Governance, Mission, Growth
Boost Your Bottom Line with More Efficient Scheduling
By Cat Vasko
As imaging centers search for ways to drive revenue without increasing costs, one often overlooked factor is idle time on expensive machinery. Increasing throughput is key to achieving rapid return on investment—and this means knowing your center’s current metrics as well as your ultimate goals.
David A. Dierolf, director of performance improvement for Outpatient Imaging Affiliates LLC, Nashville, Tenn, knows firsthand how hard it can be to improve throughput. He conducted performance improvement projects at University of Virginia Imaging LLC (UVA), Charlottesville, and Raleigh Radiology Cedarhurst, Raleigh, NC, that focused on how to analyze and increase throughput.
“That’s everybody’s dream,” he said. “Financially, it’s very attractive. If you can add just one more exam per day, that turns out to be significant additional dollars.”
Dierolf recommends different strategies for improving throughput. “One is simply trying to make better use of the current schedule,” he said. “An appointment that is not used is like an empty airline seat in that once it’s gone, it’s gone. So, the first thing you do is try to make sure that all of the appointments that you have are filled.”
Appointments may go unfilled for several reasons, Dierolf said. “Some of these things are under your control, of course, and some aren’t,” he said. “But people not showing? Maybe you can do something about that.”
Dierolf suggests calling patients a day ahead to remind them of an appointment. “At UVA, even though our schedule was very full, we did confirmation calls, and sometimes people said, ‘Oh, I can’t make that,’ and they rescheduled,” he said. “That gave us some time to try to fill that slot, so we started calling patients who had appointments 4 days out to see if any of them wanted to come in early. That increased our patients per day.”
An even more obvious solution is to increase the number of appointment slots. This can be accomplished by extending your hours, although Dierolf warns that the cost of doing so can outweigh the benefits. “It’s not the first thing you want to do because there’s cost involved,” he said. “You have to pay for a technologist and a registration person. But if you’re getting another MR, you can cover those costs. As long as those appointments are full, it’s an easy decision to extend those hours.”
Finally, it may be possible to trim time off of each appointment to fit more slots in each day. “Make sure you’re not scheduling too much time for every appointment,” Dierolf noted. “At UVA, we were able to trim 5 minutes off of every appointment. Rather than schedule at 45-minute intervals, we scheduled at 40-minute intervals. That gave us two more exams every day on every machine.”
For Dierolf, the benefits of this strategy made it worth the extra effort. “People were working a little harder—no question about that—but what was interesting was that we had such good information on when people came and when they didn’t,” he said. “We were able to show the technologists that there was time to catch up if they got behind.”
If you’re willing to get even more creative, there are ways to condense your schedule further. “In Raleigh, we found that they were scheduling all of their exams at 45 minutes, but the administrator and the chief tech knew they could get a lot of those exams done in 30 minutes,” he explained. “But they wanted to make sure they had some time in their schedule for same-day add-ons. As a marketing concept, if I can take your urgent care, I’ll get all your business. So, they didn’t want to pack the schedule too tight. We did the analysis and found that most of the exams that could be done in 30 minutes were extremity exams. We modified the RIS system to allow them to schedule those exams for 30 minutes, and that allowed us to get more exams through per hour.”
Dierolf stresses that modeling is crucial to increasing throughput. “How do you know how well you’re doing?” he said. “How do you know how much you could do? You need to know where you would be if you were operating at 100%. And it’s not quite as simple as, I have 100 appointment slots per week, so I can do 100 exams. Depending on what kind of exams you’re doing, you might be able to do 110 or 120. Once you have that information, you can say, this is how well we’re doing, and there is room for improvement.”
Cat Vasko is associate editor of Axis Imaging News. For more information, contact
Retaining Radiologists Begins with a Warm Welcome
By Dana Hinesly
Recruiting new radiologists takes a lot of work, but signing the contract does not signal the end of the process. A few strategic moves can make new hires feel at home even before they set foot in the door.
“Prearrival contact is even more important than what you do once they arrive,” said Lauren Krebs, radiology recruitment specialist for American Medical Recruiters, Ft Lauderdale, Fla. “Sometimes they don’t start for months after they’re hired. As soon as they sign the contract, somebody from the group had better be in touch with them, or they may not even start.”
Reaching out can be as simple as monthly e-mails or phone calls. To ensure this takes place, Krebs recommends facilities assign each new radiologist a mentor.
“Offer to have dinner with them, maybe even host a cocktail party with the partners,” she suggested, emphasizing that it is the thought that counts. “It doesn’t have to be big, but doing something social provides a chance for the new radiologist to ask questions and for existing staff to get to know them as a person.”
Viewing a recently hired radiologist as an individual—not just as the latest addition to the reading room—is a vital component of Krebs’ plan to smoothly integrate new staff.
This can be particularly crucial for those who are relocating to accept the position or radiologists who are taking their first full-time job after completing a fellowship. The assigned mentor, along with radiology administration, should provide a wealth of information in advance of the first day on the job.
“You want to get them adapted to the community, so send Chamber of Commerce material and links to local government Web sites. Give them information on how to get a new driver’s license or send lists of Realtors; tell them about professional organizations other doctors are a part of that they may want to join,” Krebs said. “Find out what their hobbies are; for example, if somebody skis and they take a job in the Southwest, give them information about where can they still do things they enjoy.”
Aside from earning a reputation as a friendly staff, there is a tangible reward for partnerships and departments making such efforts.
“What I hear a lot from radiologists I’ve placed is, ‘I like the group, I like my job, but we are not happy here,'” Krebs said. “By not doing these things, practices and departments are risking turnover. This will help them with retention.”
Putting Out the Welcome Mat
Neighborly behavior should continue once the new radiologist is on-site. A number of things should take place before a single study is reviewed, including a tour of the building, an orientation on how the health care facility operates, and introductions to radiology department staff, hospital administrators, and referring physicians.
“Yes, you hired them because there is a caseload for them to cover, but don’t just throw them in a dark room and tell them to go start reading x-rays,” Krebs said. “If you do that, 90 days later, they’ll call us and say, ‘This group seemed so friendly, but now nobody talks with me, I don’t know where anything is, I don’t feel like I’m part of the group … take me out.'”
With that one phone call, the substantial investment a group or hospital has made in locating and recruiting is wasted.
“You want your doctor to feel comfortable so they want to stay,” Krebs said. “Think of the things you take for granted: where do they get their facility badges? Where do they park their car? Where is the break room? It is all so that they are not walking around feeling lost—and it has to start once they accept the offer, not when they walk through the door.”