DRA Survival Strategy: Volume vs Quality and Utilization Management

I recently attended an outpatient imaging center conference where, not surprisingly, surviving the DRA, dominated the discussion. It also was no surprise that increasing volume was the prevailing recommendation for solving the issue. Economically, it makes sense. When the price goes down, a company must attract more customers and serve them more efficiently. What was a surprise, however, was how little quality of care and utilization management factored into the discussions. While aggressive marketing, increasing referral bases, and subsequently increasing volume are no doubt survival strategies, they will not in themselves, position imaging centers for long-term survival. In my opinion, the successful imaging centers will be those that can demonstrate both quality and mechanisms for managing utilization. If imaging centers focus solely on volume alone to drive survival, they will be shortsighted. While imaging centers may indeed bolster their bottom lines with volume increases, the unintended consequences will be more unwanted scrutiny on our industry. Accusations abound regarding over-utilization of imaging. Any strategies to increase volume that are not accompanied by equal efforts to ensure appropriateness will only intensify and quite possibly justify the accusations of over-utilization. Furthermore, it is just a matter of time until payors steer contracts and/or provide more favorable contractual terms to imaging centers that can demonstrate quality and a solid process for ensuring appropriateness in the delivery of radiology procedures. Imaging center operators must be proactive. It is far better to police ourselves than to be policed by others. Quality and utilization management must be as high on the priority list as increasing volume. Imaging centers should ensure that they have a comprehensive quality assurance program in place that includes, for example, regular peer review, optimization of protocols to reduce radiation dose, and allocation of resources for ongoing patient safety training initiatives. They should also work diligently to educate referring physicians on appropriate ordering practices, approach referring physicians when an ordered exam is not warranted or not the appropriate exam for the indications, and track and document ordering patterns to understand trends. It is the imaging centers that embrace these practices that will be best positioned for long-term viability.