October 19, 2009
Radiology Today Interview With Anne Hoyt, MD — Customer Service in a Women’s Imaging Center
Vol. 10 No. 17 P. 19
Anne Hoyt, MD, is director of the Santa Monica-UCLA Women’s Imaging Center. Although UCLA has provided breast imaging services for a number of years, those services were expanded with the October 2008 opening of the Santa Monica Women’s Imaging Center. Hoyt recently discussed the customer service aspect of a women’s imaging center with Radiology Today (RT).
RT: What range of screening services does Santa Monica provide?
Hoyt: We offer screening mammography and, for our high-risk patients, screening breast MRI. This month, we’ve begun offering non–breast-ultrasound services, which will include pelvic ultrasound.
RT: Approximately how many screening exams do you provide per year?
Hoyt: The Santa Monica center just opened in late 2008, so we don’t have a full year’s worth of data at this point. However, when we look at the last three to six months and extrapolate those numbers out over a year, we’re probably going to be at about 10,000 screening mammography exams a year.
RT: What range of diagnostic exams does Santa Monica provide?
Hoyt: We offer diagnostic mammography and ultrasound of the breast, image-guided core needle biopsy, diagnostic breast MRI, galactography, and preoperative wire localization. Since diagnostic mammography combined with breast ultrasound is the first step in the investigation of a woman with a breast lump or other breast problem, this is our most common pair of diagnostic exams. We also have a 3T MRI on which we offer imaging of the body, brain, spine, and musculoskeletal system.
RT: Approximately how many diagnostic exams and procedures do you provide per year?
Hoyt: Again, we have less than one year of data for the new center. However, we know that about 20% to 25% of our mammography volume is diagnostic work. This translates into about 2,500 diagnostic mammograms. In addition, we expect approximately 2,000 breast ultrasound studies, 200 breast biopsies, and 600 breast MRIs.
RT: How many radiologists, technologists, and support staff members does Santa Monica have? Also, how many exam rooms are there?
Hoyt: There are five faculty radiologists who rotate through the center. In any given day, the center has a staff radiologist and a fellow, three mammography technologists, and two MRI technologists. There is also one technologist for the non–breast-ultrasound services. The site operates with one manager, who is also a mammography technologist.
The front desk and film library are supported by three staff members, each cross-trained to handle multiple tasks. Also, because we are part of a large academic center, we have ancillary support staff that are not based directly out of our women’s center but still play important roles in what goes on here.
Our center has three mammography exam rooms; three ultrasound exam rooms, with the potential for a fourth; and four changing rooms. There is also one MRI suite, a reading room, a staff kitchenette/lounge, and a conference room. Women enter the facility through a front waiting room, but once they disrobe and put on a gown for their exam, there is a separate “gowned” waiting room. We have tried to make the center as comfortable and relaxing as possible. The gowned waiting room offers computers with Internet access, or women can just relax and listen to the sounds of falling water from our nearby wall-mounted water display.
RT: Does UCLA operate more than one site?
Hoyt: There are two centers, both are part of UCLA Radiological Sciences: the Iris Cantor Center for Breast Imaging and the Santa Monica Women’s Imaging Center.
Iris Cantor was the first facility in the U.S. to be certified by the ACR Mammography Accreditation Program. It was also the first mammography center in Los Angeles, the first to offer breast ultrasound, and the first totally digital mammography facility in California.
RT: Do you use digital or film screen mammography and, if digital, when was the change made?
Hoyt: Our center is using digital mammography. UCLA’s history with digital imaging dates back to 2000, with both UCLA and our original Santa Monica mammography center converting to 100% digital in 2005. UCLA was one of the sites involved in the Digital Mammographic Imaging Screening Trial, which compared film screen mammography with digital mammography.
RT: Is Santa Monica primarily a provider of imaging services or more of an integrated breast center?
