15 minutes at the most, and ask them what ruins them about their current imaging provider.  Let them all speak.  You may find, as I have many times, that having them together in a forum allows them to all build on each other’s dissatisfaction of their current imaging provider (your competitor).  Again, let them speak, and just BE with them.  Don’t try to fix their situation, don’t try to solve their problem or complaint by saying your place can do it better – if you do, you are a salesman/saleswoman.

Empathize with them.  Sit with them.  Do not BE your competitor.

That’s the only way to beat them.  It is to not BE them.

Empathy, Compassion, Trust, Integrity and Expertise will help you win.  Do you and your organization possess those characteristics?  If so, does your community know about these characteristics?

How will you prove that you are the imaging center that takes the best care of patients, referring physicians, their staff and their concerns?

One hint – go back to your imaging center and instruct your staff to do exactly the opposite of what you learned from asking all of those questions. 

Stop Acting and Start Winning.

Zach Bauer is responsible for all management and operations within Medical Imaging Specialists. Zach also leads the MIS Client Delivery Strategy Team, which focuses on delivering the Volume Generation, RCM, Imaging Center, and Hospital Radiology Department Operations Management and Finance offerings for MIS. He has proven experience in developing strategies with clients that help them increase their imaging center, hospital radiology department, and/or practice volumes on average by about 20 percent.

We would all like to believe that we are running an efficient operation, but have you analyzed yours lately?  Changes in our current healthcare environment are making it even more difficult to run a profitable business.  Decreasing reimbursement from payers, decreased utilization, multiple procedure discounts, etc are driving many facilities out of the market, or at the very least, making it extremely difficult to operate in the black.  Don’t wait till it’s too late to perform an assessment of your operation.  There are many organizations that can offer assistance in this area.  They will also offer an unbiased analysis of your operation in order to identify any deficiencies or opportunities in your facility/market.

When assessing the ‘what if’s’ of the current environment, one answer continually resurfaces:  VOLUMES, more volume.  How do you mitigate the decreased reimbursement?  More volume.  How do you offset the multi-procedure discounts?  More volume.  It seems that this answer is the solution (or one of the best) to most of the difficulties in our current environment.  The comforting thing is that growing volumes in your facility may be easier than you think.  The only concern in this analysis would be; why haven’t you done this a long time ago?

Let’s look at MRI for examples of opportunities.  How many no show patients to you encounter?  How many patients show up late, or get rescheduled?  How many are cancelled because of pacemakers etc.?  How many days out are you scheduled?  What is your competition doing?

Answering these questions honestly will give you an indication as to your opportunity here.  Do you confirm your patients the day before their MRI?  A simple call by the technologist will work as a reminder, an opportunity to briefly screen patients, and a chance to instruct the patient as to how to dress for the exam in order to decrease delays at your facility.  Decreasing no shows in the MRI and CT area should be a primary focus of your daily operations.

Do you have a high number of patients that refuse their exam, or reschedule after attempting their exam?  If this is an issue, your problem may lie in your staff.  Improperly trained staff, or staff members with a less than positive attitude can directly affect the patients in your MRI environment.   Anxiety can quickly escalate in to a sense of claustrophobia if it is not identified.  Taking a couple of extra minutes to calm these patients down, talk with them between sequences, or even have someone to hold their hand during an exam can be the difference between a billable exam and a lost charge.

Cancelling exams because of pacemakers, or rescheduling because of the need to research implants can often be avoided.  The reminder call should identify the pacemakers.  We also incorporate a pacemaker question into the order forms we supply to our physician offices (though it is not 100% reliable).  As for the implants, there are many different resources available to research the different implants and foreign bodies that many patients have.  Having at least one MRI Technologist knowledgeable in this arena will minimize loss due to this concern.  Unfortunately, sometimes you are at the mercy of another facilities medical records department, waiting on a surgical report.

How far out are you scheduled, and what is your competition doing?  Offering evening appointments can be an added area for your volume generation.  Especially if you have patients scheduled out for several days.  If your competition is not offering this service, it may also garner you more business, since evening appointments appeal to many of the working class patients.  Face it, your equipment is paid for at some point in the regular work day.  Adding patients to the afternoon and evening are just going straight to the bottom line.

