Put Some Beer in Their Fridge!

If you are a hospital radiology manager or executive, you may view the radiology group you have contracted with as all take and no give, just like that annoying nephew who keeps drinking all your beer.  Sure, they do a fine job reading your exams, but you pay them handsomely for it, and they keep requesting things like new workstations and interfaces. Conversely, if you are an IT manager for a radiology group or Managed Services Organization (MSO), you should pay heed to how your group is perceived, and work hard to minimize any annoyances.  Better yet, you need to provide clients value beyond the basic services you have been contracted for.  Put some beer in their fridge, so to speak. But how?

As radiology practices look for these new ways to provide hospital clients with value beyond cost control, subspecialty, and 24/7 reading services, we see the best received efforts being those that help them understand and manage their entire imaging service. This involves going beyond understanding turnaround time and study volumes by modality, as (hopefully) these are already understood. Rather, forward thinking groups are trying to help their hospital and imaging center clients understand their non-clinical and clinical operations, including the impact of non-diagnostic clinical activities on cost, quality of care and reimbursement. Basically, using analytics to provide an understanding of the entire integrated operation as if it were a single entity.

Achieving such a goal requires the seamless gathering and sharing of information across organizations and locations with a sophisticated approach to analytics that make this easy and cost efficient for all. The radiology group’s IT team will likely be tasked with identifying the integration points for gathering the necessary data and ensuring the relevant information can be captured, visualized and shared among all parties in across the organization.

This presents a unique challenge from both an integration and operations perspective, as it requires viewing a customer as a partner; the service provider only wins when the client wins. This necessitates IT integrating with client systems as well as the systems owned by the MSO, which can be hamstrung by political challenges, never mind the technical challenges. Keeping things simple and inexpensive are really important for minimizing demands on the client hospital’s IT team and maximizing the likelihood of success. We see the following as key factors when planning for a cross-enterprise analytics solution implementation:

  • Partner with or acquire an analytics platform versus building one yourself – never fool yourself that your IT project team can successfully be turned into a commercial software development team (the road is littered with the corpses of teams that have tried).
  • Ensure your partner provides a hosted analytics solution to minimize upfront hardware costs, speed rollout and minimize ongoing hardware support demands.
  • Utilize an analytics solution that doesn’t require your IT team to become data analytics experts, SQL programmers or knowledgeable about the reporting language.
  • Don’t purchase outright an analytics product; rather, pay per study or rent the application, thereby limiting long-term commitment to any given vendor or solution.
  • Never choose a solution that charges per user or per seat, as you want to encourage access to the system instead of limiting or dis-incentivizing it.
  • Learn about forthcoming hospital and government reporting requirements and radiology performance measures, and be sure your analytics platform can report on those to your client.
  • Choose a self-service analytics platform that empowers all clinical and business users to quickly answer their own questions, without requiring your IT department to develop custom reports.
  • Choose a cloud provider so that the analytics platform can be used by your entire team, regardless of location.
  • Choose a solution that can easily segment data access by role so that you can allow your hospital clients to also sign on to your analytics platform without compromising data privacy of your other clients.

Do most or all of the above, and you haven’t just put beer in their fridge, you have stocked it with their favorite hoppy microbrew and mounted a fancy bottle opener on the side!

With business relationships changing quickly and industry consolidation a strategic trend, IT leaders at radiology groups must be able to move quickly and optimize the use of available resources. Fletch famously said of jet maintenance “it’s all ball bearings these days”, but in healthcare, it’s all about the software, and integration and interoperability among systems can be a killer. As the business models of radiology groups continue evolving, the need to monitor a range of financial, operational and clinical metrics is likely to only increase. With the creation of virtual connected organizations on the rise, the need to measure performance will not abate and IT leaders need to step up to help maximize profit margins and revenue, despite the uncertainty caused by new payment models and value-based imaging.

CQI – It Doesn’t Stand for ‘Cardiologists Quietly Indoctrinated’

CQI stands for Continuous Quality Improvement, but to achieve cardiology CQI requires that everyone, including the physicians, adapt and change to the new program.  

We all know that changing our behavior can be challenging in the best of circumstances! Trying to achieve clinical, financial or operational improvement through staff behavioral changes can therefore be a daunting task.  It is virtually impossible without access to detailed and accurate information about ourselves that can be used while our actions are still fresh in our minds. Because each cardiology subspecialty (electrophysiology, Echo, Cath Lab, Non-Invasive, TAVR, surgery, etc.) typically works with unique technology and IT systems, meaningful and actionable information is highly unlikely to be found in any one system or data warehouse. This is compounded by the fact that cardiologists will need to access clinical, operational and financial data elements that are likely in numerous non-cardiology back office IT systems they might not be able to access.

CQI behavioral changes require a decision support tool that supplements the cardiologist’s clinical expertise by enabling decision making based upon information from yesterday’s patients, not just last months or last years. This is the essence of CQI and the nature of real-time understanding and the actionable information needed to achieve it. Service line managers should be able to provide their cardiologists with the ability to, at a minimum, enable:

  • Measuring the clinical value and productivity impact of their diagnostic cardiology efforts.
  • Obtaining timely and continuous feedback that can be used to quickly improve individual productivity and quality performance against personal and group goals.
  • Tracking clinical outcome improvement activities, care information and cost measures that are required to meet ACC continuous quality improvement guidelines.

Maintain Understanding

Achieving CQI, by definition, requires an ongoing effort that reflects a new way of thinking and delivering healthcare. It’s not a one-time correction. It should be a series of ongoing assessment and corrections that gradually move the organization in the desired direction.

