Pushing Productivity: How Imaging is Building Efficiency & Cutting Costs

The Deficit Reduction Act (DRA), competition and continuing focus on high quality patient care are all driving imaging departments and facilities to focus on pushing their productivity. From radiologists, technologists and other staff to equipment and scheduling, facilities are finding the best ways to get the most out of their valuable resources.

The Deficit Reduction Act has taken its toll and “we have reasons to believe that there will be further cuts,” says Kirk Lawson, administrator of the New York University radiology department. “Radiology is going to remain a potential target down the road in the next few years for further cuts.” As a large enterprise, NYU is surviving in spite of cuts. Also, as an independent, private center, “our volume, size and ability to be flexible lets us respond more easily.”

Nationally, hospitals are challenged to do more with less, he says. “I know that if I want additional staff, I have to know that I’m being highly productive and can justify new staff.”

Complicated workflow

NYU’s radiology department provides services for three hospitals in eight locations, and performs just over 300,000 studies a year. “As we get larger and have more locations, workflow gets more complicated.” The team offers the full gamut of interventional and diagnostic imaging studies and is highly subspecialized in MR, CT, cardiac CT, nuclear medicine and ultrasound.

The facility switched to the Workflow RIS from Siemens Medical Solutions last fall. After using their previous RIS for 11 years, the facility underwent a massive conversion, says Lawson, migrating forward 3.5 million studies. “We decided to convert data rather than start with a clean slate. That made the project more challenging.”

NYU also has a home-grown, internal department software called RadClinInfo—a web-based site begun in early 2000 that hosts a “cavalcade of important data for performance measurement,” Lawson says. Within the facility’s financial department is decision-support services that has its own staff. The group helps the institution look at both staff and supply productivity, Lawson says. “It’s an extremely important tool because it allows us to, by payroll, have graphic presentation of how staffing looks compared to volume.” Based on the payroll schedule, it’s updated every two weeks.

Getting granular

“We can get very granular in detail. If we don’t appear particularly productive in a payroll period, we can see what’s going on, such as whether it’s due to holidays or people covering overtime.” The same applies to procedure volumes—if they’ve dropped, Lawson can see if it correlates to a drop in hospital census. Administrators can respond on a continuous basis.

All of these tools play to the administration’s focus on “transforming us into a world-class care institution,” he says. “Embedded in that is productivity.” Hospital administration expects department leaders to utilize productivity tools and respond. Since expensive equipment is involved in radiology, any savings and making the maximum use of resources, including space, staff and equipment, are important.

Another vital element of productivity is phone reporting capabilities. NYU has a scheduling department within radiology that uses software to track the average abandoned call rate. “If it’s taking five minutes to get through scheduling, we’ll have a higher abandoned call rate,” Lawson says. The RIS conversion forced the facility to look at all processes to customize the system. That can cause setbacks in high transaction areas like scheduling. “We consistently have a high volume of encounters. Adding 30 seconds to each call has an immediate impact.”

The calls impact how effectively the scanner is utilized. Although there isn’t much empty scanner time, Lawson says the team recently whittled a five-day backlog down to four days. That reduction favorably impacts referring physician satisfaction, patient satisfaction and profitability.

On the hospital side, NYU works with the facility HIS and CPOE system. “We work with escort and expedite orders as efficiently as possible.” Escort services uses tracking software to triage and parse out the workflow, which serves as another metric. “For inpatients, productivity hinges on collaboration with escort. Discrepancies can result in empty scanner time.”

Staff and equipment metrics

Integration between the RIS and imaging systems also helps track productivity. “Information from the scanner populates our RIS,” says Lawson. The data include when a procedure began and ended, when the patient left the department, time stamp when a physician orders an x-ray on an ED patient and more. That also interfaces with the facility’s dictation system, which sends information on when radiologists finish preliminary and final reports.

“It’s very precise and very powerful,” he says. Reducing ED turn-around time and length of stay are department goals, as is setting up same-day service for MRI, and Lawson expects these reports to help reach those achievements. Plus, “The Joint Commission is very keen on understanding that we’re always working to improve turn-around times.”

Another way facilities can maintain or improve productivity is by more evenly distributing the workload among staff and locations. Medical Center Hospital in Odessa, Texas, has been using Enterprise Medical Image Management from ScImage since last fall to distribute cardiology and radiology images. “Our goal was web distribution and having one spot that the radiologist or cardiologist could go to to view images,” says Medical Imaging Manager Brad Shook. The system queries and pulls images from the existing PACS and cardiology system to display images for doctors. “We’re able to continue using our current infrastructure and put this product on top to get images out to the web.”

As a rural facility, Medical Center Hospital has a cardiologist in a remote town who reads pediatric echocardiograms. “We had never been able to get a solution that worked, other than mailing a videotape.” Eventually, Shook learned about the ScImage offering. “It worked so well for the cardiologists that we saw the potential for it working for all images, not just one discipline.”

Aside from web distribution, the facility recently replaced its PACS, RIS and voice recognition from three different vendors with a single-vendor solution from DR Systems. Shook anticipates a 20 percent increase in radiologist productivity as a result of the switch. The doctors have been using voice recognition for five years already so he doesn’t expect a big learning curve. “That being said, we’re still expecting to increase productivity because it is one vendor. We don’t have integrations between different vendors.”

