Ideas for Hospitals, Centers and Practices

Practice-Management Firm Proves Efficient, Affordable
Fuji FCR Go Slashes Wait Times for Radiologist
Successfully Connecting Systems at Multiple Sites

Practice-Management Firm Proves Efficient, Affordable

For Steven R. Nokes, MD, president of Radiology Consultants of Little Rock (RCLR), in Arkansas, finding the right business manager was no easy task. Personnel with business credentials lacked radiology-specific knowledge; those with a radiology background did not have the management savvy the practice needed.

Steven R. Nokes, MD

With hire after hire, Nokes spent valuable time filling in the blanks. Realizing that hiring someone on his own was not working, he began to research practice-management firms with experience in radiology. Ultimately, he went with Medical Management Professionals (MMP), a firm based in Austin, Tex, that provides billing and practice-management services to hospital-based physicians.

“We found it very difficult to find a business manager who had radiology-specific knowledge and had good CPA skills and MBA skills all in one package,” Nokes said. “When we found MMP, they had all that infrastructure in place.”

According to Nokes, the billing side of RCLR was in good shape before MMP arrived—he was primarily interested in help on the practice-management side. While MMP does take an active role on the billing side—such as converting the practice software to the Amicus billing system—one of the determining factors for Nokes was that the company retained his existing billing personnel.

“It’s not like all those jobs went away,” he said. “That wouldn’t have been acceptable for us.” The practice, founded in 1961, employs a staff of 100.

Nokes was also swayed by MMP’s experience in radiology. “They’re able to benchmark us against the other 40 practices that they manage,” he said. “These guys know radiology inside and out. So, they’re coming to us saying, ‘Here’s what our other groups do, maybe this would work for you.’ “

MMP provides its clients with a report chock-full of blinded data from each of the practices the company manages. None of the practices is mentioned by name, but the report provides details such as how many radiologists are employed, how many films the average radiologist reads, and how the profit-sharing, benefits, and pensions are arranged at each location.

“This is the kind of real-world benchmarking that we could use going forward to be sure that we’re a competitive practice,” Nokes said.

In the first 6 months, MMP has already helped RCLR revamp its pension and profit-sharing system as well as update the contract that the practice has held with its flagship hospital for 30 years. They have also enacted better reporting procedures.

“That was one of the things that we were missing with our other management folks,” Nokes said. “We weren’t getting the kind of reports that we felt we needed to make good decisions. So, now we have a better reporting process.”

For the first 6 months, MMP’s team in Austin has been coordinating most of these efforts. But there are also two staff members on site. In May, MMP hired a billing manager to work in the RCLR office, and in December, it brought on an in-office business manager.

“This is somebody who has radiology business experience,” Nokes said. “So, the beauty for us is we don’t have to train him.” He adds that if the business manager has any questions, he reports directly to his boss at MMP, which takes the burden off of Nokes. “It’s just easier than what we had before,” he said.

A practice-management service like MMP may sound cost-prohibitive, but Nokes found it to be surprisingly affordable. “They are doing our billing and our practice management for the exact same price we were doing our in-house billing and our practice management before,” he said. “So, it was a no-brainer.”

Now that MMP is on board, Nokes has more control over his time. “My job is so much easier since MMP has been here,” he said. “I’ve gone back to being able to read films and doing what I like to do.”

In the next year, MMP will help RCLR review its internal documentation to make sure it is up to date before submitting it to the practice’s lawyers. MMP’s involvement will reduce the legal fees associated with this project. MMP will also focus on cost-saving measures as well as improvements in workflow, such as implementing new procedures for teleradiology.

Nokes feels very comfortable with the direction MMP has been taking and has high hopes for its continued relationship with his practice. “Right now, you just don’t have a lot of margin for error in radiology practices,” he said. “We feel like we’ve got a team on board that’s ahead of the curve on what’s going to happen with radiology and is looking out for us with an eye to the future.”

Fuji FCR Go Slashes Wait Times for Radiologist

When Barry L. Borel, divisional director of imaging at Trinity Mother Frances Hospitals and Clinics, Tyler, Tex, hosted an educational session on CR last winter, upgrading the hospital system’s portable CR machines wasn’t a top priority. But during the presentation, a new portable option caught his eye.

“I had an aging fleet of portable units, some of them 25 years old, and I’d been looking for a solution,” he said.

Although Borel thought that the displayed product looked a little bulky, the photo inspired him to run a Google search on the available options. He was immediately drawn to the Fuji FCR Go from FujiFilm Medical Systems USA, Stamford, Conn, because the hospital was already running Fuji’s PACS system. Soon afterward, Trinity Mother Frances became the first test site for the FCR Go.

The hospital also was already running Fuji CR, which was a determining factor in Borel’s decision. Having the same system meant the hospital could use the same CR plates for the portable units. It also gave the staff a home-court advantage. “The techs already knew how to run the Fuji CRs,” Borel said. “The learning curve for us was greatly diminished by going with Fuji.”

The FCR Go features the FCR Carbon XL CR system as well as a notebook version of the Flash IIP technologist console. The unit offers image availability in less than 23 seconds and allows for wireless communication of updates. It is also designed to be lightweight and easy to maneuver.

