Radiology practices will need to continue adapting to the fast-changing healthcare landscape in 2016 as reform gains momentum and new opportunities, challenges and risks arise, McKesson experts say.
Michael Parr, executive director of radiology operations and client management for McKesson Business Performance Services (McKesson), and Joanne Watson, senior director, client management, said it is essential that groups seek out opportunities to participate in alternative delivery models.
At the same time, organizations must develop data that can demonstrate the variety of ways the practice is creating or adding value. Finally, groups should closely monitor regulatory and marketplace developments to make sure they’re prepared for forces or changes that could impact their business.
“Groups simply can’t afford to sit back and react to change,” Parr said. “You’ve got to become engaged if you want your practice to survive and prosper in the years ahead.”
Taking a pro-active role
For radiology practices, acclimatizing to the reform environment means being vigilant to -- and involved in the formation of accountable care organizations (ACOs). Because radiology typically is not a primary focus in the creation of an ACO, Parr said groups must be pro-active to get in the ground floor.
“ACOs that are sponsored by hospitals, physician groups and insurance companies are popping up, but they may not be giving a lot of thought to imaging,” Parr said. “So radiologists really need to be aware of what’s going on in their immediate area in terms of ACO formation. The risk is that someone else will play that role, and patients will be steered away from the practice.”
Groups should volunteer their time and get involved in the nascent ACO’s finance and standards committees. Failing to do so could mean that even if the group ends up participating, it is left out of the critical development and planning stages and consequently joins the ACO at a financial disadvantage.
“You should proactively offer your assistance and involvement, versus sitting and waiting for somebody to come knocking on your door,” Watson said, adding that groups shouldn’t hesitate to explore multiple opportunities.
“Some of them will probably be dead-ends or blind alleys, but that doesn’t mean they’re not worth looking at,” she said. “If it’s not productive in the end, it is still going to be a learning experience and hopefully that knowledge will help the next time around. The main thing is don’t sit back and wait for the perfect opportunity.”
As part of this process, groups need to be open to exploring alternatives to traditional fee-for-service reimbursement.
“Radiology is a huge expense for payers, so it’s an easy target,” Watson said. “That means you need to be prepared to look at different mechanisms of payment.”
Deep data dives
A key element in adapting to healthcare reform is being able to demonstrate performance and value to potential partners. To that end, practices should develop business analytics that enable real-time or near-real-time trend analysis across a range of clinical and operational areas. Not only is the information important for potential partners, but it can help the group operate more efficiently and effectively.
Metrics that quantify productivity per physician, report-to-dictated time, read turn-around time, as well as a variety of financial elements all are important in establishing the practice as a contributor to overall healthcare value, Parr said. By being able to show specific advantages, groups strengthen their position with hospitals and are less likely to be replaced, he said. At the same time, benchmarking will provide insight regarding the extent to which the practice is showing positive or negative variance vis a vis a similar-sized organization.
“You need a platform that can produce the data, and then you’ve got to be able to manipulate that data in order to produce actionable information,” Watson said. She pointed out that groups are using analytics to refine their physician staffing and scheduling, particularly in instances when expensive and time-consuming new technology is deployed.
“The idea is to even out workflows to accommodate new demands on time,” she said.
Monitoring the marketplace
Along with getting involved in the creation of ACOs and developing robust analytic capabilities, groups need to keep a weather eye out to systemic changes that could impact their business model. That means tracking emerging Centers for Medicare & Medicaid Services (CMS) initiatives and monitoring changes among commercial payers.
“In the past, I think radiology practices have been a little bit cavalier in terms of the programs and initiatives that were rolled out by CMS,” Watson said. “But change is coming fast and furious now and commercial payers are following suit. There are penalties: 1% here, 2% there, and pretty soon it adds up. So you really have to stay on top of things.”
Part of this involves staying current regarding new rules covering different kinds of imaging services, such as low-dose CT, as well as mandated exam reductions.
“Radiologists traditionally haven’t been very visible, and that’s always been an uphill battle that groups have had to fight,” Parr said. “But you can’t afford to sit back any longer. The key is to stay informed."