Shared Management: A Manifestation of Imaging 3.0

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 - Syed Zaidi, MD
Syed Zaidi, MD

Imaging 3.0 is the ACR’s manifesto for moving radiologists from volume-based to value-based care; transactional to consultative medicine; radiologist-centered to patient-centered care; and finally, after years of discussion, from invisible to visible, or at least more accountable, explains Syed Zaidi, MD, president, Radiology Associates of Canton, Ohio. Zaidi delivered a talk entitled  “Imaging 3.0: Better Together,” with practice CEO John Vizzuso on October 21, 2014, at the Fall meeting of the Radiology Business Management Association in Seattle.

The Imaging 3.0 blueprint, introduced at the ACR annual meeting in 2013, specifies activities and services that a state-of-the-art radiology practice must provide, including imaging appropriateness, documenting safety, providing more actionable reports with patient follow-up, collaborating with other physicians to improve care and empowering patients.

Clearly, the mandate is to provide more not less service, both before the interpretation (in making sure the study done is appropriate and performed with the correct protocol) and after the interpretation (by following up on patients). “Part of this,” says Zaidi, “is [figuring out] how to get paid for all of this.”

For those practices considering making the concept of Imaging 3.0 concrete in their settings, the path of the 24-partner Radiology Associates of Canton (RAC) may be enlightening. In 2010 when Zaidi was elected president of RAC, the practice was successful, had three stable hospital contracts, had never outsourced its nighthawk service and had earned an excellent reputation with clinicians.

It was, however, confronted with the same pressures others in the specialty were facing: reimbursement cuts, a lack of service engagement from all partners, productivity gaps, mediocre relationships with hospital administration, a stagnant local economy and national competition from teleradiology companies (four of which were located and actively seeking contracts in Northeast Ohio). Like other democratically run private practices, it struggled with effecting change. “One partner could veto something,” he relates. “People had their pet peeves, and they would turn into big issues.”

Driving change

The first step in driving change was swapping its governance model for a more central model, electing a five-member board with strong decision-making authority. “The only items that go to the partners are when a new contract is being considered or if we are potentially leaving a hospital contract,” he says.

The group initiated regular strategic planning retreats in the fall of 2010, adopted a service and ownership mentality, made a strategic plan to partner with its hospitals and planned to invest in information technology (IT) to deal with the operational issue of routing work to radiologists so that they could be more productive.

Zaidi also began to attend leadership conferences, beginning with the ACR’s three-day annual leadership conference, a low-cost option. “If you want to drive change, send your radiologists to leadership conferences,” Zaidi says. “If you are a 10- to 20-radiologist group, you can drive change very quickly rather than the 70-person or academic group, where you have to go through layers of hierarchy. The key is leadership.” RAC now sends two radiologists a year to the ACR’s annual Radiology Leadership Conference, an investment in time and tuition that the practice agrees to supports.

RAC came together around the following mission: excellent and appropriate patient care is the best business model. It adopted a service commitment to clinicians and patients and required partners to take ownership. “If something isn’t working, fix it, take an active role in making sure things get done,” Zaidi says.

A pivotal concept that RAC gleaned from conference attendance was the definition of value. While some define value as quality over cost, Zaidi believes the equation must be outcomes over cost.

“I think you need to better define quality and that is outcomes, actual clinical outcomes,” he says. “We talk about the value of hospital-based radiologists, and there is a key role there for us because we are in the trenches where we can coordinate admissions and help decrease the length of stay. There’s a particular role for interventional radiology (IR) in providing high-value care, because any procedure done in the IR suite is an automatic savings compared to the OR, and we need to make that pitch to the hospital management.”