Holland: Where does radiology fall
within the C-suite priorities today?
Terry Lynn Bucknall, CRA: I think it’s
way up there at our facility. We just redid
our whole imaging department and
added a cardiac cath lab and cardiology
services. The C-suite has hired a senior
director to oversee all cardiology, ultrasound, and diagnostic imaging. They’re
really promoting our department around
Syliva Lesic, CRA: I think they’re looking for a return on investment more now
than ever. As things get ratcheted down,
they’re trying to get every dime they can
out of any investment they put forth.
We’re getting a lot of attention because
we’re capital intensive, we’re supply
intensive, and we have a lot of people
come through. The other part is that as
more and more people are paying toward
their imaging services, they’re expecting
a higher level of customer service than
we’ve ever seen.
Steffen: I am seeing imaging take a back
seat to other services lines—cardiology,
oncology, creation of institutes—and
sometimes we have to fight to be at the
table just to say, “If you’re going to design
a neurology program, why aren’t the
radiologists and the director involved?”
Olivi: I feel very much the same. It’s
about what return you have. You don’t
get a lot of comments that “You’re doing
great with all these patients.” It’s all about
utilization. It’s how you’re embedded in
all the other services and how you make
them more efficient. It’s a very different mindset from years ago when you
just imaged more patients, made more
money, and dollars fell from the sky for
Lynne Roy: Imaging is getting a lot of
attention because we are cost-intensive,
and we have to be able to deliver what
we deliver at a much lower cost. I think
imaging is viable. Our product is infor-
mation, and that information needs to
be provided to the right patient, at the
right time, in the right delivery model. I
think where imaging and radiology are
going to change the most is in how imag-
ing is delivered to the general population.
It will be delivered very differently. Aca-
demic hospitals provide a valuable por-
tion of imaging care, but they’re going to
have to redesign themselves the most.
Palmucci: I think in my facility there is
a lack of recognition toward radiology.
There is a significant amount toward
cardiology and some of the other “
olo-gies” because they’re bringing patients in,
and there are patient stays and surgeries,
which certainly helps with inpatient revenue. Whereas, there is an infusion of
capital into those areas, radiology tends
to get a bit of a short shrift in the capital
budget, at least in the last couple of years.
Holland: What are your thoughts on
how to move radiology from a defensive
posture to a more offensive posture?
Rhynus: Maybe we need to come up with
a strategy and talk about, “Because we
did these exams, we didn’t have to open
that patient up, and that saved money in
the long run.” I think that’s a really good
position. If we focus on the advantages
we consistently bring that nobody thinks
about any more, that could be a good
thing for us.
Reilly: I think a key thing that needs to
be framed is the word “value.” We talk
about cost, we talk about efficiency, but
I think this whole equation needs to
be built more on a value story. Sure we
need to be more efficient, but we need
to think about the value that radiology
brings to the entire disease state, department, ology, you name it, and it’s got to
be horizontal. Right now it’s a scan and a
payment, but how does imaging impact
oncology and other specialties?
Lesic: One thing we’ve found is we
don’t promote subspecialty interpretation, which is what really drives quality,
especially for the academic institutions.
We’ve found that the more our subspecialist radiologists are out there talking to
the orthopedic practices, neurosurgeons,
and oncologists, the more often we’re
invited to the table in their decision making. So a lot has to do with the physician
leadership in your department—getting
radiologists to play more the role of the
consultant; getting them out of their
caves and away from their monitors and
out there walking around.
Roy: The reading room doesn‘t have to
be in the reading room. It can be in the
ortho institute or the pediatric institute
or wherever. The radiologists have to
leave the department. They can still do
what they do, providing information, but
they can do it in a visible way, so that they
become invaluable in the care process.
Bedel: For the academic hospitals I work
with today in the outpatient environment, they’re all great radiologists, but
few of them are practice builders. Few
of them will cultivate relationships with
referrers. Few of them are comfortable
going to a luncheon or selling the value-add that imaging provides.
Palmucci: I struggle with the cannibalization of imaging that goes on
throughout an organization. Watching
neurology, urology, GI, and neurosurgery perform exams in their offices that
they interpret—that’s a struggle. I have
this discussion with my chairman all the
time, the importance of radiologists and
how we can’t allow these things to occur.
Rhynus: When neuro, GI, vascular and
all those people are doing cases—for
what reason? Is it for the patient’s benefit
or for profitability? When profitability
changes in the future, will they still want
to do that? Maybe then central radiology
will again be the most cost-effective way
to do that.
Olivi: I talk all the time with C-suite
people, and I say central radiology is
cost-effective. When you parse out MRs
and CTs and they sit there in individual