Pinpointing productivity

Alegent Health, a health system based in Omaha, Neb., with five metropolitan hospitals and two rural hospitals, implemented Workflow RIS, Sienet Magic, syngo Dynmics, Soarian Clinical Access from Siemens Medical Solutions specifically to maintain its high level of productivity. The software replaced a manual system that was “cumbersome and time-consuming,” says RIS Administrator Craig Luedtke.

The software’s RIS application lets Luedtke tie relative value units (RVUs), as designated by the American College of Radiology, to specific procedures for a breakdown by department. Users can manipulate the various fields to produce detailed charts on any metric.

The ability to track equipment has most benefited CT and MR, says Luedtke. “Their schedules are so tightly packed that tracking allows them to move staff around to better handle workloads.” Plus, it allows for justification for new equipment if the time comes. “If RVUs are going through the roof, we know to add equipment and/or staff.” If one location is low on staff for the procedures scheduled, they can share staff members with another location, ensuring better utilization of staff.

Right now, the organization has one main radiology group which services five hospitals. The group rotates and uses worklists set up within the RIS to divvy up the workload. That, Luedtke says, “lets us get very good utilization out of them.”

Distributing duties

Metro Imaging, a five-location radiology practice in St. Louis, has been a Merge RIS customer since 2003. In 2005, the practice added Merge PACS and in 2006, its mammography viewing software. Rather than tightening its belt, the practice implemented digital mammography when the DRA went into effect, says Christine Keefe, CFO. “With the cuts, everybody worried about buying new equipment, but it turned out to be a real benefit because it increased our volume and our reimbursement.”

The practice also uses productivity measures to improve its service and work distribution.

“We have transcriptionists in each location with their own dedicated dictation system,” says Keefe. By implementing Merge’s dictation system, the transcriptionists can share the workload. “It has really improved our efficiency.”

The practice implemented a new service last June—an onsite results program that lets patients receive results before they leave the office. “Patients love that,” says Keefe. “It’s been a huge program for us that no one else is doing.” PACS has given the practice the efficiency to offer the service, but there have been challenges. Technologists have to spend more time with patients, explaining their results. The radiologists also now have more interaction with patients. By monitoring productivity, Keefe says they can convert exams to exam hours and see how many hours the staff works per day or month or year. “That lets us fine-tune our staffing.” Plus, if there are any complaints over being overworked, “a look at the numbers lets us know if they truly are.”

Metro’s volume has grown by 4 percent since beginning the program, but it hasn’t had to hire any additional FTEs—radiologists or technologists. PACS also lets the practice see when some sites are busier than others and even out the workflow between the radiologists.

Monitoring is huge, says Keefe. “We’ve done more monitoring of staff productivity than we ever have, from each individual transcriptionist to how many patients each person has scheduled and checked in. We know when to add staff and move people around. I think it is a worthwhile effort.”

The last word

“To address market demands, especially the impacts of DRA, we must increase our volume or reduce expenses,” says Keefe. “Our biggest expenses are equipment cost and staffing. We won’t reduce staffing, because that could impact patient care. It is difficult to reduce equipment cost, because we have to continue to upgrade equipment to stay competitive and insurance plans are now ‘grading’ us on quality care based on our equipment. So, we must increase volume in a highly competitive market. Because we have a strong PACS, we can increase our throughput without increasing our costs.”

Working to increase productivity makes it “easy to forget we’re talking about saving patients’ lives and providing high-quality care,” says Lawson. “As we focus on efficiency, we’re not for a moment letting go of the patient in front of us.” 


Tips and Tricks from the Field
Using information systems and the reports and tracking metrics they make available, facilities are targeting specific areas in which they can improve productivity.

If you’re not focusing on productivity, “then you really don’t focus on the areas that can be improved upon,” says Craig Luedtke, RIS administrator for Alegent Health in Omaha, Neb. “If your numbers are down, you’re going to end up with people sitting around.” Flexible scheduling lets Luedtke extensively utilize the staff. “They are secure in knowing that they will be utilized elsewhere no matter what.”

Healthcare facilities have no choice but to look at productivity, says Kirk Lawson, radiology department administrator for New York University. Some of the reasons to be thinking about this are referring physician satisfaction, patient satisfaction and justification for getting more resources.

“When done the right way, you’re really working with your department,” he says. “You’re helping them understand the value to the institution of being efficient. When they understand how it really helps their company succeed and thrive, you end up with increased employee satisfaction.” Engaging employees involves them in the problem-solving process. A goal of increasing MRI volume by 5 percent, for example, can only be accomplished, he says, if it’s a mission for the entire team.

At Metro Imaging in St. Louis, the staff schedules mammography patients for their next exam when they come in for their annual screening. As of late February, the practice already had 750 exams scheduled for 2009, says Christine Keefe, CFO. Metro Imaging is in the process of implementing online mammography scheduling. That will reduce calls. “Anything you can do to reduce phone calls and manage workflow helps,” she says.

Another step Metro is taking to improve its service is providing patients with estimates of their out-of-pocket expenses before they come in. “Many don’t understand how deductibles work so they get their MRI bill and they’re shocked,” Keefe says. “We check on their deductible and coinsurance and they’re very appreciative. In the long run, hopefully that will improve our collections. An informed patient is better than someone who is surprised and gets angry.”

Another convenience for Metro’s patients is being more clear about exam preparation, such as that required for abdomen CTs, for example. Patients need to come in an hour before the exam actually starts to drink the contrast. Metro reconfirms with patients and lets them know the time required so that they’re not upset when they arrive. Keefe says a practice analysis program offered by Merge lets her pull up wait times immediately and ensure that patients have little reason for complaints.