In spite of market challenges, a large private practice achieves its mission to improve operations and increase revenue.

Keith Radecic, chief executive officer, Radiology Alliance, PC

It’s the same story across the country. With the economy down, Americans are holding off on elective procedures. As a result, radiology practices that depend on referring physicians are taking a big hit from decreases in production.

However, Radiology Alliance, PC, in Nashville, Tenn, was able to face this volatile climate head on with the help of solutions from Merge Healthcare. In fact, the group, which provides services for four imaging centers and performs reads for six local hospitals, has grown its revenue despite challenges from the market.

“We’re completely a referral-based business,” explained Keith Radecic, chief executive officer. “So if our referral business is down, then our business is down as well—other than potentially the use of the emergency room. Being primarily a hospital-based practice, we are at the hands of what our referral physicians provide us. We are limited to what they send to us.”

Still, Radiology Alliance has been able to prosper, which Radecic says he owes in large part to his staff and their use of four products: Merge Financials, Merge Dashboards, Merge RIS, and Merge Documents. Using these solutions, the practice experienced a 2009 revenue growth of 1.3% in spite of a 2.3% drop in total charges.

Getting Rid of the Old

As Tennessee’s largest private radiology practice, Radiology Alliance offers a range of services, including diagnostic imaging, mammography, nuclear medicine, CT, MR, ultrasound, PET, PET-CT, and dedicated breast MRI. The group, founded in 2001, is the result of a merger between three different entities: Associated Radiologists, PC, Radiology Associates of Nashville, PC, and Radiology Consultants Inc. As of press date, the practice is in the process of merging with another organization, which would add two more hospital facilities to its clientele and bring up its roster of radiologists to 55.

Prior to its switch to a Windows-based product, Radiology Alliance had been using a legacy billing system that lacked automation and ease of use. Most importantly, the on-demand reporting system could maintain only a million records at a time, which was problematic for a practice that pumped through almost 700,000 records each year. Furthermore, its cumbersome reporting capabilities required Radecic to spend 40 hours a month creating financial reports.

“It worked well as a billing system, but as a reporting system with tools that we needed to really dissect our practice, it was becoming very obsolete,” Radecic said. “As we had to archive older historical data from the platform, we would only be able to run data off the system that was not archived. So we would be limited to 13 to 18 months’ worth of data. If we wanted to see a year-over-year trend analysis on referring physicians, on physician productivity, or whatever the inquiry would be, we would be limited to only a short time frame.”

After undergoing an RFP process in 2008 to look at multiple vendors, Radiology Alliance decided to stick with the Merge product line.

“With the new platform, we have all the historical data from all of the archived systems,” Radecic said. “We’ve been able to utilize the data for historical processing, for looking at our trends. We are also comfortable that what is being returned to us is an apples-to apples comparison. There is consistency with reporting, and we’re able to store those reports onto our platform, go back and inquire, run them multiple times, and change parameters very quickly so we can update the analysis.”

In with the New

Through the Merge Financials billing platform, Radiology Alliance was able to automate its workflow, reduce its FTE staff, and decrease its outstanding accounts receivable. Specifically, the fully automated system handles input of charges, output of claims, and follow-up on the AR.

As the scheduling piece for radiology, the Merge RIS system is fully integrated with the financial solution. It features real-time charge out and integration of all the practice’s support tables, eliminating the duplication of work and the need to maintain two separate databases. Meanwhile, the group employs Merge Dashboards on the back end as its reporting solution, reporting on AR and projections.

Rounding out the Merge suite of products, Radiology Alliance has turned to Merge Documents to serve its paperless needs. Integrating into both the RIS and financial products, Merge Documents ensures approved users have convenient access to patient information.

Radecic noted the positive changes particularly observed in his accounts receivable department.

“Before, you had to run reports that were manual processes, and you had to manually work those reports,” he said. “Now, a lot more tools are electronic and can generate appeals on claims much faster.”

Not only is it easier for staff to work the accounts receivable, but also it is more manageable from Radecic’s end. “The reporting is significantly better than what the old reporting system used to be,” he said. “When we analyze the practice, and we analyze the data that’s there, it’s much more timely. It is quicker to access, and we have high confidence of what’s being generated.”

Radecic added, “Some reports used to run from 24 to 36 hours to access an inquiry. Now we’re talking about things that are taking 15 minutes, maybe 30 at maximum, to put a query out there, run a report, and get at least the general data back. We may have to tweak it in Excel or manipulate it a bit, but for the most part the data query piece has cut the processing time significantly, by days at a time.”

Business Improvements

According to Radecic, the business has always strived to staff to an internal metric. Thanks to the enhanced efficiency achieved from moving from a character-based system to a Windows-based system, Radiology Alliance was able to shave off six staff individuals from billing, who were effectively becoming obsolete. Consequently, the practice was able to save hundreds of thousands of dollars in overhead costs. “Where we used to work somewhere in the neighborhood of 1,500 CPT codes per FTE, now we’re around 1,900 CPT codes per FTE on average across all of our departments,” Radecic said. “We’ve gained overall about a 25% efficiency.”

Additionally, the practice has been able to reduce its AR days from 56 to 41, its overall AR from 12 million to 7.3 million, and its billing costs per CPT code from $3.75 to $2.50.

And How Have His Colleagues Responded to the System?

Any change makes the staff uncomfortable, Radecic responded, with a chuckle. “They disliked the old system until we got the new system, at which point they said, ‘This doesn’t do what we used to do.’ But now they embrace the product. It’s just a completely different way of processing independently, and we’re able to keep up with all the advancements.”

He continued, “We’ve got good relationships with the hospitals. We work well together to make sure we capture as much good information as possible. With the way that we capture data, with our efficiencies, we were able to increase revenues while actual production slightly decreased for the year.”

Radecic emphasized that the overall goal of his organization is maximize cash flow. In order to accomplish this, Radiology Alliance plans to harness the product as a data tool.

“I think that is key for the overall practice that we are able to extract the data and be able to analyze what we’ve been doing, to help us manage our business: be it internally, looking at our own physicians, or externally, at how we interact with our referrers,” Radecic said. “I think it’s important to know where our business has come from historically and where we should focus our efforts to ensure that existing relationships are maintained, and that new relationships we find from the data can be worked and expanded upon.”


Elaine Sanchez is a contributing writer for Axis Imaging News.