Hoyt: While we exclusively offer imaging services, we work closely with our colleagues in surgery, radiation oncology, and medical oncology. Although they are not physically in our imaging center, many are close by. For example, in our Westwood site, surgeons at UCLA can drop by our reading room and review images with one of the radiologists. The same situation is true in our Santa Monica site, which is located close to a large medical building where many physicians have their offices.
RT: How does radiation therapy fit into the picture?
Hoyt: We provide the appropriate pretherapy breast imaging for treatment planning. From there, patients go on to receive their radiation therapy at UCLA or another practice in the community.
RT: We’ve touched on the relationships Santa Monica has within its surrounding medical community. More specifically, what are some of those relationships?
Hoyt: We have long-standing relationships and open channels of communication with our colleagues in surgery, pathology, and oncology. We work to keep these relationships strong and do so with such things as regularly scheduled conferences.
During a weekly radiology/pathology correlation conference, radiologists and pathologists review together the imaging findings for the mammograms and the ultrasounds. Then the pathologist shows us the results of the core needle biopsies under the microscope. Together, we decide whether the pathology findings adequately explain the imaging findings, meaning that they are concordant, or whether the imaging and pathology do not adequately explain one another and are considered discordant. The latter requires additional evaluation of the tissue with a surgical biopsy. Finally, we put an addendum on the biopsy report that includes a statement about whether the imaging and pathology are concordant or discordant and a final management recommendation.
Imaging-pathology correlation is the important part of any well-developed core needle biopsy program. When it’s appropriate, we call the referring physician for anything that requires intervention beyond routine follow-up. So while we’re not all formally part of the same center, we’re all on the same team.
RT: How much and what type of competition do you have in your marketplace?
Hoyt: Santa Monica is based on the west side of Los Angeles, and Iris Cantor is based [further east] in Westwood. These are both large metropolitan areas, so we are surrounded by other practices, some small, some large. Some of these practices are hospital based, while others are freestanding imaging centers. Many of them offer breast imaging services, while others offer more general imaging. So, we have a whole spectrum of competition.
RT: How does Santa Monica differentiate itself from the competition?
Hoyt: We differ from our competition in that we are an academic center. Therefore, we have faculty radiologists who specialize in breast imaging. Also, as radiologists, we’re unique in that we perform our own ultrasound exams personally rather than having a technologist perform the study. This allows us to meet individually with patients who have been referred for evaluation of a breast lump. After reviewing her mammograms, we begin the ultrasound exam. This allows us the opportunity to hear the patient’s history directly from her—she can explain when she first developed her breast lump, etc. We are then able to examine the lump and perform the ultrasound. This gives us a tremendous advantage, since we get to know the patient and develop a relationship with her rather then just review her images.
RT: How do you attract new patients? What marketing does the center do?
Hoyt: While the Santa Monica center is relatively new, UCLA has a reputation for excellence. Many patients hear about us through word of mouth, but this is never enough. We have ongoing relationships with our referring physicians and strive to keep an open line of communication with them. We try hard to keep our referring healthcare providers informed about what’s new at our center. We do this by personally visiting them in their offices, offering occasional special evening presentations, and providing written correspondence. We want to make sure that our referring clinicians are up-to-date with what we’re doing.
When the Santa Monica site first opened, the center held an open house for the referring physicians to introduce our new center and familiarize them with our services. It was an opportunity to see the imaging center and our equipment, meet the physicians and staff, and see how it’s laid out.
Afterwards, I wrote a letter to the local physicians, which was mailed or personally delivered to their offices along with our new referral pads. In that letter, I invited those who could not attend the open house to stop by the center for a personal tour. Several of them took us up on that invitation. It gave us a chance to say hello to our colleagues, to meet people who we knew by name but had never met in person, and to meet physicians who were new to our center. One of the powerful things that resulted from physicians personally touring the women’s center was that many of the female referring physicians came to us for their own mammograms and then mentioned that they would be sending more of their patients to us. I think that this is a real compliment.
RT: What makes it difficult/easy to reach patients in your market?
Hoyt: Physicians have their own referral patterns that have been established over a number of years. Because of this, it can be difficult to reach certain patients. Their physicians may refer to another facility, and well-established patterns are difficult to modify.
