Unmet needs birth a new breed of radiology partner: The story behind Collaborative Imaging
This is the story of how Texas Radiology Associates’ Managing Partner Ted Wen, MD, along with his board devised a plan to utilize expensive, top-tier technologies without having to turn to private equity. In the process, they started Collaborative Imaging—an industry-revolutionizing disruptor that’s helping rad practices across the U.S. to boost efficiency and economics.
In 2018, Texas Radiology Associates (TRA) in Plano, Texas, was doing everything right. It was serving seven hospital systems and was growing; its Press Ganey patient satisfaction scores were consistently in the top 2% to 3% in the country; and the practice consisted of excellent radiologists performing quality work with short turnaround times. Yet as Wen realized, such success simply wasn’t enough to produce the value TRA needed to be competitive in a world increasingly dominated by private equity.
To stay both competitive and independent, Wen and the board knew TRA needed to accomplish two things. First, it needed to utilize technology in ways that could create greater efficiencies while advancing patient care. Second, it needed to optimize its revenue cycle management to fight the increasingly frustrating, industry-wide phenomenon of high denial rates from payors.
TRA was at a crossroads, needing either to solve these problems, or capitulate and turn to private equity to access advanced technology. For sure that would be the easiest route—but it would come at the high cost of losing some TRA radiologists and TRA’s independence. The group’s senior radiologists decided to put the decision to a vote, letting mid-tenure and incoming partners have the final say. Their decision? Independence reigned supreme. There would be no private equity deal for TRA. They set their sights on creating innovative ways to solve problems.
That was the beginning of a new chapter for their practice, and a new solution provider for radiology practices across the country. Wen approached Dhruv Chopra, an old friend with an MBA, strong business acumen, and vast experience in revenue cycle management. Both lamented the pervasive struggles of private practices.
After lengthy consideration and very frank discussions, the two agreed it was time to create a much-needed new option for radiology practices. Thus, in 2018 Chopra and Wen cofounded Collaborative Imaging (Ci), with Chopra serving as its chief executive officer and Wen serving as Ci’s chief medical officer. The premise for this innovative new venture was their shared belief that they could offer a solution to the technology and management struggles of private practices, but that collaboration would be the key. Four years later, Ci’s customers’ successes have proffered demonstrable evidence showing that Chopra and Wen were absolutely correct in their discernment of the private practice status quo and in devising a collaborative solution.
Here, Wen and John Kim, MD, also a TRA radiologist and Ci board member, discuss how Ci is using the most advanced technology-based solutions and expert revenue cycle management to free private practices across the country from administrative and fiscal dilemmas. Concomitantly, collaboration between Ci and private practices helps physicians in private practices concentrate on the practice of medicine and reach their full potential—without sacrificing their independence.
Collaborating on leveraging top-tier technology to amplify efficiency and patient outcomes
Ci’s goal was to create a path forward to nurture and maintain independent practices—including TRA—by identifying and optimizing the use of the very latest in technology to advance patient care. Perhaps equally important, they wanted to do it in a way that wouldn’t cost-prohibitive for a private practice. The foregoing are key components of the “collaborative” part of Ci.
“…so our thought was, Wouldn’t it be wonderful to create an alliance of physician groups that are independent-minded? Then, we could develop these technologies together, for all of us. You need tools to compete—and that was the biggest driving force behind Ci.”
- Collaborative Imaging Chief Medical Officer Ted Wen, MD
The very notion of collaboration presupposes knowledge of the other parties’ goals and active support of said goals. So it is with Ci, and its relationships with radiology practices. The needs and goals of private practices may and do vary; accordingly, Ci offers practices an array of options. Private practices can either join Ci as full equity members, or pay a licensing fee to use Ci’s technology. Irrespective of the selected paradigm, the collective nature of Ci means that each individual practice can spend less, yet reap the rewards of a common vision and increased budget for and access to industry-leading technology.
“Yes, TRA could probably invest an exorbitant sum of money ourselves to do it—but that's a lot of money to ask any physician practice to spend,” Wen explains. “And so our thought was, Wouldn’t it be wonderful to create an alliance of physician groups that are independent-minded? Then, we could develop these technologies together, for all of us. You need tools to compete—and that was the biggest driving force behind Ci.”
Now in his role as Ci’s chief medical officer, Wen uses his extensive industry knowledge and background as a biomedical engineer to work directly with 30 in-house programmers, advising them on the solutions that would render the most positive impact on patient care and related processes.
"We tell the developers what we need, and in a week or two, there it is,” he says. “It's incredible. The previous software companies we've worked with, it would be six months for regular turnaround. With Ci, we get to work on the alpha/beta versions and improve them to meet our exact needs, providing feedback along the way.”
Physicians still may need to exhibit patience as developers perfect early versions of different technology-based products. Simultaneously, however, the aforementioned methodology means that physicians can request ongoing changes as necessary and have much more say in what those technological advancements ultimately look like.
“The beauty is, there's no ‘finished product’—we are constantly building and improving,” Wen says. “And to me, that is an incredible benefit."
Among Ci’s most impactful tech solutions to date are: CIVR, a standalone or add-on product that integrates AI into speech-to-text solutions; CIVIE, a cloud-based patient portal to simplify scheduling; and Radflow, a modular, end-to-end workflow solution to remove inefficiencies and cut down on administrative tasks.
