Assimilating a general radiology practice into a highly specialized academic imaging department

Amid increasing demand for hyper-specialized imaging services, one East Coast provider recently decided to assimilate its community-based general radiology practice into the larger enterprise and is seeing rousing early results.

Brigham and Women’s Hospital previously operated the division to help cover care at outpatient facilities and offer services to imaging centers that weren’t part of the academic health system. But in 2018, the Harvard-affiliated provider cut ties with most of these outside sites, leaving its handful of general radiologists in the lurch, according to a piece published Wednesday.

The Boston-based institution opted to assimilate the 10 general radiologists into its subspecialty-focused imaging department, using change-management methodologies to execute the switchover, those involved noted. It appears to be paying off, with nearly 87% of the general radiologists’ reports falling within one designated subspecialty division, compared to 24% prior to the transition. Ambulatory turnaround times, meanwhile, stayed steady, experts explained in Current Problems in Diagnostic Radiology.

“Though medical centers have integrated or created community divisions after acquiring community hospitals or groups, this community group differed in that it was longstanding and offered services catering to the local culture,” first author Jessie Chai, MD, with Brigham and Women’s Department of Radiology, and co-authors wrote March 17. “Therefore, assimilating the community division and assigning the radiologists and their work to the academic subspecialty divisions required detailed planning and execution.”

Chai et al. said communication, transparency and data were all key components to the effort. They created a workgroup involving all affected divisions to steer the process, established a project timeline, and held weekly workgroup meetings for three months both before and after the change. The oversight committee was tasked with assessing the resources and clinical capabilities of the 10 general radiologists while anticipating how exam volumes would shift from the community into each division.

Four of the general rads were incorporated into subspecialties matching their fellowship training. Another was asked to spend half of their time with an outside primary care contract, while the other half was spent in cancer imaging at the main hospital campus. The other five continued covering an independent general radiology practice in a for-profit delivery network.

Altogether, Brigham and Women’s academic department consists of 10 separate subspecialities with a total of 115 faculty radiologists. Despite success on the ambulatory side, those involved have found “significant” variation in turnaround time among disparate divisions after the intervention and are now working to address the issue.

“This is of particular relevance during the COVID-19 pandemic as healthcare delivery systems work to limit patient's ‘dwell’ time in our various clinics to enhance social distancing capabilities,” Chai and colleagues noted.

You can read much more about the project in CPDR here.