Lastly, are you scheduling your MRI slots appropriately?  Opportunity can lie in the regular work day.  In some cases, by simply adjusting your scheduling, you can

increase your revenue in MRI by 20%.  This avenue requires some of the newer equipment, but not necessarily a 3T scanner.  It also requires continuity in the workflow in your facility.  Done correctly, it results in more volumes, happier patients, and greater revenue.

This method can be applied to most of the modalities in the imaging environment.  The opportunity lies in applying the knowledge gained through the unbiased analysis of your daily operations.  !

David Rushing, RT(R), MR, is operations manager for Medical Imaging Specialists. He has 19 years of experience specializing in radiology program development, implementation, and management. He has organized several mobile MRI programs for hospitals, served as hospital radiology department manager, and managed a full service free standing imaging center

Are you ready to engage your partners in a serious conversation about aligning your practice around shared goals and challenges? If so, here is a series of steps you can take that move the practice in that direction.

But first, a caution. In my last blog, I suggested that you and your partners have similar fundamental concerns. If you believe this is not the case, you should revisit this subject before taking any action to move forward. It does not make sense to be in conversation about aligning around goals and challenges if you think that you and your partners hold vastly different concerns. You may want to hold a serious, offsite meeting before you move any further.

If you think you and your partners have similar fundamental concerns, how can you team up together?

Here are three practices that have worked for our groups:

Quarterly meetings: Take time to meet quarterly to discuss the state of your business, opportunities you have, and what risks/threats you are looking to avoid. These meetings should be properly structured with a specific agenda that has some or all of the following topics: 1) partner concerns/achievements, 2)

customer/client satisfaction, 3) financials, 4) milestones/outcomes you are looking to achieve. Try to avoid administrative items such as new healthcare plans and vacation schedules.

Leadership and administration: Respect that someone needs to be the leader and that administration is important. If you are running a large practice with multiple hospital/imaging center contracts, then you need to make sure there are radiologists on the ground feeding your lead managing partner information. Do not criticize or challenge your managing partner during the course of the day. Write down specific issues and present them to him or her during a designated weekly or monthly session. Remember that your managing partner holds multiple concerns (profitability, administration, client delivery, interpretation, etc.) and that you have elected her/him to make the best decision for the group at that specific moment.

Strategic plans: Come up with plans (no more than two a quarter) that will allow you to thrive. Get help where you and your partners may lack specific knowledge on how to make improvements. Get your partners involved. Here are a couple of examples.

Situation: Your hospital client is losing volume due to operational issues. Solution: Invite the hospital administration to join you in putting together a strategic plan to address the issues. Set specific outcomes (improve volumes by 5%, quality metrics by 6%, etc.) and track your progress.

Situation: Your monthly collections are down due to an increase in self-pay and patient-due issues. Solution: Work with your billing department to take steps to improve collection of patient-due revenues. Ask other groups or your hospital clients how to improve. See what others are doing.

 Arun Jethani, CEO, Medical  Imaging Specialists 

Jethani has broad entrepreneurial experience in healthcare. He has founded a radiology practice, a healthcare outsourcing company, and a medical billing company. Prior to joining MIS, Jethani was a founding member of The Radiology Group where he served as the CFO and executive vice president.

Reach Arun at: jethani@medicalimagingspecialists.com

In my last blog, I spoke about how you and your partners have similar fundamental concerns. If you do not or cannot see this reality, you must revisit this subject before taking any action to move forward. It does not make sense to be in conversations to align if you think that your concerns are more important than your partners from the start. You may want to produce a serious off-site before you move any further.

Now, that you may be thinking that you and your partners have similar fundamental concerns, how can you team up together?

Here are three practices that have worked for our groups:

1)      Quarterly meetings: Take time to meet quarterly to discuss the state of your business, opportunities that you have and what risks/threats you are looking to avoid. These meetings should be properly structured with a specific agenda that has some or all of the following topics: 1) Partner concerns/achievements; 2) Customer/Client satisfaction; 3) Financials; 4) Milestone/outcomes you are looking to produce. Try to avoid administrative items such as new healthcare plans, vacation schedules, etc.

