For many hospitals, radiology can be just another contracted service. But for those who recognize the impact prompt and accurate radiology can add value to all the inpatient services hospitals provide, retaining the right partner is imperative.
Standardization to minimize duplication and waste is critical, but radiology isn’t always where many healthcare leaders expect to find those opportunities. It should be, says Allen Tseng, chief operating officer at Memorial Hermann Memorial City Medical Center, a 444-bed hospital in the Memorial Hermann Health System in Houston.
Memorial City, like many hospitals, contracts with an outside radiology practice, in this case, Radiology Partners.
“We needed them to go beyond interpreting images correctly,” says Tseng. “A few years ago, we looked into deep dive in ER processes because we had experienced a downward trend in turnaround for our 70,000 annual visits. Radiology was one of the stakeholders in interpreting the data.”
Fixing ER and Imaging Bottlenecks
Throughput bottlenecks are common in ERs, one of the most complex and uncertain places to practice medicine. Each of those bottlenecks can increase length of stay, and thus the cost of a patient encounter. Memorial City contracts with several key physician groups, including anesthesiology, emergency, and hospitalists.
An ER process redesign about four years ago was revelatory for Tseng because in part because of that engagement from the radiology group. The group found that the ER was failing to accurately anticipate peak volume and low-volume times and staff accordingly, radiology included. Fixing that problem led to marked improvements in turnaround times, and thus, length of stay.
The data showed that deploying the right resources at the right times, from 11 a.m. to 2 p.m. on weekdays and 8 p.m. to 11 p.m. on the weekends could save plenty of time and money through better radiology throughput. Before that exercise, staffing was flat at all times, with only two radiologists assigned. But increasing radiology staffing during peak times and reducing it during slack times improved ER discharge.
“When they only had two radiologists assigned, it held up patient discharge through the ER, so to improve that, we moved some resources from other campuses at certain times to help process patients quicker,” says Tseng.
Look at Imaging Utilization
As the bulk of revenue becomes bundled and capitated in risk, hospitals truly become a cost center, says Tseng, and though that trend hasn’t yet fully played out, Tseng says when it does, “everything has to be more efficient.”
Radiology can play a key role in reducing costs through the quality and turnaround time on their reads, in making sure expensive tests aren’t repeated, and in helping the hospital reduce length of stay.
“Post-surgical follow up requires several images and if they don’t have their act together and it takes them a day and a half to do reads, we just added another half day or another day in length of stay,” Tseng says. “And it’s not just about turnaround, but quality, in whether hospitalists or specialists can get key recommendations. Radiology can be a strong tool for physicians to make decisions behind.”
What’s unique about the partnership with the 600-physician radiology practice, says Tseng, is that their governance model is locally led. Local departments have the ability and autonomy to make decisions without having to go through several layers of bureaucracy.
For example, Memorial City’s radiologists have developed key clinical recommendations on thyroid nodules and abdominal aneurysms, and have standardized reporting procedures.
“Before, every radiologist interpreted differently. Now that they’ve streamlined and use similar styles to save time, referring physicians don’t have to dig through seven pages of detail,” says Tseng. “That’s been helpful.”
Thanks to benchmark data across all the practice’s partners, radiologists can compare how the local practice is doing against others. This is especially valuable in ensuring proper patient follow-up after discharge. For example, by reviewing data on abdominal aneurysms, the practice found that 36 patients did not have proper follow-up care, which could lead to much higher care costs, suffering, or death.
“So, they’ve standardized that to contact referring physicians to ensure follow up exams,” says Tseng.
“That alone has saved lives and avoided huge costs down the road.”
Invest in Radiology Focus and Leadership
Leading operations at a high-volume surgical hospital, Tseng counts on this type of partnership behavior, rather than just hiring a group of physicians to perform specific tasks.
Memorial City does about 5,000 orthopedic surgeries a year, and that level of volume had started to crowd out the ORs. In part by analyzing data over two years, leaders were able to successfully lobby the health system to build a $30 million standalone orthopedic hospital.
Without prompting from Memorial City’s leadership, the practice recruited a radiologist who specialized in orthopedics from a major teaching hospital and had that person hired and trained in time for the new facility’s opening.
“This is what I mean when I talk about a valued partner,” says Tseng. “What was amazing about that was they knew we had invested quite a bit to build a nationally-recognized ortho facility in Houston and wanted their radiology capability to be as recognizable—someone fellowship-trained on ortho.”
In terms of advice for other hospitals, Tseng says now that he’s seen this type of behavior in action, “these relationships can be so much more than just transactional. They get paid to do to be true partners, so there should be an expectation that they are engaged in medical leadership, and contribute in areas where they can impact operations.”
Philip Betbeze is the senior leadership editor at HealthLeaders.