Today?s radiology managers require a sophisticated skill set including the ability to generate revenue.

Over the past few years, Medicare and many other payors have placed radiology in the cross hairs. The draconian reimbursement cuts in outpatient diagnostic imaging posed significant challenges for center operators across the county and a deathblow to many centers. What was once a fairly easy business to operate has, in many ways, become a challenge, especially during the past 2 years. Since the Deficit Reduction Act of 2005, many outpatient centers have aligned with larger publicly traded organizations or forged local alliances with hospitals and radiology groups. Now in light of further anticipated cuts in 2010 and hospitals demanding more from their respective radiology group administrators, the challenge to find the right management candidates has become that much harder.

Patricia Kroken, FACMPE, CRA, from Healthcare Resource Providers, a provider of radiology consultation and billing consultation, explains it this way: “The complexity of today’s business environment demands an extensive skill and experience base. We are well past the days of walking into a management position and successfully ?learning by doing’ while on the job because the regulatory and financial implications of errors are staggering and?the landscape is getting more difficult by the day. This isn’t to?say?an employee with a good track record elsewhere can no longer be promoted into management, but that move must be accompanied by sufficient education, skill development, and mentoring—and competency will not occur?within a short period of time.”

Furthermore, many departments such as billing, accounting, and HR have decreased in size or have been put under the radiology manager’s supervision in order to cut costs. The definition of the radiology manager’s role remains the same as in the past. General priorities still include looking for good technologists, working closely with radiologists, taking care of patients’ needs, tackling personnel issues, and managing vendors and supplies. Those represent the most basic needs to exist in a manager position.

However, today’s managers must tack on a few more skills to make them truly valuable and to generate revenue for the organization. Attempts to successfully hire these skilled managers seem to be causing angst for radiologists and imaging companies.

Tim Henning, senior vice president at Alliance Imaging, has tried recruiting firms and word of mouth but still cannot find qualified applicants. Henning said, “Our HR department receives volumes of applications like most organizations in this economy, but they lack many of the essential skills critical to our operations and business development team today.”

Operators find that costs associated with hiring these skilled professionals are skyrocketing in an industry where cutting expenses is the latest trend. Qualified managers are now demanding higher salaries. But investing in the right candidate can pay off in the end for a practice or imaging center.

The following characteristics and expertise are what today’s radiology manager should bring to the table to make any practice hum along:

  • Knowledge of IT and EMR: Understanding what RIS/ PACS and EMR systems are and their integration with various disparate systems is critical. One not only needs to know how to program in HL-7 computer code or trouble-shoot IT firewall issues, but also must know the systems’ workflow and importance and how each system relies on each other in order to assure maximum workflow, reimbursement, and HIPAA compliance.
  • Best practices: Most radiology centers run on PACS/RIS systems. The days of paper are slowly dwindling, and thus it is important for the manager to understand the best practices up front in order to avoid errors in the patient revenue cycle. The communications and understanding between the billing and operational departments can save a single center upwards of hundreds of thousands of dollars a year.
  • Quality improvement and assurance: The job of the radiologist is increasingly driven by volumes. This means both radiologists and managers are collaborating to stay compliant and Q/A measures are updated in the department to keep patients and staff safe. Gone are the days of ignoring updating compliance standards whether they are ACR, state regulations, JCAHO, or Medicare/payor standards. As practices become increasingly busy, the focus on keeping their heads above water can override the basic items such as calibration.
  • Strategic thinking: Unfortunately, this trait is not always learned but instinctual. But the right mentor can help bring out the strategic in a manager. With 15% to 25% reimbursement cuts on the horizon and private payor changes, managers will be faced with real issues regarding the long-term viability of business and the bottom line.
  • Accounting: Astute understanding of profit and loss and cash flow statements, balance sheets, and budgeting is critical to the operation. Managers must be able to work in conjunction with the billing manager to track daily posting, denial trends, and debt. It is the manager’s responsibility to ensure that all departments are on board to collect co-pays and assess if deductibles are met and authorizations complete.
  • Financing and negotiation skills: Managers need to know how to refinance and/or finance new or used equipment without giving away the store. This is a growing need as financing has become more difficult to obtain. Negotiating with vendors to obtain the best deals is a value-added asset that can save thousands of dollars in interest. Managers must be willing to negotiate with fervor to save employers’ money. It does not hurt to remind your manager that the money they save can justify their position.
  • Human resources: Many companies that used to outsource have brought payroll in-house to save money. Today’s managers should be aware of the changes in HR laws and the tightening of fines and penalties relating to policies and procedures that many states are now employing. Also, assuring proper work schedules are being met as well as productivity is essential.
  • Payor contracting and relations: This area can mean the difference between profit and losing a business. Two years ago, many managers were unclear and overwhelmed, and did not keep track of the fiscal intermediary, thus causing many providers to lose their Medicare status as well as the contracts that require Medicare. Overnight, many centers found themselves in deep trouble. Also, providers are fighting to become or stay privileged as radiology business utilization managers grow in popularity. Adding a new contract or becoming privileged to increase business is what it takes to achieve the highest reimbursement. Once a contract is secured, it is important to understand the language, decipher the details, and ensure its success.
  • Workflow optimization: Every manager must excel at ensuring maximized procedure throughput without sacrificing patient safety, service, or quality of care.

