RBMA Spring Summit Roundtable: Imaging and the IHN

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On May 22, “Imaging and Accountability: Imaging’s Role in the Integrated Health Network” was presented at the RBMA 2012 Radiology Summit in Orlando, Florida. This discussion has been excerpted from the statements of that panel, which was composed of a practice-president radiologist, a hospital president, an imaging-chain executive, and an industry analyst.

Chad Calendine, MD, a diagnostic radiologist, is president of Advanced Diagnostic Imaging, LLC (Goodletsville, Tennessee).

Josh Gray is managing director of the Financial Leadership Council of The Advisory Board Co, specializing in strategic finance, performance improvement, and imaging-performance partnerships.

Curtis Kauffman-Pickelle (facilitator) is publisher of Radiology Business Journal.

Robert LaDouceur is vice president of operations in business development for CDI, one of the oldest and largest chains of freestanding imaging centers. He is responsible for sales, operations, profit, and new-center development in Missouri, Kansas, and Florida.

Marion McGowan, RN, is president of Lancaster General Hospital in Pennsylvania (a 525-bed regional and referral hospital); president of Women & Babies Hospital, Lancaster (a 98-bed specialty hospital); and vice president of Lancaster General Health, a regional not-for-profit health system.

Cheryl Proval (moderator) is editor of Radiology Business Journal.

Kauffman-Pickelle: In 2011, we assembled the CEOs of five radiology benefit management companies and had a spirited discussion to kick off this series. It was followed, later that year, by the assembly of the executives and an architect of decision-support systems to talk about utilization management. Now, for our third RBMA panel, we have a radiologist representing a new practice, an analyst, an operations person who is running imaging centers, and the president of a hospital. Together, they will give us a very interesting and diverse perspective on the issues affecting radiology’s future in the integrated health network (IHN).

Proval: Many people in health care agree that coordination of care is a necessary step in achieving the triple aim of reducing cost, improving quality, and widening access. In your market, what kinds of conversations are you having about alignment with health-care systems, payors, and physician practices?

McGowan: Generally, we’re trying to understand what the heck’s going to happen. There’s a question about how we might be able to work together to be as successful as we’ve been in the past—specifically, how we move from a production orientation to that of better alignment to help us reduce fragmentation, improve coordination, and succeed economically.

We’re talking about how we change the model to support population health and value-based purchasing. How do we change the incentives? How do we change the team roles and systems of support?

For the independent physicians, there’s a deeper and more challenging discussion. How do we handle clinical arrangements so that they can stay independent as long as they like, yet find a way to work together so that we can be more successful?

We have a strategy based on priorities and on coordinating care in a way we haven’t been able to do in the past. One powerful strategy involves incentive pay associated with outcomes; other arrangements in certain specialty areas include bundled payment.

Calendine: We are a 30-person private radiology group for a number of reasons—one being to remain relatively independent—but I understand the need for alignment. Several years ago, we started looking for an opportunity to align. We had built and grown three imaging centers in Nashville, Tennessee.

We subsequently acquired four additional imaging centers. We had significant market share in outpatient imaging and were competing with some of the hospitals, and we realized that would not be a long-term solution for us.

We were approached by the health system with the largest market share in our area. It wanted to enter into a joint venture with our existing centers; it contributed two centers, one in the suburbs and one in Nashville.

It also contributed its outpatient volume and the name of its Nashville hospital. After two years of discussion (and large legal fees), we put together a joint venture for our outpatient imaging and all of its outpatient imaging. It has been in place for a year.

I think the health system took a great and bold step, moving its outpatient imaging from a higher-cost, less-efficient,