Right now, just about anyone with a large enough line of credit can purchase a new, state-of-the-art MR or CT scanner. Going forward, what will separate the highly successful radiology practices from those muddling through—or hanging on for dear life—is not impressive equipment.

The fact is, over the next three to five years, the decisive differentiator on this playing field will be the ability to sustain strong referrer relationships—stable partnerships built on trust and cemented by smart IT investments that allow radiology groups to not just understand their referrers’ challenges, but actually “get in there” and help solve them.

So says 30-year healthcare veteran Douglas Gibson. For the last three and a half years, he’s served as CEO of 21-radiologist Colorado Springs Radiologists/PENRAD Imaging, leading soup-to-nuts business operations for a four-site joint venture with Centura Health.

The practice also provides professional reads for two Centura hospitals, 364-bed Penrose Hospital and 158-bed St. Francis Medical Center, both in Colorado Springs. Through the joint venture, the partners will open a new outpatient-imaging center by the end of this year.

“The main thing we’re working on with our referrers right now is their EMR integration,” says Gibson, offering an example of hands-on collaboration. “When I look at what they’re involved with, and how we work with them in a large way, primarily it’s around their being able to attest for Meaningful Use incentive payments. This is a major focus for clinics in our area.”

Perpetual listening tour

It’s big, but it’s not the only item on the to-do list, Gibson adds. Referring physicians regularly need answers to questions they have regarding which studies to order, for instance, as well as guidance on intricate business issues they run into.

Indeed, in a healthcare economy marked by falling reimbursement and rising complexity, an open line of communications is essential, so a PENRAD provider-relations representative makes the rounds to referring docs every day. Gibson himself sits in on many of these sessions, plus he regularly meets with hospital C-suite leadership.

“There are inpatient insights that the hospital brings to us that we may not see on the outpatient side right away,” Gibson explains, “so we’re working together with them on a variety of programs at any one time.”

Currently in the works is a joint effort to install a physician assistant position to help with the hospital’s growing biopsy business. Up to now, duties in that service line have been taking away reading time from the radiologists. The commitment has proven time-intensive and low-reimbursement, Gibson says. But it’s also critical to the relationship.

“With our referring physicians as well as our hospital partners,” says Gibson, “everything comes down to trust and relationships.” Neither of these can be forged, built and reinforced by one-to-one meetings alone. Today’s referring physicians need more than strategic alliances: They need technology-enabled capabilities.

A flick of the RIS

Recently Colorado Springs Radiologists/PENRAD Imaging updated its RIS, and the improvements included beefing up its billing functionality and deepening the system’s integration with the group’s PACS—all with an eye on helping referring docs prepare for their near- and long-term future.

The group has been using FUJIFILM’s Synapse PACS/RIS, which incorporates Technology Partners’ IMAGINEradiology billing component, for several years. Gibson says he has found the combination elegantly simple and immediately advantageous to all parties. 

“When the patient comes to us for imaging, our technologist takes down the illness history and enters it into the RIS, which drops it directly into the template for the radiologist to see as he’s creating his report,” he explains. Just like that, “efficiency is greatly increased. The information gets sent directly over to our financials, and the report goes out electronically to the referring doctor’s EMR.”

Gibson itemizes several other features and capabilities the RIS upgrade has brought:

• the capacity to automatically send patients appointment-scheduling messages, and follow up with appointment reminders, via text messages;
• a mobile app, FUJIFILM’s zero-footprint Synapse Mobility, that allows referring offices to view images and reports wherever and whenever they like; and
• the capability to have referring offices order exams electronically, directly out of their EMR. 

“The order comes to us electronically and we schedule off that,” Gibson says of the last item. “We already have this in place with a large, multidisciplinary group here in town. It seems to be working well for both parties.”

Efficiency maven

Gibson says Colorado Springs Radiologists/PENRAD Imaging is always looking for ways to introduce efficiencies into both its organizational processes and its technology systems.

“The upgraded RIS has helped us streamline our workflow processes to be able to orient our [staffing] toward growth or sometimes reductions,” he says. “Every practice has to continually look at ways to reduce the costs of production as reimbursements continue to decline. At some point, you just can’t tolerate declining reimbursements without commensurate decline in expenses.”

When difficult decisions are on the table, Gibson appreciates having a vendor partner whose business acumen is as reliable as its high-tech products.

“One thing you don’t want to spend time doing in this day and age is refereeing fights between vendors,” he says, noting that FUJIFILM works closely with various third-party vendors to provide Gibson’s group with seamless, subspecialized technology services.

All of Centura is on FUJIFILM PACS, he points out, and having all images from both inpatient and outpatient settings available through the Synapse Common View makes it easy for radiologists to review them regardless of where they, the radiologists, happen to be.

“That’s a huge win for us,” Gibson says. “And it’s a huge win for patients, because oftentimes not having outpatient images available results in having the same test repeated unnecessarily when the patient is hospitalized. Having all those things linked electronically is good for patients, for referring doctors and for our radiologists.”

Impactful investment

Looking ahead, Gibson is excited to be working toward adjusting PENRAD’s outpatient business to accommodate the growth of high-deductible health-savings accounts, a development spurred in Colorado (and other states with their own exchanges) by Obamacare. These plans force patients to take a much greater role in directing their own care, including making payment decisions, to which many patients are not accustomed. 

Accordingly, PENRAD is implementing eligibility software, which automatically checks for any dams in the patient-payer-provider stream, later this year. Payment-estimation software that will facilitate payment collections at time of service also will be implemented this year.

The group’s RIS will be “the backbone of our being able to do all that,” says Gibson. “It holds the data about which patients we anticipate coming in, what care they received while they were here—all the pieces we need” to optimize cash flow. 

“Some time ago, large national labs figured out how to get orders and send results back electronically,” Gibson reflects. “Frankly, we in radiology are just now catching up. I think those practices that make the investment in IT infrastructure to be able to do all of the things we’ve just talked about are only going to benefit from their foresight.”