More than a Title

Clearly, the role of the radiology manager today is far more complex than in the past. Imaging operators can no longer afford to simply dish out a few more hours to a chief technologist or front office worker and add “manager” to their business cards. Dividing the administrator role among several staff members is another disastrous remedy. Calling in a consultant merely patches the problem if the underlying issues are not confronted first. Radiologists, technologists, and front office managers typically lack the skill set necessary for recouping lost monies due to reimbursement cuts and the economy in general.

The fact is, many of today’s outpatient imaging managers do not possess the qualifications required to maximize business operations. They must have an extensive arsenal of skills to navigate these turbulent times. Managers require a broad knowledge base to succeed—only then can they warrant higher pay and prove their value.

Prior to recent cutbacks, finding or grooming a radiology administrator or center manager was fairly easy, assuming employees were eager to learn, brought a keen understanding of customer service to the job, and had technical skills within their areas of expertise. It was also beneficial if these managers understood new technologies and could write a business plan for upgrading equipment and/or building a new center. Today, however, the role is far more complex and demanding.

Finding the Right Fit

Many outpatient imaging centers operating in the United States today are managed by former technicians who worked their way up to management positions. Many of them possess little experience in accounting, billing, compliance, payor relations, workflow optimization, structured financing, or human resources. Yet these are necessary skill sets to succeed in today’s management positions. The prized few technicians who have successfully made the transition and mastered the managerial role rarely surface on the job market because they are already well paid.

The best way for managers to acquire more experience is to educate themselves. Bringing in outside consultants can help a manager strengthen skills in a specific area. For some, enrolling in an accounting class or obtaining continuing education units expedites the learning process. Classes for improving skills are typically offered through trade associations such as the Radiology Business Management Association and the American Healthcare Radiology Administrators (AHRA). The AHRA has a certification program that offers CEUs through webinars, conferences, and books, testing managers and potential managers in given subjects. On average, just 50% pass the test, so it is no easy task. Equipment vendors have also identified critical areas where industry professionals could benefit from further education, and they have made this a focus at conventions by offering classes.

How to Find the New Breed of Radiology Managers

Many businesses are finding displaced workers in other health care areas and using skilled technicians to teach them the technology and business of radiology. Sue Otis, chief operating officer of Rely Radiology, a teleradiology provider, explains it this way: “To be successful in the management of health care requires a broad range of knowledge and experience. Having a subspecialty (ie, radiology, cardiology, etc) expertise is not nearly as critical as having experience in specific management disciplines such as compliance, human resources, accounting, billing, and operations. A successful manager must be able to look at the entire practice—not just a segment.” These people can be found in pharmacy and medical sales and other businesses like physical therapy.

Henning’s philosophy is similar to Otis’. He says: “It is not critical that they have imaging background, although it is a plus. I want a manager to treat the business like it is their own company and think outside the box.”

Aside from employees running out and acquiring an MBA or MHA, and operators turning to part-time consultants and outside management teams, perhaps it is best to hire managers trained in this business who can help overcome the dips in revenue while tackling increased competition and embracing market consolidation as opportunities to enhance business. Those with the appropriate skills can quickly revamp operations and focus on the components necessary for reaching profitability.

But where are these folks? It has become extremely difficult to fill radiology management positions.

Some say these management experts are fleeing the business due to high levels of stress and greater pay offered by other health care industry sectors. Operators should look in their own backyards for an eager and appropriate candidate and arrange a well-financed and strategically planned grooming program. Making the transition to a management position requires investments in accounting, billing, HR, and compliance classes for employees as well as close collaboration with radiology consultants proficient in all the areas listed above. This combination of consultant and continued education has proven very effective for many operators and helped speed the learning process.

As we look toward the future of employment within the imaging sector, we know that the thought of significant spending can be frightening to many. But when it comes to radiology managers, the right hire can ensure a smooth-sailing business—one with an increased revenue stream, significant earnings potential, and stronger profitability. The benefits of investing in a strong manager far outweigh the costs. Providers nationwide are busy attempting to recoup some of the losses brought on by the DRA and now health care reform. Astute radiology managers may be the saviors in the long run.

Steven R. Renard, MBA CHE, serves as chairman, president, and chief executive officer of Roseville, Calif-based Diagnostic Radiology Services Inc, a provider of a range of tailored consulting services for the diagnostic imaging and radiology industries. Renard has nearly 17 years of related experience, primarily in imaging center operations.