September 2010

Staying Competitive
By David A. Myrice, CPA, MBA
Radiology Today
Vol. 11 No. 9 P. 10

Groups must take a serious look at whether they need to upgrade their services and technology in a changing marketplace.

Hybrid teleradiology companies have taken over hospital contracts, raising red flags for many radiology groups. These groups are re-evaluating their use of these services, as well as other technologies within the hospital that impact scheduling and workflow. It is too late to put the genie back in the bottle, so what should a group do to compete with evolving teleradiology companies and remain relevant in a changing marketplace?

Work Harder and Smarter
For a group to meet a hospital’s needs, it will likely need to reevaluate its scheduling. Using staggered shifts is one option to meet the hospitals’ interpretation needs. Hospitals commonly need on-site coverage until 9 or 10 pm, but absorbing night call will also be a challenge if no teleradiology service is used. There may be plenty of groups not currently staffed to provide this level of coverage, but technology that can help is still progressing. Voice recognition systems have come a long way in the past few years. This, along with the vast improvements in remote reading technology, allows radiologists to read and dictate final reports from virtually anywhere with a good Internet connection.

When analyzing ways to meet radiologist scheduling needs, a group may start by looking at the age demographics of its physician staff. Older physicians may believe scheduling long shifts is not a problem due to a different generational view of work and life balance, while younger physicians believe in more of a lifestyle focus with fewer work hours, especially in the evening. The same may be true of physicians nearing retirement who may believe they’ve earned the right to scale back a little. Younger doctors may be more comfortable adopting technology that makes them more efficient. Finding acceptable compromises among various staff physician preferences may provide groups with scheduling solutions that make sense.

Scheduling residents at night provides an easy option for groups in teaching hospitals, but it may also come at a cost. The group benefits from the residents’ working night call, but using residents will impact turnaround times on reports and can impact the volume and efficiency of the group. Not only will the group still need to do final reports on the preliminary reports done by the residents at night, but it will also need to slow down and show the residents any missed items and teach the residents working during the day. Both processes will slow down any radiologist and thus impact turn-around-times. Hospitals dedicated to teaching benefit by having a steady supply of candidates for regular positions, but not without slowing down the daily reading process.

Rapport With Reports
A famous anonymous quote states, “If you don’t create change, change will create you.” In the case of teleradiology, the customers are driving the change. The sleek and simple reports many teleradiology companies have developed are well received by hospital administration and medical staff. While many radiologists believe them to be flawed or lacking detail due to their use of voice recognition software, the truth is that customers like and prefer them. Providing customers what they want is a good way to survive in any industry.

To meet their hospital customers’ evolving needs and desires, groups would be wise to match this perception. The use of voice recognition software with canned macros is a reality many radiologists dislike, but with this technology hospitals can cut transcription costs, and final reports are usually generated more promptly and in a consistent, standardized format.

Most radiology groups are accustomed to PACS/RIS, so reading remotely is not a troubling issue; the issue is generating the report. A hospital’s medical staff wants prompt turnaround time with easy-to-understand reports while many radiologists in smaller groups have been slow to accept and incorporate available technology to provide them. The technology is not going away, so groups must adapt or risk becoming irrelevant.

Groups can meet the required technology investment in several ways. Partnering with the hospital to invest in voice recognition technology is a solution that also saves the hospital money on transcription. Many radiologists believe voice recognition hampers their productivity mainly due to the editing that is often required. From the hospital’s perspective, shortened turnaround time for reports improves services and reduces transcription costs, but radiologists may believe they must comply with canned macros that spit out specific statements and then edit those statements, requiring more physician involvement.

Current voice recognition technology supports macros that can be customized to radiologists’ individual needs, including the entry of frequently used ACR guidelines and modifications. Because of this flexibility, radiologists do not have to view the technology as a thief of their independent judgment that dictates what they should say on a report. A smart approach to managing this new technology is to base the system entry on coding guidelines. This way radiologists can increase their procedure payments if they program coding-compliant terminology within the system. Both could provide cost savings up front and over time, increase revenue, and could ultimately save time because fewer reports will be returned from billing due to coding errors or questions.

Like most technology, voice recognition comes with a learning curve. The system must be programmed to the radiologist’s voice and diction. The radiologist has to learn how to speak into it to get it to list a procedure correctly. Implementation requires radiologists to patiently make adjustments, but in the end, the reports themselves provide a needed and wanted service to the referring physician customer. As service-oriented professionals, radiologists willing to adapt understand that voice recognition is not going away. Many hospitals and referrers like the standardized report formats and fast turnaround times these services offer.

Voice recognition combined with off-site reading capability can improve a group’s capacity to serve a client, but smaller, traditional radiology groups still may not be staffed to meet hospitals’ demand for more radiology coverage into the evening and beyond. Most hospitals and groups have experienced the convenience of using teleradiology.

If your group must use a teleradiology service, include a noncompete clause in your contract. This will at least help ensure that the service you are using will more likely work with you than against you.

— David A. Myrice, CPA, MBA, is a senior finance manager with Medical Management Professionals, Inc. He has specialized in medical practice business financial operations since 1981 and is a certified public accountant and a licensed nursing home administrator.