Radiology department economics in a value-based world

Philips: Ultimately, healthcare providers must remain focused on the patient and quality of care amidst the operational and financial challenges of healthcare. Do you as radiology administrators have ownership of the quality of the patient experience in imaging for your organization? 

Paula Gonyea, UVMC: We have always been responsible for the patient experience, but many of the aspects of that experience are out of our control. For example, things like wayfinding or wait times – things that happen before they even get to the imaging department – are still included in the patient satisfaction surveys. There’s a lot of pressure on us to improve the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores because it affects reimbursement. Consequently, we have a huge focus on creating a more patient-centered imaging experience by improving the things we can control such as patient preparation and communication, as well as comfort during the exam. Quality of care also includes providing the best imaging equipment to facilitate first-time-right scans to reduce the need for rescans and increase patient safety by reducing dose or the need for sedation. In this context, we are certainly looking at reliability of imaging equipment and being able to deliver more confident diagnoses as a key priority.

Perry Kirwan, Banner Health: There is constant demand to improve patient satisfaction and the patient experience overall. We know many factors contribute to the patient experience, but the greater challenge is identifying the best way to measure it. We have many patient experience improvements, various tools and metrics, NPS scores, surveys, etc. – and they all provide value. But, the real question is, what is the sweet spot? We need to think wider about the problem and be expansive enough in our thinking in each area of the imaging value chain to really make a difference in patient experience in a more significant way. This means gathering insights on patients and looking at the issues from a more consumer-driven view that is more typical of B2C (business-to-consumer) organizations. 

Philips: A key piece of today’s healthcare economics mandate is improving efficiency to enable greater patient volumes. What are you doing to overcome increasing demands on your departments without commensurate increases in staff? 

Paula Gonyea, UVMC: Volume and backlogs are one of our key challenges. We’ve seen an uptick in oncology as cancer rates are increasing, so our CT scanners are always in high demand. We’re putting in more second shifts to address the need from a staffing standpoint to reduce stress and burnout. Increasingly, my job as a radiology administer includes lots of staffing issues and people management. We also need to ensure uptime, reliability and service support of imaging equipment so that we don’t incur added delays or backlogs. So, we’re focused on improving staffing, workflow and scan efficiency. Reducing the need for rescans with a first-time-right image is an important element of driving operational efficiency as well.

Mark Thompson, Premier Health: I would say patient no-shows can have a big impact on workflow productivity and backlogs. When patients don’t show up for an exam it can create a domino effect of issues including lost revenue for the exam, lost productivity at a staffing level and lost time for patients that are waiting for those appointment slots.

Philips: Radiology leaders are looking for ways to use data to drive better imaging, operations and business decisions and connect data and technology so everyone in the radiology department can do their job better. How are you dealing with unstandardized and unstructured workflows that can lead to inefficiencies?

Mark Thompson, Premier Health: One of the frequent obstacles I see is the connecting of information or the insight and data gathering effort across third-party systems. Getting information out of one system and into another shouldn’t be so hard. We need to come up with better ways to integrate and connect information across various tools, electronic medical records (EMRs) and systems. 

Perry Kirwan, Banner Health: I would agree that there’s a broader issue in healthcare around integration and interaction between tools and electronic medical records from third parties that hamper workflow. We shouldn’t have to maintain duplicate systems. There should be a single source of truth. We need to find a better way to work within it; there needs to be a better EMR eco-structure. But, it’s not just getting the information out of systems: the differentiation lies in what you can do with the information you capture.

Philips: Let’s talk about total cost of ownership (TCO) and how cost and value discussions are playing a more central role in imaging purchasing decisions. Radiology administrators are looking at cost management and ways in which they can support better clinical outcomes, departmental operational efficiency and patient satisfaction. We see that there are now more groups influencing purchasing decisions and many more factors in assessing the clinical and economic benefits of a given technology investment. How do you look at cost and value in your organization?

Mark Thompson, Premier Health: We’re always thinking about how we can reduce operating costs as they are more fluid than capital costs, which are more rigid. So staffing is a big cost for us, and scheduling patients around staff resources effectively is one of the hardest KPIs to measure.

Paula Gonyea, UVMC: Quality assurance is a big metric for us when evaluating TCO and is a real differentiator. We need to make sure our imaging equipment is working effectively, that our technologists are adequately trained and that our protocols are standardized to obtain consistent images and information from wherever and whoever is utilizing the equipment. We need to know that the correct images are in PACS for the radiologists to read because, ultimately, that affects patient care and accurate diagnoses. If we have to rescan a patient, we want to know why we had to rescan them–was it because of a non-diagnostic image set, incorrect protocol or order, patient movement or an equipment issue? That kind of information is essential to my job and helps me better understand the value of a purchase versus the cost, not only in terms of dollars but in terms of time, missed opportunities or long-term options that can add value and save money.

Perry Kirwan, Banner Health: Equipment uptime and image retrieval are always big KPIs. Overall though, sometimes it’s hard to pinpoint what “moved the needle” when it comes to defining cost and value. I think the real opportunity, when it comes to TCO, is to look at the larger issues we’re trying to solve and find a solution and a partner that addresses those needs rather than make decisions based on technology, since it’s increasingly difficult to differentiate suppliers. The key word here is partnering with suppliers. We don’t need problem validation partners; we need problem-solving partners. The value isn’t in the new features and specs of the equipment or technology: the value is in the service and willingness to continually help hospitals get the most benefit out of that solution long-term. We need partners that go above and beyond what we expect. Healthcare needs partners that will work with them on the more strategic and more complicated issues we’re all trying to solve in imaging.

Philips: What are some of the opportunities you see for your role in particular or for the role of imaging in healthcare in general?

Mark Thompson, Premier Health: I really enjoy working with the radiologists to create unique and innovative workflows that really impact what they do on a daily basis. Workflow is so critical to what we do to deliver patient-centered imaging in healthcare. It’s a huge part of my job.

Paula Gonyea, UVMC: I would echo one of the comments that Perry made earlier about the importance of partnering with suppliers. This job is challenging because it’s multifaceted and intertwined with so many other aspects of great importance to our hospital. But, knowing that we have an imaging partner that will work closely with us to address problems, co-create and be responsive to our needs as they arise, makes all the difference.

Perry Kirwan, Banner Health: With healthcare, I see so many opportunities. My job is so dynamic and changing constantly; it’s uncomfortable yet invigorating. Everyone’s involved in the change, and it opens up our business to disruption – which is exciting.