ACR Task Force Reports on Hospital-Radiologist Relations

As tensions between radiology groups and hospitals mount nationwide, in some cases leading to contract terminations, it’s increasingly critical for radiology practices to build successful relationships with the hospitals they serve. In the June issue of JACR: The Journal of the American College of Radiology, the ACR’s Task Force on Relationships Between Radiology Groups and Hospitals and Other Organizations identifies key factors impacting these relationships, and makes recommendations toward improving them. The report identifies several issues contributing to escalating tensions between radiology practices and the hospitals and other organizations they serve. Included among these are underlying financial trends such as revenue decreases and the DRA; teleradiology and the outsourcing of radiology services that it enables; turf issues, which, the report notes, are complicated by the fact that “contracts often merely protect one radiology group from others, affording radiology little protection from other medical specialties"; and eroded loyalty between both parties. The report does not let radiology groups off the hook, noting that practices “may fail to attend to the service needs of hospitals and other medical staff members . . . when such issues lead to contract disputes, they can precipitate a vicious cycle of erosion in the relationship.” But the report also observes that “hospitals may fail to ensure an appropriate environment of care conducive to high-quality radiology practice, as in the failure to provide up-to-date imaging or therapy equipment, PACS and voice recognition.” The task force recommends that radiologists align their goals with those of the hospitals they service, and, in keeping with that philosophy, makes specific recommendations for how groups can improve hospital relations. Radiologists should be responsive to the needs of referring physicians (and their patients) and should attempt to see the situation from the hospital’s perspective by maintaining open lines of communication. They should also provide “value-added” services to both referring staff members and hospitals—which could include longer coverage hours, more subspecialty expertise, or increased availability for consultations—and actively aspire to taking a leadership role in the organizations they serve. “Hospital administrators often express concern that radiologists do not have sufficient leadership skills to serve as active partners with the hospital,” the report observes. “Although some tasks can be delegated to the nonphysician business executives in a practice, failure of physicians to provide input and oversight can prove disastrous.” On the opposite side of the coin, the report recommends that hospitals include radiologists on hospital committees, including boards and advisory groups; that they schedule regular meetings with designated radiology practice spokespersons; that they jointly discuss hospital-wide initiatives like 24-hour services; and that they be aware of the long-term consequences of granting imaging privileges to nonradiologist clinicians. “Replacing radiology practices has never been easier,” the report states in its conclusion. “In some situations, the process is out of the control of the incumbent group; however, in most circumstances, radiologists can substantially influence their tenure.”