Data Mining: Imaging Executives Crunch the Numbers

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RIS data, keyed to billing, can be analyzed to improve competitive capability and pare inefficiency to the nub

Physicians and executives are similar to scientists; they like data to assist them in making decisions,” Rob Cercek says. Cercek, vice president of ambulatory services at Rochester General Hospital (RGH), Rochester, NY, adds, “If you can put credible data in front of people, discussions between hospitals and physicians become more meaningful.” He is talking about arming his department representatives with data when they go out to solicit radiology business from referring physicians, but he could just as easily be describing radiologists themselves. Like physicians in any practice, radiologists are indebted to numbers for answers to their operational questions: Are practice RVUs stacking up in a positive way? Are imaging rooms and equipment being used maximally? Are there too many (or too few) technologists on staff?

Radiology managers and executives like Cercek are working diligently to create useful reports to guide themselves—and their practices’ physicians—as they make many types of decisions. Should a new clinic be opened? Should certain procedures be marketed, or should they be quietly left to decline? Should productivity be demanded, or will quality suffer if too much pressure is brought to bear?

Cercek says that some of the most helpful reports have been those showing patterns in physician referrals to the radiology department at RGH. By comparing referrals from doctors on the hospital staff with those from referrers outside the hospital, Cercek says that he can gauge when a referring physician is falling short of sending the number of cases that might be expected. The department representatives can then be deployed to seek, politely, that missing business. Cercek says, “The people who use these reports feel they are invaluable,” especially for making it possible “to walk into the physician’s office knowing the pattern—knowing what the referral rate should be—and getting them to turn in your direction.”

At RGH, which is licensed for 585 beds and conducts about 175,000 radiology exams per year, the RIS is at the heart of the data-gathering effort. The RIS, from the same vendor as the hospital’s PACS, collects patients’ demographic data from the hospital information system (HIS) and correlates them with radiology data from the PACS, such as exam types, exam times, and modalities used. When a radiology report is signed, the RIS also triggers the billing cycle. All these data—exams, referring doctors, technologist times, patient demographics, billing codes, and much more—can be mined from the RIS in the form of either preprogrammed reports or, more pointedly, as customized reports prepared by the RGH staff.

Reports like those being done at RGH can be used to shape (or reshape) a radiology practice. Moreover, the cost of the software needed to issue reports is modest, by hospital standards. The return on investment for data-analysis software is so rapid (a matter of months) that many don’t bother to track it. At RGH, the work of turning out most reports falls to Pam Moseley, radiology informatics director.

A Data Gold Mine

When RGH installed its RIS, Moseley says, the radiology department took over its own billing because the RIS could drive that process. Now, when an exam is completed, the patient data and radiology data, including CPT® code and pricing, are automatically entered into the billing system via RIS. Billers in radiology make sure that all the data match, then send the bill to the hospital’s master billing system for the technical component and to the physician’s billing system for the professional component, Moseley says.

“Prior to this, everything was on paper and medical records was billing,” she adds. “They’re not familiar with radiology exams and functions; thus, there were a lot of charges that weren’t being billed.” Since initiating semiautomated RIS-driven billing, Moseley says, the radiology department’s receivables have shown a 30% to 40% improvement. This has added up to hundreds of thousands of dollars in recovered income. Moreover, billing time has dropped from more than two days to a day or less, she adds.

Moseley says that the RIS software turns out a number of automated reports, including patterns for the hospital’s top 20 referrers, although this particular task required special programming by the RIS manufacturer. Most of the reports that Moseley submits to Cercek