The easier part happens after patients come to our center. Once they see our new facility, caring staff, and quality service, they tell us that they plan to return again next year or will tell their friends about us.
RT: What is your customer service strategy?
Hoyt: Our focus is academic excellence at community speed. We achieve that by working toward several goals. Our main goal is patient satisfaction. Everyone from our physicians to our front-desk staff understands that and works as a team. They understand that this is not just a radiology center where women come for their mammograms. We need to create a comfortable setting, starting when the patient walks in the front door. We personally greet each woman and introduce ourselves. Our technologists work one-on-one with each woman, telling them exactly what their exam will be like and answering any questions they might have. Radiologists are available to answer patient questions as well. It sounds cliché, but we work hard to treat women the same way we would want to be treated.
With our referrers, the main focus is that we really listen to what they need and try to accommodate them as best we can. For example, when we were visiting the physicians’ offices in person, many requested pelvic ultrasound services. Although this was in the plans for the center, it was not a part of the original opening. Subsequently, we took that information and put it at the top of our list and now plan to begin offering pelvic ultrasound soon.
In terms of access and scheduling, you need a finely tuned system. While nothing is perfect, access and scheduling must run smoothly. Oftentimes, a patient’s first contact with us occurs through scheduling. We have two scheduling options: a main scheduling line that patients can call or a direct line to the front desk. We also offer same-day walk-in service for screening mammography and usually for diagnostic mammography as well. We emphasize to our referrers that if they encounter a patient who has a lump that is worrisome, they can call the center and we can arrange a time for that woman to come in on the same day. This isn’t possible every day, but for the vast majority of the time, we can accommodate these women.
We also track and modify our appointment availability so that we can change our scheduling templates as needed to keep appointments available. If we see that we’re suddenly having longer wait times for screening or diagnostic mammography or ultrasound, we will modify our scheduling templates, temporarily or permanently, to accommodate that need. It’s an active, ongoing process.
With turnaround times, we track our modalities. We strive for a 24-hour turnaround time. However, diagnostic reports are generally available the same day as the exam.
In terms of authorizations, most of the women coming to the center are there for screening mammography, and these women are typically already authorized. However, sometimes a woman presents for screening but ends up needing a diagnostic study or breast biopsy and, in these cases, we facilitate any necessary authorization. In cases where the lump is suspicious for cancer, we try hard to get them in for a same-day biopsy. Doing this lessens the anxiety-ridden wait time that may precede a breast biopsy and gets the patient one step closer to finding out if her lump is cancerous or benign.
Annual screening mammogram reminder letters are sent to women who do not return to the center within 12 months of their last screening exam. They receive an automatically generated letter reminding them to schedule their mammogram if they have not already done so. Also, once a woman has scheduled an appointment, she will receive a reminder phone call the evening before and an appointment reminder letter in the mail. This letter contains her appointment time, a map, directions to our new center, and parking information.
We also track and follow up with patients who are to return for short-interval follow-up imaging. This is done automatically by a computer that flags women who have not returned by their specified time.
RT: How did you decide on this customer service approach, and how does it make a difference in your marketplace?
Hoyt: The west side of Los Angeles is a sophisticated market. The women here expect outstanding service and quality in a timely fashion. I think that meeting these expectations while providing expertise in breast imaging helps us to attract and retain patients.
RT: What are the challenges to finding and keeping patients in your marketplace?
Hoyt: The Santa Monica Women’s Imaging Center is located on the west side of California’s 405 freeway rather than the east side, which is where UCLA is located. A lot of women who live west of the 405 freeway prefer to have their healthcare in the same area where they live. Now that we have an expanded center in their community, we’re attracting a lot of women from this area.
The challenge to keep women coming back is to maintain a high level of service so that these women, who have tremendous choices in the marketplace, remember us rather than another center. You want their experiences to be memorable in a positive manner. If we can do that, they will return. Sometimes they may not be receiving good news, but they will remember that they were well treated and cared for at our center.