Q&A: Why does radiology need to be taking risks now?

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 - doctor tightrope decision

The radiology practice or department hoping to hide from the market and regulatory forces currently reshaping all of U.S. healthcare is in a bad place: Lacking a strategy for survival will soon mean having slim chances for success.

Attendees of AHRA’s spring conference in Chicago on March 15-17 are sure to hear as much everywhere they turn. Those who’d like a crash course on the particulars would do well to attend the Thursday talk titled “Imaging Transformation.”

The session’s two presenters—Jason Theadore, MHA, vice president of ambulatory services and business development at Mercy Health in Toledo, and Christopher Masone, senior manager, healthcare, in the Hudson, Ohio, office of the accounting and consulting firm Dixon Hughes Goodman—gave Health Imaging a taste of pointers to come in a phone interview. Here are excerpts.

HealthImaging: You two have spoken about being “risk-capable” and about the value of taking risks. In the context of providing healthcare, including imaging services, that R-word can sound pretty scary. What do you mean by it?

Masone: We’re referring to the new payment models that Medicare and, by extension, healthcare as a whole are moving into. For provider organizations, there are really three sides to this. There is the revenue transformation side, where you have to be able to manage value-based contracts. You have to understand how to collect and bill and do all the things that affect the revenue side of risk-based contracting.

The second part is, provider organizations have to be clinically aligned with their physicians. As risk-based contracts come, and as the shift comes from volume-based to value-based and then back to volume, the physicians have to be involved in care coordination that cuts across the continuum of care. Within the world of bundled payments, the physician has to be concerned about post-acute service—about everything that happens after that patient leaves the physician’s office.

And then the third component of risk capability, from our perspective, is really enterprise intelligence. That’s the data side. Organizations are going to have to become risk-capable when it comes to the data intelligence that they have within their organization. They have to be able to measure and monitor and predict the care that patients are going to receive, such that they can use data to drive decision-making.

Moving from volume-based to value-based and back to volume? Please clarify.  

Theadore: Over the last 10 years, we in healthcare have talked about transitioning from volume to value. And while that is critically important, whether it is the customer’s perception of value or the physician’s perception or the payer’s perception, ultimately, we all still need volume. Like any business, we have to stay focused on understanding how we are going to continue to grow. So it’s really not transitioning from volume to value. It’s transitioning from fee-based to value-based and then going out to get more volume, to grow your market share.

What new opportunities do you see opening up to grow market share?

Theadore: The way things are structured today across the country does not support a culture of innovation. Because we are in a fee-for-service structure and tied to the insurance carriers, the way we can grow our business is limited. There are things like telemedicine, which people have been talking about for a long time. Some folks have it figured out. But we struggle to really put those innovative approaches into place.

A good leader who knows how to get things done by working through the large systems, the large vendors and the large partners—that leader will find success in today’s environment like nobody else has been able to find success in the past.

In this environment, I think opportunity and challenge are one and the same. People have to be innovative. And then people have to be willing to take the risks to drive what’s best not just for short-term gain but for the long term picture of where healthcare is going.

In your recent AHRA Link article, you talk about having so much data that it paralyzes decision-makers. Can you describe a real-world example you’ve observed?

Masone: A real-world example would be, if a health system providing comprehensive-care joint replacement within the world of bundled payments sees that they are a high cost provider, how do they drill down far enough to understand where those high cost patients are really coming from? That’s a challenge, because what you’ll oftentimes find is that it might be one or two outliers, where you can look and see that a lot of that cost is actually coming on the post-acute side.

The patients who are discharged to home care versus to a skilled nursing facility may have a different overall cost of care. Or you might look and realize that the same skilled nursing facility to which these patients are getting discharged keeps having them readmitted with infections.

Who knows what’s really driving your cost up? Understanding your data well enough to know what to look for in light of what your goal is—making sure you are looking at the data that is most important and then drilling down into it for what you really need to know—that’s key.

Lately there’s more talk than ever about the need to build relationships. Is anything changing there, in terms of the people or organizations you need to build relationships with, or in terms of how the relationships need to be oriented?

Theadore: There’s just going to be a greater need than ever before for relationship building. For people working in health systems, there are a lot of predictions that health systems will become larger. If you are struggling with building relationships today, it will only become more complex in the future.

And for the folks in the room who are imaging experts: You touch everything in the hospital. So you have to be really good at it now to make sure you are going to be good at it in the future.