By Jenny Lower

The quest for value has wrought major changes across the healthcare industry, driven by payors seeking to contain costs by transitioning from a fee-for-volume to a fee-for-value model. Imaging is no different, as radiologists have seen workloads increase and reimbursement rates slashed. But what does that mean for the imaging provider in the trenches?

The answer: Innovate, innovate, innovate.

Ray Montecalvo MD

Ray Montecalvo, MD

During a recent webinar hosted by research firm Frost & Sullivan (“Innovating Radiology: Is It in You?”), Ray Montecalvo, MD, medical director for Virtual Radiologic (vRad), outlined how the current environment has affected imaging providers. Long gone are the “good old days” when radiology practices were “fat and happy,” he said. Then, radiologists could focus on providing the best diagnosis possible without worrying about how to prove “quality” or even define it. The revolution under way has upended that approach.

Most practices have already responded by trying to work harder. Having reached their physical capacity, they must now learn to work smarter. “The practices and health systems that try to perpetuate the good old days and throw capital at an ever diminishing revenue source without taking a step back and looking critically at practice and service line data—those are the folks who are going to miss the opportunities that will invariably present themselves in the future,” Montecalvo said.

But how to avoid falling into that trap? According to Nadim Daher, principal analyst with Frost & Sullivan, one solution is analytics: “It is the key to assessing value—to measuring it, to demonstrating it.”

Nadim Daher Analyst Frost Sullivan

Nadim Daher, Analyst, Frost & Sullivan

Analytics for the imaging field have been advocated before to varying degrees by both providers and vendors. But medical analytics as a whole lag far behind other industries, where such metrics are more established. In fact, Frost & Sullivan works with a variety of clients in diverse industries—many of which, like the airlines, for example, have successfully leveraged analytics to improve their long-term businesses.

But in radiology, current imaging tools, such as PACS dashboards, tend to focus on descriptive capabilities—measuring current practices and perhaps indicating areas where a center could improve, such as tightening turnaround times. However, new technologies are slowly and surely pushing out that frontier by developing analytics that are both comparative (evaluating a practice vis-a-vis competitors of a similar size or geographic location) and predictive (tapping historical data to project future outcomes).

The Holy Grail, said Daher, is prescriptive analytics—metrics that not only describe what is or what will be, but point to what could be. This type of data highlights steps radiology practices can take now to improve outcomes down the road.

vRad, the largest radiology practice in the country with both on-site and teleradiology services, has taken a step in the descriptive, comparative direction with its Radiology Patient Care Indices, a compilation of data from 25 million imaging studies freely downloadable on vRad’s website since late last year. The project earned the company Frost & Sullivan’s 2014 Visionary Innovation award.

“The ultimate goal is to use the data as a spotlight on the practice and the service line. We want to be the ones holding that light,” Montecalvo said, instead of payors or the government. “The only way to do that is to have normalized data at our fingerprints that represent our practice and our health system, and to be able to compare ourselves with similarly situated practices and systems.”

The indices have aggregated data on regional use of CT in emergency department settings, finding that the rate of findings varied significantly from state to state.

Another analysis in the practice setting focused on the relationship between hours worked and total relative value units (RVUs). It found that while early morning and weekend readings accounted for nearly half of total hours worked, those shifts produced only 11% of total RVUs. Practices can use similar studies to evaluate their own practices and make tough staffing and strategic decisions.

The recipe for successful innovation is simple, Montecalvo said: “You analyze, you adjust, and then you reanalyze. Repeat that as necessary.”


Jenny Lower is the associate editor of Axis Imaging News.