Almost as soon as the five machines were delivered to Trinity Mother Frances in July, Borel started receiving enthusiastic responses from every department. The radiology staff appreciated the wireless capabilities of the unit, and surgeons were excited to be able to view the images before they were even sent to the PACS system. One of the most noticeable changes was how quiet the units were—a big change from the previous machines.

“The old ones were making a lot of noise,” Borel said. “We actually got complaints from patients.”

The most important change has been the speedy delivery of results. Since bringing on the Fuji FCR Go, radiologists save time at almost every step of the process. They no longer have to wait at crowded elevators, which can tack on an extra 30 minutes on a busy day. They also reduce wait times for using the stationary CR readers. This gives staff more time to invest in longer procedures, and it adds up to a significant cost savings as well.

“We figured if we shaved off 15 minutes per x-ray that the amount of savings in just tech time was incalculable,” Borel said.

Not only are lines at the CR readers shorter, but the department also can relocate those readers from areas where portable units are more effective. “We freed up a CR reader from the ICU because we don’t need it over there anymore,” Borel said.

Of course, being a test site means that glitches do arise. For example, when staff were unable to connect the unit to the wireless network, they could not plug it into the wall without disconnecting the router. When Borel alerted his representative at Fuji, they immediately addressed the software problem and sent faster routers to the hospital as well.

The Fuji team also solicits feedback for future revisions. “They have come and talked to the staff to get ideas on how to improve the units,” Borel said. For example, some staff at Trinity Mother Frances find that the pole on the tower blocks visibility when they are moving the unit—so the manufacturer plans to reduce the height.

Overall, Borel is delighted with the purchase. He notes that the speed of the portable CR system is another factor that has greatly improved the aggregate turnaround time for each exam. Since Borel arrived in the department 3 years ago, the time from order entry to final radiologist signature has shrunk significantly from 129 hours to 13.69 hours.

“It’s just been phenomenal,” he said.

Successfully Connecting Systems at Multiple Sites

Medical Imaging Northwest (MINW), headquartered in Lakewood, Wash, has an ambitious goal—to grow the practice from reading 350,000 diagnostic exams per year to reading 550,000 annually. But until recently, disparate software systems at MINW’s 12 locations posed a significant obstacle to increased productivity for the 23 board-certified radiologists on staff.

“MINW provides diagnostic services to patients across a broad geographic area from a large number of our satellite sites and imaging center clients,” said Andrew Levine, MD, chair of MINW, in a press statement. “The resulting system conflicts and manual data entry and workarounds impact our productivity and reduce our ability to get the right image to the right specialist, regardless of system or location.”

As a result, MINW recently entered into an agreement with Compressus Inc, a Washington, DC-based software-technology company. Using components of its MEDxConnect System, Compressus will integrate the independent digital imaging and data management systems used at the different MINW locations into a single worklist solution by early 2009. The integration—which will focus on RIS, PACS, voice-recognition software, and workstation viewers—will provide the workflow and data management, workflow viewing, patient ID management, and short-term archiving requirements needed to support MINW’s expansion goals.

“Providing high-quality and cost-effective teleradiology services is increasingly difficult as radiology practices battle both resource constraints and system connectivity conflicts,” Janine Broda, chief marketing officer for Compressus, said in a press statement. “MINW came to us with very specific goals for a comprehensive interoperability solution to support its high standards for quality patient care and aggressive business expansion goals.”

The idea behind MEDxConnect is to create a single workflow from multiple systems, and it is designed to provide an infrastructure for a facility’s growth. The system enables various PACS, HIS, RIS, and other data information systems to communicate across multiple locations. It is designed to help control the flow of images, reports, messages, and standard patient demographics among otherwise independent systems. 

MEDxConnect features include a Web-accessible single worklist, a subspecialization focus to allow real-time delivery of information to the appropriate physician, and automated routing. While it connects the information stored in multiple RIS and PACS systems, it also allows radiologists to use the viewer of their choice. The system also implements a standardized dictation system.

The MINW implementation will integrate with McKesson PACS for storage and retrieval transmission of imaging data to McKesson HRS and Kodak Carestream workstations. It will also integrate either directly to the RIS or via Cloverleaf.  To standardize the generation of reports, MINW will use PowerScribe v. 4.8 voice-recognition software across the enterprise.

Building the functionality required for remote connectivity, the system will enable users to access diagnostic images and reports in the existing data stores at each facility. The improved workflow efficiency will ultimately translate to cost savings.

“The MEDxConnect solution emphasizes the electronic collection and distribution of DICOM and HL7 digital imaging data with the goal of providing MINW with a workflow management and integrated diagnostic solution that improves productivity and helps us manage operational costs,” Levine said.

Levine notes that while these measures will streamline the workflow for MINW radiologists, the benefactors are actually the imaging-service customers and their patients. “Automated prefetching of prior studies from disparate archives will result in better diagnostic services and fewer repeat or unnecessary exams,” he said.

Connecting MINW’s disparate systems will be instrumental in reaching the facility’s goal of increasing productivity by 200,000 exams per year. “Combined with full integration with our McKesson PACS and multiple PowerScribe and voice-recognition and dictation systems, this implementation will enable our radiologists to dramatically cut the turnaround time on reports and read more exams,” Levine said. “Ultimately, we expect the result will be faster, more accurate, and better patient care.”