Incentives Matter: Maximizing Radiology Productivity
Hospitals across the country have employed a variety of relatively simple, yet enormously effective, productivity-enhancing measures that also improve patient care, ease administrative budget pain and provide increased professional satisfaction. Consider:
- A $2,500 semiannual per physician incentive spurred radiologists at Massachusetts General Hospital (MGH) in Boston to slash report turnaround from 43 hours to six hours;
- Managed care organizations have increased funding for enterprise quality initiatives at Advocate Physician Partners in Oak Brook, Ill., from $6 million to $40 million since the program started; and
- Mayo Clinic in Scottsdale, Ariz., sustained an 11 percent increase in technologist productivity, saving the radiology department $174,000 annually.
Measuring upHalf of radiology departments or practices either don’t measure radiologists’ productivity or report doing nothing with the information, according to Richard Duszak Jr., MD, of Mid-South Imaging and Therapeutics in Memphis, Tenn., and Lawrence R. Muroff, MD, CEO of Imaging Consultants in Tampa, Fla. (J Am Coll Radiol 2010;7: 482-289).
Baseline measurements are an essential springboard to achieving genuine productivity increases. Without them improving productivity amounts to a guessing game. Measuring productivity—and involving staff members in the process—can inspire thinking about efficiency. Michelle Wilt, RT, and colleagues at Mayo Clinic discovered this: within six months of measuring productivity, radiographers in the department of radiology voluntary increased productivity by 11 percent, saving the department an estimated $174,000 per year.
Along with adaptability, almost every administrator and study stresses transparency and a bottom-up approach. Sites that have instituted effective productivity programs often share productivity procedures and results with staff (sometimes anonymously, sometimes not).
Measuring work habits and sharing the data can help quell disputes. In many cases productivity varies between individuals substantially less than staff members contend. “People realize it’s not really true that I’m working so much harder than everybody else. Having numbers available gets rid of a lot of bickering because people realize they’ve taken a small difference and blown it into something big,” explains Richard Woodcock, MD, medical director for MRI at St. Joseph’s Hospital in Atlanta.
Pay for performanceMany efforts to improve productivity have focused on pay-for-performance. MGH recently implemented a hospital-wide, department specific pay-for-performance program, in which each department was tasked with choosing and implementing its own objective. The department of radiology selected report turn-around time. By the end of the program, the department cut average report turn-around time—from examination to final signature by 37 percent—from 43 to six hours, shares Giles Boland, MD, chairman of MGH’s department of radiology.
The department incentivized quicker turn-around time by providing radiologists who met requirements semiannual $2,500 bonuses. “For a relatively small amount of money, we had a major effect on patient care. Ninety-eight percent of our radiologists conform and provide good service,” Boland affirms. As Woodcock opines, “Incentivization is the key to getting extra productivity out of any employee.”
In another program involving 3,500 physicians at 10 hospitals across northern Illinois, Advocate Physician Partners saw diagnostic mammography report turnaround plummet from an average of 49 hours to eight hours in three years. The program targets performance in 41 separate clinical initiatives with financial incentives.
“This program is funded by managed care organizations. The successes that have been achieved have not only resulted in continued funding, but the organizations have increased the funds dramatically, from about $6 million five or six years ago when we started the program, to now about $40 million,” explains Pankaj Patel, MD, medical director for quality improvement. “The payors are voting with their feet by saying, ‘OK, this really does make a difference, we’re willing to fund this.”
Pay for productivityWoodcock is part of an effort to create a practice-wide traffic management system with Atlanta Radiology Consultants. Using an add-on PACS program, the practice tracks the quantity, modality and other characteristics of studies that each radiologist reads throughout the day. A trained administrator monitors the number of studies read within the 14-member group, and at noon, remaining studies are doled out based on individual workloads and specialties.
Early in the process, Woodcock says, “Having a traffic manager select out studies that are specific to different specialties and fit particular skillsets is good for patient care and good customer service because it ensures that more studies can be read by subspecialists.”
As the process evolves, radiologists may receive monthly bonuses for reading a specified caseload. “From an efficiency standpoint,” Woodcock continues, “the total workflow management process takes about 30 minutes or less. To do this manually, it’s less efficient, less equitable and more costly.”
Incentivization can be applied on multiple levels. Even executives are not immune to the lure of cash. Duszak and Muroff emphasize: Pay your presidents! They cite surveys from the 2008 and 2009 Economics of Diagnostic Imaging National Symposia in which more than half of the 350 radiology physicians and administrators responded that their departments allotted administrative heads no additional time or compensation for the roles.
If time and resources are not allocated, administrative positions are likely to be diminished and so should salaries. But Duszak and Muroff highlight the productive functions radiology administrators can play if given license by representing the department in hospital or community committees, establishing relationships with referring physicians and building alliances with other hospitals or academic programs. These functions can have valuable effects on recruitment, retention, patient care and funding.
Flexibility and feedbackMany successful facilities reward individual radiologists and the group for improved productivity, which facilitates a group-mentality and peer motivation and reinforces studies showing that radiologists who feel invested in their practice, whether through time practicing, collective mentality or as shareholders, work harder (J Am Coll Radiol 2010;3: 108-114).
Experts agree on the value of group feedback. “Ultimately, the grassroots, the workers themselves, are where improvements are going to come, not from the leaders and supervisors. These guys know where the problems are. They know best how to solve them,” concluded Johnson. However, no metric or initiative is fixed, and all are liable to fail if they are not flexed and adjusted to the radiologists and the objectives that drive each department.
The common denominators? Aside from first measuring productivity—adaptability, transparency and feedback from the bottom up are crucial to any productivity initiative. Finally: Incentives matter.