Dollars & Sense: Keeping Your Practice Financially Viable

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In today’s climate of diminishing reimbursement and the continuous battle to hold onto referrals and contracts, radiology practices are focused on providing superior radiology services and being fiscally fit. While there are many reasons why a radiology practice—especially those offering outpatient imaging services—can falter, practices that are thriving are carefully blending a combination of politics, patient research and preparation for the long-haul.

The politics of radiology

Service issues, including responsiveness to referring physicians and radiology practices not aligning themselves with the goals of the hospital, as well as competition with other radiology groups can be to blame for why radiologists may lose their contracts with hospitals, says Lawrence R. Muroff, MD, FACR, CEO and president of Imaging Consultants in Tampa, Fla.

In addition, diminishing reimbursement is impacting outpatient radiology even harder, he says. “If the radiologists have an office, they are more apt to be impacted and will be impacted to a greater extent.” By situating themselves into the medical, social and political fabric of the hospital and community, radiology practices can work to overcome these obstacles, as well as maintain fiscal viability, Muroff opines. Developing relationships with key referring physicians, serving on hospital boards and running for medical staff office are ways in which radiologists can preserve their contracts, as well as prevent “turf erosion.”

Muroff explains that by becoming an integral part of the hospital, radiologists will become “far more resistant to being replaced. I personally have never heard of a radiology practice losing its contract if a member of the practice was serving on the board of a hospital,” he says. “It’s very difficult for a hospital administrator to fire a board member.”

In addition to networking, radiologists must keep in mind that they are a part of a service specialty, and providing high-quality service to their patients and referrers must remain the top priority, says Muroff. 

To help radiologists forge better alliances with hospitals, the American College of Radiology established the Task Force on Relationships Between Radiology Groups and Hospitals and Other Healthcare Organizations. In a report released by the task force in June, it recommended, “Radiologists must rededicate themselves to the concept of service. Radiologists must be more visible to patients, referring physicians and the hospital administration… This can entail expanded hours of onsite coverage, a greater number of available radiologists, more subspecialization, and greater opportunities for consultations with referring physicians and their patients.”

Patients & payors

Geoffrey G. Smith, MD, president of Casper Medical Imaging Radiology Group in Casper, Wyo., believes that patient mix and payor types have much to do with diminishing reimbursement, noting that Medicare’s current reimbursement reform is focusing on outpatient settings. 

“If the radiology practice or outpatient imaging center is in an area with a high number of indigent patients and these patients are serviced as outpatients, then groups might actually see improved reimbursement due to coverage of previously uninsured patients,” says Smith. “But a lot of that has yet to be seen,” regarding the current healthcare reform in the U.S. 

For radiology practices that maintain separate outpatient facilities, relationships established within the local marketplace, including referring physicians remain crucial, explains Smith. And as for hospital contracts, differences of opinion in how patients should be served can play a large role in the disbanding of a contractual agreement between the radiology group and the hospital. 

To avoid these pitfalls, get involved in the governance of a hospital organization or allowing a hospital administrator to become “part and parcel within the imaging center,” says Smith. While networking may not be the complete solution to navigating away from these hazards, it can help, he advises. 

In addition to networking, three main principles reign supreme for radiologists to preserve the integrity of their practices. “Be available, be affable and be able, in that order,” advises Smith, drawing from advice a consultant gave him while he was a resident, which he says has been reinforced by his own experience.

Perhaps most importantly, “radiologists should know in a general sense where their patient volumes are