8 key considerations when weighing whether to expand a radiology department
Radiologists are offering eight key considerations when weighing whether to expand an academic radiology department’s footprint.
Jeffrey W. Dunkle, MD, and colleagues at Indiana University contend it’s crucial radiology residents and fellows understand the nuances of partnerships, in addition to the clinical side of the specialty. They offered an overview of the most important factors in partnership conversations in a perspective piece published Tuesday by Academic Radiology.
“Success in such efforts requires more than clinical capability—it also demands cultural alignment, strategic leadership and well-structured contracting,” Dunkle, vice chair of finance and strategy for IU’s Department of Radiology, and co-authors wrote Sept. 2. “This article does not attempt to cover every detail, but it offers a focused overview of some of the most important cultural and contractual considerations departments should weigh when exploring new partnerships.”
Here is a brief rundown of Dunkle and co-authors’ advice:
1. Expansion motivations: IU experts believe it’s important to understand the motivations behind expansion at the outset. “Ambiguity about goals can unravel partnerships,” they note, emphasizing the need for both sides to state what they want and be “willing to walk away if those goals diverge.”
2. Cultural compatibility: While motivations provide direction, Dunkle and colleagues contend cultural alignment is the most critical factor in these conversations and will determine if the effort succeeds. Leaders must determine whether the cultures of the department and new facility are aligned, divergent or at odds with one another.
3. Leadership approach: Those involved also must understand how each organization approaches leadership and develops rapport because “trust and collaboration are not optional but foundational.” They highlighted the importance of establishing “clear local leadership,” often in the form of a medical director with well-defined duties. This individual will serve as the academic practice’s on-site liaison at the new location and a consistent contact point for facility leadership.
4. Logistical considerations: Many logistical considerations need to be ironed out when responding to a request for proposals or negotiating a contract. This includes clearly defined service boundaries—particularly when other specialties are involved—along with an agreed-upon start date for assuming radiology services. Hours of operation, mix of inpatient and outpatient studies, modality volumes, and on-site considerations must be discussed. IU experts also underlined the importance of hiring lawyers to draw up and modify contracts.
5. Information technology: Practices must investigate the various matters related to IT. These include whether the new site requires its own picture archiving and communication system, along with how remote rads will access images and other electronic health records.
“From the academic department’s point of view, it may be unwise to take on new relationships if they involve a substantial increase in workflow complexity, as this can create considerable burdens for radiologists who need to stay focused and efficient when providing clinical service,” the authors noted.
6. Financial issues: Radiology departments also must ensure the new venture is financially sustainable and potentially profitable. Those involved need to understand aspects such as the new site’s payer mix, who handles billing, and appropriate targets for net revenue per RVU. All these factors should align with the rationale for the partnership and cultures of the two organizations, “because if they are not, such issues may prove intractable.”
7. Care quality: Along with revenue expectations, Dunkle and co-authors believe radiology department leaders should not compromise around care quality in these conversations. If the new facility operates with lower standards, this may take a “real toll on academic radiologists, who may become discouraged by needing to sign off on work that they feel uneasy about or even ashamed of.”
8. Staff buy-in: Even the best-planned initiatives are likely to struggle without earning the necessary faculty and staff buy-in, the authors wrote. “Morale is not an afterthought,” they believe, it is an “indicator of success.”
“Few busy radiologists are excited about taking on additional clinical volume, but by ensuring that they hear from patients and staff who benefit from the transition, they too can experience enhanced professional fulfillment,” the authors noted.
“Expansion done well is more than a business transaction—it is a reaffirmation of an academic department’s mission to lead, to teach and to care,” they added later. “The right partnerships can bring that mission to life in new places, with lasting impact on patients and physicians alike.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.