Radiology at large has long survived the unkind combination of swelling workloads and shrinking paychecks. The good news is that it’s still possible for radiology practices and departments to thrive in the face of the twin headwinds.
Researchers from six leading medical schools have laid out two sets of straightforward strategies—one financial, the other operational—to help with the cause at hand.
Although their focus is on academic radiology, some of their principles apply to other practice settings as well. Current Problems in Diagnostic Radiology published the paper online July 21 [1].
En route to summarizing their suggested steps toward prosperity, corresponding author Prabhakar Rajiah, MBBS, MD, of Mayo Clinic and colleagues give a brief history tracing radiology’s fiscal journey from where it was to where it finds itself today.
Some key milestones in their chronological recap:
- 1997: The HOPPS (Hospital Outpatient Prospective Payment System) legislation moves outpatient services from a cost-based reimbursement model to a prospective payment model.
- 2005: The Deficit Reduction Act of 2005 requires CMS to pay the lower of the OPPS or Physician Fee Schedule (PFS) rate for the technical component of in-office imaging procedures.
- 2006: CMS reduces the technical fee by 25% for CT, MRI and ultrasounds performed on contiguous body parts under certain billing codes
- 2011: CMS reduces the technical fee by 50% and professional fee 25% for all billing codes.
- 2015: Overall radiologist payments drop almost 20% over a nine-year lookback, from $5.3 billion in 2006 to $4.3 billion in 2015.
That’s just a few—and the writing of the present paper preceded CMS’s release of its dreaded MPFS for 2023.
Strategies for Financial Thriving That Apply Across Practice Settings
1. Optimize payments. Payers have been denying claims at an accelerating pace over the past several years, and the pattern only gained momentum during the COVID-19 pandemic, Rajiah and co-authors note. Their tactical recommendations:
Systems should be placed to optimize billing and minimize denials. Billing should be accurate to get reimbursed for the services rendered. Appropriate CPT code and modifiers should be used, with corresponding verbiage included in the radiology reports. … A revenue cycle manager can evaluate the causes of denials, which should be appropriately followed up and managed.”
2. Consolidate practices. Merged, joint-ventured or otherwise partnered practices can widen catchment areas, diversify service sites and build capacity for staffing shortfalls, Rajiah and colleagues point out. In addition:
[N]on-financial non-measurable advantages include social integration, mentorship, improved branding and research [or other extra-clinical] collaboration. … Aside from the practical implementation challenges, this model could potentially optimize healthcare resource allocation and increase radiologist productivity. [One caution:] Differences in culture and career goals between the practices could be challenging.”
3. Demonstrate your value. Emphasizing that value-based reimbursement rewards practices that improve patient outcomes while reducing care costs, the authors remind that imaging can contribute to these aims by consistently supplying early and accurate diagnoses.
Improved outcomes can be demonstrated by decrease in mortality following the use of screening programs such as those for breast and lung cancers. Imaging can also shorten an episode of care by providing early diagnosis and treatment and assessing short term response to therapy to allow adjustment of therapy.”
4. Employ and appropriately deploy ancillary staff. By performing repetitive tasks with lower complexity and educational yield at competitive costs, nonphysician providers (NPPs) such as radiologist assistants can help reduce radiologists’ workloads while increasing their productivity.
Utilization of NPPs in diagnostic interpretation is increasing, accounting for 0.01 % of all U.S. imaging services in 1994 and 1.27 % in 2015. Although one study showed that the number of studies interpreted by trainees increased with the use of NPPs for repetitive tasks, the potential adverse impact on future radiology training due to expansion of scope of practice of NPPs should be carefully considered and addressed.”
5. Help individual radiologists formulate sound financial strategies of their own. Steadily falling reimbursements may force some practices to cut radiologist compensation, Rajiah and colleagues acknowledge. However, they add, a fair compensation scheme is essential to attract and retain talented radiologists. Toward that end, department or practice leadership can help radiologists optimize their financial resources and benefits.
Training and support for retirement savings and investments should be offered. Guidance can also be provided to decrease existing financial debts. For example, the public service loan forgiveness program modified in 2007 allows physicians working for government or nonprofit organizations to have their federal debt forgiven after 120 monthly payments. Up to 62 % of medical students pursued this loan forgiveness program in 2014.”
Money Still Matters, But Nonmonetary Extras Can Compensate When It’s Tight
Breaking out dedicated thriving strategies to achieve professional and academic aims, Rajiah and team encourage supplying radiologists with tech-based productivity tools, integrating AI with clinical workflows, supporting and rewarding innovative efforts, developing and mentoring individuals and fostering multidisciplinary collaboration.
The authors also take up managing burnout and promoting wellness.
Commenting on the latter, they remark that building and sustaining a radiology culture that rewards efforts in the delivery of excellent care rather than productivity “may counteract the synergistic effects of fiscal concern upon burnout risk factors.”
More:
Radiology leadership should acknowledge quality work and accomplishments of radiologists on a regular and timely basis. This practice can lead to sustained motivation for one's job even when the reward is no longer tendered. The rewards do not have to be monetary or tangible [and might include] providing constructive feedback, promoting an inclusive work culture … [and] endorsing opportunities for shared decision making.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.