Radiology’s Role as a Value Center: How to Excel in Both Quality and Accountability

Our University of Utah Health Care system was recently ranked No. 1 in Vizient’s 2016 Quality and Accountability Study Rankings. One critical contribution to this success was an innovative cost/outcome accounting system called Value Driven Outcomes (VDO). Created by Vivian S. Lee, MD, PhD, MBA, senior vice president, dean of the school of medicine and the CEO of the University of Utah Health Care System, VDO captures the true costs of healthcare across the entire enterprise and connects them to patient outcomes, supporting growth through the value equation: Value = (Quality + Service) / Cost.

Utah has long been a community of creative and hardworking entrepreneurs. Our university’s administration is open to new ideas, and the success of VDO has created an opportunity for the radiology department to assume a leadership role in driving enterprise-wide value.

In national efforts to reduce healthcare expenditure, radiology is often seen as a cost center. However, it is actually a value center that can empower the entire health system to provide value-driven patient care. To enable such value, our department and the University of Utah Hospitals and Clinics took the bold step of integrating the two systems for imaging operations to create a dyad model called IMAGER, or Integrated Management and Governance for Enterprise-wide Radiology.

The quality, service and cost of imaging is closely tied to the effective management of manpower, supplies, capital equipment, space and finance. IMAGER merges the finances of our clinical and academic entities to grow research, education and clinical missions throughout the institution. It is integrated, comprehensive and completely transparent to the entire health system, tracking metrics around clinical and academic outcomes. It incorporates powerful analytics such as VDO to examine our costs, productivity and quality in all these areas. In addition, IMAGER tracks local exam volumes, predicts changes, and pulls in regional and national benchmarks to guide decisions.

For example, IMAGER allows us to estimate faculty manpower and financial support based on volume projections for the entire health system, including projections of how imaging utilization would change based on new faculty hiring in specific provider departments. The system brings together multiple national benchmarks to establish appropriate targets for work RVUs per radiologist and suggests matching compensation based on triple-averaged national benchmarks. Year-to-year variations are accommodated through budgeted reserve allocation, transparent within IMAGER. All imaging assets in every location across the system—from high-end MRI scanners to point-of-care ultrasounds—are integrated under IMAGER, prioritizing capital spending that allows the most strategic and value-driven services to grow.

Integrating the finances for research, development and education efforts together with the hospital and clinical operations is especially vital. This ensures that those academic priorities are maintained and adequately resourced. Research and education allocations are appropriated by differentials between clinical and academic radiology benchmarks, and the budgeted distribution of funds and incentives to faculty is tied to metrics for quality.

Any above-budgeted margin produced by IMAGER is then invested back to the healthcare system, supporting growth and innovation across the enterprise. All of this information is open to health system leadership, making it clear how central imaging operations are to the financial and academic strength of the institution.

The trust and accountability this builds between the department and hospital leadership is critical.  As Gordon Crabtree, interim CEO of the University of Utah Hospitals and Clinics, said to me, “IMAGER is an exciting first step toward our mutual goal of creating value-drive enterprise-wide imaging operations.  It will help us learn how we can achieve the highest value in imaging operations and sciences in our integrated health system.”

Radiology is one of medicine’s newest fields, less than a century old.

We are pioneering new values in healthcare every day. Discoveries and innovations in our field can truly catapult the practice of medicine forward. We are medicine’s R&D engine, and IMAGER helps put us in the driver’s seat.

(It took a cross-organizational team to build IMAGER, and we are indebted to everyone involved. This includes Kirk Mosher and Dasha Runnions from the academic side; Rick Shumway, Brita Manzo, Candice Crawford and Karen Macon from the hospital side; and Grant Lasson from the dean’s office.)

Satoshi Minoshima, MD, PhD, is the chair of radiology and imaging sciences at the University of Utah School of Medicine in Salt Lake City, Utah.