The Current State of Radiology Administration

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Penny Olivi, MBA, CRA, FAHRA, RT, has more than one finger on the pulse of radiology administration in this economic downturn. In addition to serving as president of the AHRA—The Association of Medical Imaging Management, she manages both the radiology department at the University of Maryland Medical Center, Baltimore, and the department’s physician practice at the University of Maryland School of Medicine; together, these generate more than 600,000 imaging procedures per year.

imagePenny Olivi, MBA, CRA, FAHRA, RT

A former radiologic technologist who went on to acquire a master’s degree in business administration, Olivi likes to say that she graduated from x-ray school before the CT scanner was invented. She manages approximately 250 hospital employees and handles the needs of 50 radiologists, 20 fellows, and 36 residents. At the hospital, initiatives of which she is proud include the installation of PET/CT and 3T MRI, along with a current project to upgrade all six interventional rooms to flat-panel technology. On the physician-practice side, she has assisted in successfully extending subspecialty coverage to remote hospital sites.

Olivi brings 12 years of experience in community-hospital radiology leadership to the University of Maryland, where she has presided for seven years. “I come from a radiology background and a community-hospital background, so I very much care about hospital operations,” she explains. “There are people who come from the business side who may care more about the radiology-practice side. For me, this job is the perfect alignment of all the misaligned incentives. In the end, what I care about is the radiology patient, and however I come at it, through the hospital or the practice, it makes sense to me.”

RBJ: What is the requisite skill set for someone doing your job, and how has that changed in recent years?

Olivi: My generation of administrators came up through a clinical background. We demonstrated proficiency there, and we went on to get advanced degrees. While that model might still exist in the future, I believe that radiology leaders can be successful with strong business skills, if they take the time to understand the clinical environment.

I want to prove my competence with both my experience and my education, so I always will state publicly that a clinical background coupled with a business background is the right mix. What I am observing, though, is that there are people who are more skilled in the science of management, and actually having the specific billing/coding expertise or specific clinical expertise may be less important to them. Finding the right people with those skills will become most important.

I just hired an associate administrator on the practice side, and she has master’s degrees in nursing and business administration. She comes from a diverse nursing background, with some procedural-based experience through the catheterization laboratory and some research experience, and she has hit the ground running, from a clinical perspective. Now, I am starting to wonder whether it needs to be a radiology clinical perspective. Could it be any clinical perspective? I think we are going to see some significant changes in the backgrounds of our emerging leaders.

RBJ: How has the economic downturn affected your inpatient and outpatient radiology services? Have you seen a decline in admissions and elective procedures? Have you experienced pressure to cut costs or delay purchases? What impact has this had on long-term strategy?

Olivi: We have seen declines of that kind, and have experienced financial pressures. Here’s an interesting thing we are seeing at our medical center: There seems to be no rhyme or reason as to when we are busy or not busy. There is no trend. We have a month where we are very busy, and then we have a month when we are not. Historically, October is one of our busiest months, but last October was one of our worst. March has always been a huge month for us; it was not, but April was huge.

We are still experiencing tremendous stress on our emergency department. We believe that there are people who truly may be using the emergency department rather than their primary care physicians, but we don’t have a lot of evidence of that. It’s just conjecture. The other thing I am hearing a lot about is that people are delaying their elective procedures, mostly because if they have a job and insurance, they are worried about being away from work. We are hearing