A veteran of the peer-review wars shares a novel approach to instituting a successful program

Incidental findings are a growing problem, amid wide variation in follow-up recommendations

If someone asked you to define quality in radiology, what would you say? The precise definition of quality is certainly nebulous, but it has never mattered too much—until now.

What policymakers and payors want from radiology departments is not volume, but value. If radiologists can help hospitals contain costs, improve quality, and increase market share, then these radiology providers will be well positioned to carry their hospitals—and themselves—into the era of quality- and performance-based pay.

As consolidation in the hospital market continues apace—driven by the increasing prevalence of integrated delivery networks (IDNs), accountable-care organizations, and other new payment/delivery models—many radiology groups find themselves at a crossroads. How can they gain the scale necessary to meet the mounting demands of today’s care continuum, given the continued downward pressure on reimbursement? RadAnalytics spoke with Bill Pickart, CEO of Integrated Medical Partners, about an emerging option that strikes a compromise between independence and scale, enabling groups to take a proactive approach to meeting hospitals’ evolving quality and service directives and needs.

A. Mark Fendrick, MD, is a self-described generalist. His research (as a professor of internal medicine and director of the University of Michigan’s Center for Value-based Insurance Design) has probed the cost of the common cold, explored the value of new imaging techniques, and quantified the value of Katie Couric’s colonoscopy in preventing colon cancer in the United States as worth more than $1 billion in National Institutes of Health funding.

Radiology groups’ conversations with their hospital partners are undergoing an evolution, in the experience of Edward Rittweger, MD, president of Navesink Radiology (Red Bank, New Jersey). “In the past, most of the hospital discussions involving imaging have been about decreasing turnaround times and increasing efficiency in response to decreased reimbursements,” he says. “As we move forward, however, it will be more important for the radiology group to assist the hospital in developing metrics to evaluate how imaging adheres to decision-support mechanisms and evidence-based care protocols.”

All over the country, radiology practices are merging, consolidating, and forming networks in order to grow in size and, in theory, negotiate from a more powerful position while making the most of economies of scale. Tom Vaughan, MD, president of Kent Diagnostic Radiology Associates (Dover, Delaware), points out that the emphasis on growth raises some challenging questions, from a practice-management perspective. He says, “As you grow from being a small practice to being a large one, management becomes much more challenging. In some ways, it can be a luxury to be small.”