Building an Efficient, Effective Women’s Imaging Service

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Ask providers of women’s imaging services why they stick with the niche, in spite of declining reimbursement and the risk of malpractice suits, and the answer you’ll get is a simple one: patient interaction. It’s the ability to work directly with patients in potentially life-changing ways that continues to attract talented radiologists to the subspecialty, and that’s also the factor that makes mammography the unseen backbone of an imaging practice. Women have a unique opportunity to get to know their radiologists, and women are more likely to return to those radiologists for their other imaging needs.

Kerry Chandler, MD, director of the breast-imaging section at Wake Radiology, Raleigh, North Carolina, says, “There’s a lot of satisfaction in it. You have a lot of interaction with patients, more so than in other subspecialty areas, and you can do something where you’re making a definite difference. You can see it and know about it. It’s not the most well-reimbursed imaging modality in radiology, and the malpractice issue has been a problem, but all in all, the positives outweigh the negatives.”

Tina Hodge, RT(R), manager of breast imaging at the Montgomery Breast Center in Alabama, describes the business of providing women’s imaging as “investing in their influence.” She says, “We know that we can offer good services to women, who will, we hope, direct their families’ care back to the center.”

That notion is seconded by Stephen Feig, MD, director of breast imaging at the UC Irvine Breast Health Center (UCIBHC) in California, who adds that women who receive their breast imaging in a hospital setting are more likely to return there for any further treatment that might be needed. “Breast imaging is good public relations,” he says. “It draws patients to the medical center. Although we may lose money on it, the hospital will gain downstream revenues from patients who are there for breast surgery, breast radiation therapy, oncology, and even pathology, because we’re there.”

Throughput Counts

Clearly, there are strong business reasons for both hospitals and OICs to invest in building high-quality women’s imaging services. To keep the doors open despite low reimbursement, there also is a compelling need to construct an efficient patient flow.
The process begins with scheduling; Montgomery Breast Center’s patients are sent reminder letters two months in advance, and if they haven’t scheduled exams by a month after they were due for mammograms, another reminder is sent. UCIBHC sends reminder cards, while Wake Radiology sends yearly reminder letters and allows patients to request appointment times through its Web site. “Mammography is one of the few areas where we can let the patient initiate the scheduling,” Chandler explains.

At UCIBHC, 15 to 20 minutes are allotted for a screening exam, while diagnostic time slots run up to 45 minutes; at Wake Radiology, screening patients are assigned five-minute slots, while 20 to 30 minutes are allotted for a diagnostic exam. Feig explains that because UCIBHC still uses analog mammography at one of its three sites, patient throughput can take slightly longer there. “We try to take as much of the preregistration and demographic information as we can when the patients call to schedule, so when they get here, we can avoid backups at the front desk,” he notes.

Wake Radiology uses what Chandler calls a subwaiting area as an intermediate space between the front waiting room and the mammography suite; patients who have already changed into their gowns wait in the second room until it’s time for their exams. “We got them robes that aren’t skimpy so that they wouldn’t feel uncomfortable waiting in them,” Chandler says. “They could wear them to the mall. Now, the technologists aren’t always tied up helping patients undress and dealing with clerical issues.” Freeing the technologists to focus on the exams themselves has enabled the center to reduce total patient time for screening mammography to an average of 13 minutes.

“We always talk to the patients who come back personally, unless we call the physician and that person specifically wants to talk to the patient. We think you need face-to-face communication. It’s time consuming, but it really is worth it. The patients never forget it.”

—Kerry Chandler, MD, director, breast imaging section,
Wake Radiology, Raleigh, NC

Similarly, UCIBHC’s center has been designed for optimal flow for both patients and technologists. “When you design a center,