At RSNA 2009, analysis of key metrics was emphasized as a means for radiology practices to improve operations, augment quality, and reduce costs. In 2010’s health care environment of ever-declining reimbursement and renewed focus on outcomes, what are the key metrics for practices to use? ImagingBiz.com spoke with Marcia Flaherty, CEO of Riverside Radiology and Interventional Associates Inc, Columbus, Ohio, for an inside look at the 40-site practice’s robust data mining and analytics.
ImagingBiz: How has Riverside used practice metrics to stay competitive in the past? What are some key metrics analyzed in 2009?
Flaherty: We internally develop metrics, benchmarks, and goals for each major business function, including IT, finance, billing, and clinical services and operations. Each year, these goals and benchmarks are reviewed and used to develop long-term and annual plans. On the clinical side, we have a peer-review process that spans all practice sites to review quality. We also review staffing and procedures by hour to determine physician resource allocation—this is further defined by subspecialty area, in some instances.
We measure turnaround time in about every fashion you can imagine; we have a standard that we want to make sure we hit at each of our locations, and we also want to make sure that we’ve staffed appropriately. We’ve grown, and we never seem to have a so-called typical year.
We provide operational support to our practice sites, including measuring critical-results reporting, turnaround times for emergency-department and
stat studies, and average turnaround time for all studies. We have developed a dashboard for this monitoring that we are piloting at several locations; it shows complete turnaround time from the point of patient registration through completion of dictated reports. This allows the hospital manager to see how the total system is responding at all points in a day. This is helpful in scheduling resources on the hospital and practice sides.
Key measurements analyzed in 2009 included turnaround time; work RVUs per physician; work RVUs per location; average work RVUs per modality; revenue per procedure and by modality and location; denial percentage; accounts receivable greater than 120 days; total procedures; office visits; operating expenses; referring-physician satisfaction; and employee satisfaction. We also have a significant set of metrics for the performance of our IT functions. This allows our IT operations staff to address outstanding reports or problem studies, and it allows us to use trends to improve our performance.
ImagingBiz: Which of these will be continued in 2010, and which (if any) will you stop measuring? Will you add any new metrics?
Flaherty: We will continue all current measurements. We’ve spent a lot of time evolving the things we study; we feel that we’ve got the day-to-day aspects covered. Now, we’re trying to measure profitability precisely, return on investment on marketing efforts, and effectiveness of new service or procedure offerings. We’re always looking for better data mining so we can analyze a finer level of detail throughout the practice. With unkonw aspects of health care reform on the horizon, we need to maximize every dollar that we spend, and analysis is a big part of that.
ImagingBiz: What are key issues facing practices in the coming year, and how can measurement help alleviate the pain?
Flaherty: The key issue we face is the uncertainty of the health care climate. We are working to shore up our business practices in order to enhance our efficiency and support our quality standards. One major area to focus on is improved efficiency for the radiologists. We are working with our health system and PACS vendor to improve the system’s performance.
ImagingBiz: Will Riverside Radiology use metrics for physician productivity and performance? If so, what will be measured, and how will it be tracked?
Flaherty: We use RVUs, turnaround times, customer service, and peer review to measure our physician performance. We have a medical director for quality, and at each of our major hospital locations, we have a medical director who’s responsible for making sure all of our protocols and standards are maintained at that site.
The committee meets on a quarterly basis to review our peer review efforts across the practice. They also see the outliers (who are made anonymous), and they do some specific case review of studies.
We also measure customer service in all our areas of practice. Many of our hospitals use referring-physician survey tools to measure the satisfaction levels of our referring physicians. In a recent study at Riverside Methodist Hospital, we scored 99% satisfaction on turnaround time and 99% satisfaction on radiology professional service delivery. These high-level scores are a testament to our physicians’ focus on customer service, and to the outstanding performance of each physician in our practice.
ImagingBiz: What are the tools (software and hardware) that you are using to measure practice performance?
Flaherty: We integrate and report data from numerous sources through tools we have developed in-house, as well as existing software. Turnaround times and other operational metrics are assessed using a variety of software, such as Microsoft SQL, Crystal Reports, and other tools. We use FUJIFILM’s Synapse as our PACS and have developed a number of solutions to integrate reports and images across the system, including some custom dashboards designed to support radiologist efficiency. We have developed interfaces for utilizing CommonView to pull up patient reports and images from throughout our universe of patients. Billing performance and analytics are based on our vendor’s system, along with customized internal tools.
ImagingBiz: What role does IT play in this process? Who else is involved in measuring and assessing practice performance? Are you using national benchmarks or measuring against past performance?
Flaherty: Our IT is the backbone of our practice. We have several engineers who develop custom solutions for operational efficiency, monitoring, and analysis, and we provide 24/7 operational support. Through the monitoring processes that our IT staff has developed, we are able to analyze real-time and historical information to allow our managers and key decision makers to have a better understanding of our business. These tools allow us to quantify and track our progress.
We measure against both national benchmarks and past performance. There are a number of benchmarks for practice performance from the standpoint of billing operations, so we look at that. Most of our hospitals complete referring-physician satisfaction studies, and we look at how we compare nationally on these studies. Any time you can compare yourself to similar practices, it’s important, but we also set goals around our benchmarks for where we want to be each year.
Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.