At the 2012 Annual Meeting & Leadership Summit of the California Radiological Society in San Francisco, California, Richard Duszak, MD, presented “Physician Performance Measurement and Management: Benefits and Pitfalls” on September 8. He was originally asked to cover measuring physician productivity, but Duszak makes a distinction between performance and productivity. “What I’d like to do is get people focusing beyond the pure RVU and on other things that are more important for us—collectively, for the future of our specialty,” he says.
Duszak, who is a radiologist with Mid-South Imaging and Therapeutics (Memphis, Tennessee), is emphatic about the importance of shifting the conversation away from diagnostic productivity. “Our payment model, to date, has been one where volume drives success,” he notes. “My crystal ball says that the next wave will be one where value drives success: It won’t be how many studies you did, it will be what you did— but going from one wave to the next is not a horizontal proposition.”
In fact, Duszak says, forward-thinking radiology groups should expect friction (in the form of revenue loss) as they position themselves for the future. Providing incentives for nondiagnostic work is likely to result in reduced income, but it will be increasingly critical to survival. “As you look at how you evaluate yourself and set up performance expectations, align the incentives, the goals, and the behavior with the things that market forces are asking of us as a specialty,” he recommends. “One of the things you’ll be hearing about in the next year is taking us from imaging 1.0 to imaging 2.0.” Imaging 2.0 will be all about interactivity, he says, “and that’s where we really need to be.”
The Problem With Productivity
Measuring physician productivity, Duszak notes, is a common activity among radiology practices today that arose out of the need to ratchet up efficiency for greater revenue. “You can’t manage what you can’t measure,” he says, adding that if practices can improve their productivity significantly, they can effectively hire internally, adding FTEs by improving the efficiency of their current physicians.
Work RVUs have been widely agreed upon as the best unit for rewarding radiologists’ productivity, but Duszak stresses that even they are imperfect. “Even though they are called RVUs, they are not measuring value,” he says. “The definition of value in health care is differential quality over incremental cost. The RVU doesn’t look at value—it’s widget counting.” In addition, he notes, many interventional radiologists are disadvantaged by measuring work by RVUs, as their procedures take much longer; on top of that, there have been instances of malpractice suits against radiologists in which their daily productivity levels were cited as being antithetical to high-quality care.
The real problem with productivity measurement, however, is that it only creates incentives for one piece of the radiology-business puzzle. Not all work is medical, Duszak says, and in the future, nondiagnostic work will grow in importance. “Practice building takes time. Relationships take time, but consulting services enhance your practice,” he says. “If you simply look at how many studies you read today, you ignore all of that. You may wind up being the most productive radiologist in a group that no longer has any business.”
What Else to Measure
How can radiology practices transition from measuring widgets, as Duszak puts it, to measuring value? He says that the road is unlikely to be a smooth one. “Those of us who have had these discussions have had some very animated discussions,” he says, “but life is changing, and we do need to start measuring things to get us from the volume curve to the value curve. Your payment, in the future, will be increasingly dependent on the value of your services.”
Duszak suggests a variety of measures that practices might take into account alongside work RVUs, including academic performance, service ethic, level of professionalism, quality, and safety. He recommends that practices weigh which elements are most important to them to develop a formula for measuring radiologists’ nondiagnostic RVUs: “There’s no uniform way of doing this. You have to decide what is a priority for your practice, based on what you see as your own market needs,” he says. To enforce sought-after behavior, he suggests that practices distribute monthly report cards that show radiologists how they are performing across this array of indicators.
Duszak emphasizes that practices will have to customize their incentives as well. To start, they could link desired nondiagnostic behavior to vacation time; as an example, he suggests a model wherein any radiologist falling below 85% of the mean would lose two weeks of time off work. “There is no one-size-fits-all solution,” he says. “Where do you want to be? Where does society want you to be? What do you need to do to get the culture of your group there?”
Cat Vasko is editor of RadAnalytics and associate editor of Radiology Business Journal.