UnityPoint Health, formerly Iowa Healthcare, a multi-city integrated delivery system based in Des Moines, recently underwent a transformation aimed at empowering primary care physicians to take the lead in care coordination for patients.

Even in the wake of health care reform, radiology practices continue to struggle with managing payment from uninsured patients. The problem plagues hospital-based groups, in particular, according to Krista Pelensky, director of operations with Zotec-MMP. “Many hospital-based groups have seen an uptick in uninsured business and an increase in emergency-department services,” she says.

Few business processes for radiology practices are as fraught as negotiating managed-care contracts. Their duration and durability put a significant level of both current and future income on the line, but small and medium-sized practices, in particular, might feel that they have little leverage in the negotiating process. The keys to gaining the

Imaging Healthcare Specialists (“IHS”), a 30-radiologist practice based in San Diego, California, has a simple ethos driving its business decisions. “We view ourselves, first and foremost, as a medical practice,” Thomas Cleary, president and COO of Imaging Healthcare Specialists, explains. “Every day, every employee who works for us—from the person who schedules the patient, to the technologist who provides the exam, and from the radiologist delivering the report to the IT person—is making an impact on patients’ lives.”

The most common misconception regarding medical-practice reimbursement is that it’s about nothing more than money. In fact, reimbursement is about much more than the dollar numbers associated with CPT® codes in payors’ various fee schedules, and any discussion of it that doesn’t also touch on process, strategy, and service is incomplete.

Today’s radiology dashboards let you know how your department or practice is running. They chart patient flow; report-turnaround times; critical-results reporting; and dozens of other data points that reflect cost, efficiency, productivity, and (sometimes) effectiveness. One of the primary goals of these dashboards is to support quality improvement, as CMS and other payors begin to link payment to performance—and to define performance using quality measurements.

Eisenhower Radiology Medical Group (ERMG) has accomplished what many would consider impossible: rapid, recent expansion during a recession, with a patient base composed primarily of Medicare beneficiaries. The 17-radiologist group, located in Rancho Mirage, California, has added three imaging centers to its roster in as many years, according to Blair Dick, business administrator for the practice. “One of the biggest challenges we’ve faced was expanding from one facility to four in this economic environment, which is one of the worst we’ve ever faced,” Dick says. “We did it because we wanted to position ourselves to accommodate the increased demand for imaging services that will result from health-care reform.”

The proposed 2014 Medicare Physician Fee Schedule1 (MPFS) and Hospital Outpatient Prospective Payment System2 (HOPPS) rules have both been released, and the outlook for radiology is dim, according to Cynthia Moran, assistant executive director for government relations and economics at the ACR®. “The only good news—if you can call it that—is that CMS no longer appears to be targeting only radiology,” Moran says. “It used to be that it was seeking to take from the specialties and give back to primary care, but now, it’s not even doing that. It’s just lowering how much money is spent as much as it can.”