Collaborating to improve patient care outcomes
In the quest to build sophisticated tools, Ci and its partners never lose sight of the ultimate goal: enhancing patient care. Thus, the first major initiative that Ci undertook was building an AI-enabled product that minimizes the risk of incidental findings remaining undetected or unaddressed. Wen and Kim have both seen incidents of this nature transpire. Radiologists, primary care physicians and ER doctors alike battle constant interruptions and distractions. Not dissimilarly, busy patients postpone very important follow-up visits.
“We see 20 to 30 incidental findings a day, so not only does it take a lot of time to call doctors, but it's a lot of time interrupting doctors,” Kim says. “So, we wanted technology that could help us do this more easily, more reliably, and thus provide value to patients.”
Ci technology helps highlight incidental findings in two ways: First, Ci’s proprietary technology uses natural language processing to ensure all incidental findings are included in the report. This allows radiologists to know they’re completing the most important work at hand: The accurate identification of all problematic findings. Then, Ci’s system automatically and securely notifies the appropriate radiologists or referring physicians. These professionals, in turn, can consider ordering follow-up imaging before the patient even leaves the hospital.
"Our technology will ping the primary care and the ER doctor and say, 'Hey, Miss Smith does not have a pulmonary embolism,” Kim illustrates. “But there is a breast mass, so can you send us an order to work her up? And we can do it immediately, even before she leaves. It’s an incredible way to manage care.”
Collaborating on revenue cycle management to improve collections
Billing and collections can be one of the most challenging aspects of maintaining a private radiology practice. While many practices outsource these tasks to billing companies, the costs can be significant—and in today’s difficult collections environment, with an average denial rate of around 20% to 25%, according to Kim, the results often do not match expectations.
"Our AI tracks the entire [billing and claims] process. What code do we use here? What modifier do we use here? When do we file? Was it before or after the patient met their deductibles? We track the whole thing. And then if it's denied, we go back and figure out exactly what pattern are [the health insurance companies] using to deny? And the next time we get the same type of study, we don't repeat the process the same way.”
- Collaborative Imaging Radiologist and Board Member, John Kim, MD
“Billing is so challenging,” he says. “It's a little bit of an exaggeration, but I liken what’s going on with insurance companies to an arms race. We physicians just want to be paid for what we do, what work we generate, and the care we provide. But sometimes it feels like insurance companies just want to put up hurdles. They want to deny things, and once they deny, it’s so much more work to refile.”
Traditional billing companies, Kim says, often simply send over one of 10 or so standard responses to denials. While that rudimentary methodology used to work, insurance companies adapted and now have many different versions of reasons for denials. Therefore, a few standard responses simply aren’t enough as bills will get denied repeatedly. Hence, the arms race.
Ci wanted to help its partners escape the seemingly endless cycle of denying and refiling bills. Any prospectively successful solution would need a fresh approach that employs a combination of smart people and smart tools. So, Ci created a complete revenue cycle management system that incorporates AI modules. These modules intelligently generate responses to health insurance companies’ denials, then memorialize the ensuing steps to gather information about what works and what doesn’t. AI and machine learning then utilize that knowledge gained to achieve success in future similar bill submissions. This sophisticated design and approach ensures for Ci’s partners that future billing procedures are done in ways that will be more likely to avoid denials prophylactically by avoiding prior patterns of rejections.
"Our AI tracks the entire process,” Kim says. “What code do we use here? What modifier do we use here? When do we file? Was it before or after the patient met their deductibles? We track the whole thing. And then if it's denied, we go back and figure out exactly what pattern are [the health insurance companies] using to deny? And the next time we get the same type of study, we don't repeat the process the same way.”
Catering to an audience of independent practices, Ci’s use of AI and technology reduces revenue cycle management costs. The result: Ci can offer billing services for approximately one-third the price of what most billing companies charge, according to Kim. Moreover, Ci’s data analytics tools allow clients to follow along and track their financial progress and successes.
Next Steps: Continuing the Fight Against Consolidation
Four years on from its founding, Ci is going strong, with five practices that are equity owners and representing 500 radiologists who collectively read more than 20 million exams per year. Furthermore, many more practices license Ci’s proprietary software and benefit from its hard-won business expertise. Ci’s deep knowledge of advanced processes within the technology space permits Ci to act as a de facto IT consultant for its clients. Ci provides invaluable guidance on systems and services, even interfacing with vendors, to the tremendous benefit of Ci’s grateful physician practice clients.
In some cases, practices may simply elect to use one of among an entire array of Ci’s numerous technologies. In other cases, they may opt for a more comprehensive suite of services. Irrespective of the many options practices may choose, each of Ci’s clients maintains full autonomy over its operations. Moreover, the practices share a sense of camaraderie in battling the headwinds of consolidation in pursuit of the collective goal of maintaining effective and profitable independent practices. Ci has shaken up the radiology scene, offering a wide range of the most innovative technology options previously unavailable to practices.
“At Ci, we don’t want to force a culture change on anyone,” says Wen. “If a group wants to just align with our vision, working together to build smart products and provide better patient care, that’s an admirable enough goal in its own right.”
As for TRA? It is experiencing robust growth and success as it celebrates its 50th year in business in 2022. Today, the practice is home to 145 radiologists—not coincidentally, a 50% increase since the creation of Ci. TRA has been able to onboard new clients in weeks instead of months. Plus billing efficiency has surged and costs have plunged as the practice has reduced billing denials to about 5% and significantly drove down operating costs. The future gets brighter and brighter.