In 2006, Tenet Healthcare Corp of Dallas, Texas, was operating 20 outpatient imaging centers across the country, and it was watching its outpatient imaging volume continue to slide. Dale Skrnich, senior director of outpatient services for the organization, explains that many of the imaging centers were being operated as hospital departments; “They offered a poor patient experience, no marketing or dedicated resources for sales, and no standardized imaging technology to speak of,” he says. Where similar organizations saw half their revenues coming from outpatient services, Tenet’s outpatient services only accounted for a third. “We wanted to decrease that delta,” Skrnich says.
In “Patient Centered Business Models in Diagnostic Imaging,” an exhibitor symposium given by three presenters in Dallas, on August 16, at the 2011 meeting of AHRA: The Association for Medical Imaging Management, Skrnich shared that between 2007 and 2011, Tenet expanded its outpatient imaging presence to 54 imaging centers, while increasing volume and revenue.
“All the things we were doing on the IDTF side, we wanted to bring to the hospital world,” he says. The first step was to establish an outpatient-services division in 2007; the next was to create a retail-style patient experience. “Patient and physician experiences are a key driver of volume,” he says. “Can you deliver a quality report back to the referring physician, and can you keep that physician’s patient happy?”
Assessing the Opportunity
Tenet backed the new outpatient-services division with capital for investing in new imaging centers and acquiring new technology. Skrnich and his team assessed the company’s markets around the country, looking for opportunities to invest and compete. At the 2009 meeting of the RSNA in Chicago, Illinois, the organization went shopping. Skrnich says, “We’d identified most of the imaging-center companies across the country and went into the conference with a pretty good list. We approached all the operators and asked if they would be interested in selling.” Within 14 months, Tenet had added 26 outpatient imaging centers to its roster.
The next step was investing in competitive technology. Skrnich explains that a market assessment drove the outpatient-services team to install technologies typically seen in freestanding imaging centers, such as high-field open MRI systems, in Tenet’s outpatient imaging centers. “High-field open MRI is not something you would typically find in a hospital,” he notes. “We looked for areas like that, where we thought we’d have the biggest impact—where we could deliver a better patient and physician experience.”
The Tenet team also focused on customer service, developing benchmarks aimed at increasing patient satisfaction. “We started at the front door in assessing what we could do to give the patient a better experience,” Skrnich says. “We gave our teams a timeframe to meet new benchmarks, such as less than two minutes to schedule or less than 10 minutes to register a patient. It makes a significant difference with our goodwill from our referring physicians because they see us making an effort to give their patients a better experience. We’ve been able to establish a consistent level of customer service and care that’s noticeable.”
Technology and the Patient Experience
To enhance the patient experience further, Tenet focused on investing in imaging technology that would differentiate it from competing imaging centers. Skrnich and his team identified high-field open MRI as an opportunity, but immediately encountered an obstacle: Tenet’s radiologists were accustomed to open MRI systems with lower field strengths and were dubious about the technology. “It was a radical concept for our hospitals,” he says, “but we knew high-field open MRI could provide a point of differentiation between our centers and our competitors’ centers in our markets.”
In August 2008, Tenet installed an Oasis 1.2T boreless MRI system from Hitachi Medical Systems America (Twinsburg, Ohio), at its imaging center in Fort Mill, South Carolina. Within three years, the organization had added 10 more Oasis systems at imaging centers around the country. Skrnich explains that not only did the system “more than surpass our expectations” in terms of patient tolerance and image quality, but that it also helped to improve the patient experience in other ways. He says, “We’ve seen volume and margins affected by cancellations and rescheduling” with other MRI systems, but with the Oasis, “they’re nonexistent. Our flexibility is limitless.”
The installation of the high-field open systems also had an impact on outpatient imaging volume, Skrnich says; patients who previously couldn’t be accommodated at Tenet imaging centers because of their size or claustrophobia were now being imaged easily with the Oasis systems. “We had no idea, until we started doing the modeling for this project, that our physicians were sending 50 to 75 scans a month elsewhere,” he notes. “They had never brought that issue to us.” The radiologists have also been satisfied with the image quality offered by the Oasis units. “It’s really satisfying to go back in and hear them say, ‘You were right. We couldn’t have asked for a better system.’”
As imaging faces an uncertain future in the wake of health-care reform, Skrnich concludes, “One thing is for certain: Hospital-based outpatient imaging will continue to play a significant role in an increasingly competitive industry.” For that reason, he urges hospitals to consider how their outpatient imaging centers are positioned in their marketplaces and embrace opportunities for improvement.
“Investing in those imaging centers and in their technology is important,” he says. “Hospital-based imaging centers must continue to understand the value proposition they can deliver and position themselves accordingly in their markets. If you can do little things like this to increase your throughput and volume, while delivering good patient care, you’ll position your business well for the future.”
Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.