2)      Leader and administration: Respect that someone needs to be the leader and that administration is important. If you are running a large practice with multiple hospital/imaging center contracts, then you need to make sure that there are radiologists on the ground feeding your lead managing partner information. Do not criticize or refute your managing partner during the course of the day. Write down specific issues and present them to your managing partner during a designed weekly or monthly session. Remember that your managing partner, holds multiple concerns (profitability, administration, client delivery, interpretation, etc.) and that you have elected her/him to make the best decision for the group at that specific moment.

3)      Come up with strategic plans (no more than 2 a quarter) that will enable you to thrive. Get help where you and your partners may lack specific knowledge on how to make improvements. Get your partners involved. Here are a few situations:

1. Situation – your hospital client is losing volumes due to operational issues. Solution: Invite the hospital administration, put together a strategic plan to address the issues with specific outcomes you are looking (improve volumes by 5%, quality metrics by 6%, etc.) and track your progress.

1. Situation – your monthly collections are down due to an increase in self-pay and patient due responsibilities. Solution: Work with your billing department to deploy actions that improve the collections of the patient due responsibility. Seek help from other groups or your hospital clients on how to improve. See what others are doing here.

Arun Jethani, CEO, Medical Imaging Specialists  
Jethani has broad entrepreneurial experience in healthcare. He has founded a radiology practice, a healthcare outsourcing company, and a medical billing company. Prior to joining MIS, Jethani was a founding member of The Radiology Group where he served as the CFO and executive vice president. Reach Arun at: jethani@
medicalimagingspecialists.com

Most radiologists have fundamentally the same concerns: 1) how do I maintain a good income; 2) how do I balance the increasing demands of time/speed with my overall workload; 3) am I increasing my potential clinical risk; and 4) what is going to change next. During the last five years, I have actively been engaged in over 100 radiology board meetings (monthly, quarterly, ad-hoc, etc.) and what I find in the beginning is that the structure of most meetings produces a disproportionate amount of time spent not addressing these concerns. Most of the time is spent on passively reporting financials, clinical protocols, and addressing administrative items such as vacations, taxes, call schedules, dues, etc. The worst meetings produce animosity amongst partners without resolving the specific issues which potentially lead to a bad situation for all (legal disputes, disbanding, high emotions, lack of trust).
The concerns above are true for everyone and the fundamental breakdowns of potentially lower volumes, decrease in reimbursement, increase in compliance, increase in competition, more complexity in billing, and more distractions are similar for all of you. Therefore, it is imperative, no matter what compensation model you are in (partner, employment, RVU, or some combination), for those servicing a community to be aligned to not only collaboratively deliver care; but, to also maximize your income potential. The more time focused, as a collaborative team, the greater the probability you will succeed and reach the destination that is best for both the group and each individual (even if that means certain individuals choose to leave).
Therefore, before you independently or as a group decide to make changes in your structure, please work with one another to agree on fundamental goals and share with one another your specific challenges. For example, a 60 year old radiologist (be conservative, produce average income, more lifestyle, etc.) may have different specific concerns than one who is 40 (pay off bills, don’t know what is going to happen over the next 20 years, fund children’s college, etc.). Try not to judge; rather move to improve your mutual situations.
If you do not make an effort to align, you will not have clarity in making the proper decision for you or your practice which could lead to financial and personal disruptions. I have spoken with several radiologists who, by their own interpretation, have made the wrong career decision and feel that it will take at least 3-5 years to fix. They also discuss the emotional and legal costs associated and wish they had moved in a more deliberative way. Worst case scenario, you feel good about your decision to change because you exhausted all of your options internally.
Lastly, I encourage you to work with your partners, hospitals, senior administrators and physicians to understand what they are most concerned with; so, you can put together a less subjective solution that is focused on servicing your partners. In my next writing, I will speak about some of the specific suggestions.

 Arun Jethani, CEO, Medical  Imaging Specialists 

Jethani has broad entrepreneurial experience in healthcare. He has founded a radiology practice, a healthcare outsourcing company, and a medical billing company. Prior to joining MIS, Jethani was a founding member of The Radiology Group where he served as the CFO and executive vice president.

Reach Arun at: jethani@medicalimagingspecialists.com