As a practical matter, cardiologists are busy and highly compensated providers who don’t have any extra time in their day to analyze the impact of their behavior. Up until now, they frankly have not been compensated to do so, and the incentives have just not existed. So any tool one plans to use in support of these efforts must be easy to use, and able to quickly and easily present relevant information that provides immediate feedback on their contributions and progress towards goals. And it must do this in a way that assures accuracy and builds trust.

An integrated analytics solution like Foundations™ Cardiology enables the cardiologist to easily personalize the measures they need to understand and improve, for example, areas such as:

  • Readmission rates by cardiologist and procedure.
  • Performance metrics for stent usage, cost per vendor and performance of each over time.
  • Restenosis rates for the procedures they have performed over the past 12 months.

CQI is not easy to achieve, and cardiology service line leaders can’t do it alone. The cardiology clinical staff must participate in ways that go beyond registry reporting and reliance on 3rd party tracking. Behavior must change to support new approaches to delivering care that support CGI goals.

In our next blog post we’ll re-examine the analytics needs of the radiology group, but now examining the IT leadership perspective.

“Help me to help you” – Jerry McGuire

After using this blog to explore the opportunities for radiology group and cardiology service line leaders to use real-time, self-service analytics to drive change, I would now like to look at how radiologists can use radiology analytics themselves to understand their own behaviors and performance.

In this “run fast or get swallowed” world, radiologists must continue to prioritize activities that minimize report turn-around-time.  However, increasingly non-diagnostic activities are demanding of their attention too. The industry desperately wants to re-establish the value of the profession, particularly as the uninformed public believes that machine learning will make radiologists obsolete in the coming decade.  While that won’t happen, emerging reimbursement plans and value-based payment models that are tied to registry reporting have arrived, as has the prevalence of Clinical Decision Support (CDS) tools. Ostensibly, these activities should improve the quality of care at the lowest possible cost.

Ongoing Challenges

Understanding and monitoring the impact of these diagnostic and non-diagnostic activities is likely to be a persistent challenge that for many is the ‘new normal’.  I believe individual radiologists are wise to embrace this and work with their leadership to identify the metrics relevant to their clinical focus and business needs. At a minimum, working with group practice leadership to:

  • Understand the clinical value and productivity impact of non-diagnostic activities such as dose monitoring, managing imaging appropriateness, critical results reporting, CDS and tracking follow-up recommendations.
  • Evaluate individual productivity and quality performance against personal and group goals.
  • Obtain timely and continuous feedback that can be used to quickly improve individual performance.
  • Track clinical outcome improvement activities, care information and cost measures according to the new MIPS plans.

Achieve Understanding

As these challenges are addressed and group priorities evolve, inevitably the radiologists performance monitoring needs will evolve. Logically, any tool being used to support these efforts must provide the radiologist with immediate feedback on their contributions and progress towards goals. Let’s face it, radiologists are scientists at heart and appreciate using a sophisticated but easy to use tool that allows them to look at the data various ways until they have completely convinced themselves of its accuracy.

An independent solution like Foundations™ Radiology empowers radiologists to easily personalize the metrics they need to understand and improve such as:

  • Overall CDS utilization by specialty, facility or referring physician.
  • Referrer or patient follow-up rates by radiologist.
  • Prevalence of inappropriate exams by modality, exam type or ordering physician.
  • Screening exam callback rates by exam type, location or technologist.

In our next blog post we’ll re-examine the analytics needs of the cardiology service line, but from the cardiologist perspective.

Improved Cardiology Profitability Is Within Reach

Private radiology groups and their leadership can reap significant benefits from using real-time, self-service analytics, as we examined in our last blog post. Those looking to improve the profitability, operational performance and clinical quality of other clinical specialties can also benefit from these tools. In this blog I would like to explore the opportunity to improve cardiology profitability from the perspective of the cardiology service leader; keeping in mind we are just scratching the surface.

Leading a cardiology department and its affiliated service lines has always been challenging and this is unlikely to change in the near term. Uncertainty around the ACA, Medicare and Medicaid retroactive reimbursement formula changes, increased competition from mergers and affiliations, and emerging value based payment models are just some of the issues keeping healthcare executives up at night.

I think we can all agree that the cardiology department is typically the highest margin department within a health system, but if you ask management to quickly identify the factors driving that profitability, the answer is likely to be a resounding “No”. This is a systemic problem.

Every cardiology service line leader needs the ability to monitor a site-specific mix of financial, operational and clinical data, in order to optimize human and material resources to maximize profit margins while delivering a high level of clinical care. Our clients tell us the following are critical areas they strive to understand:

  • Emphasize activities that lower costs and improve quality.
  • Empower the organization to understand the impact of non-invasive procedures on clinical outcomes.
  • Ensure the department understands the financial impact of disposables.
  • Insights into room occupancy rates, idle time and resource utilization.
  • Implement tools that build trust across the organization, enabling the organization to quickly improve performance.
  • Understand and reduce staff documentation requirements.
  • Track and compare costs and outcomes of new devices being used in cath. labs.

Achieving these is not easy and takes time. It requires continuous access to in-depth details about the current state of the business. Unfortunately this is still out of reach of most organizations, even if they did just implement that trillion-dollar EMR or a data lake bigger than the Mediterranean. This is where real-time, self-service analytics comes in; to provide immediate feedback that bolster timely course corrections, organizational alignment and the requisite behavioral changes.

A solution like Foundations™ Cardiology allows all users to easily identify, monitor and understand important operational and financial trends using self-service dashboards, canned and customized reports, and real-time data mining. This information presents the cardiology service line leadership team the leg up it needs to stay ahead.

In our next blog post we’ll revisit the needs of the radiology group, from the radiologist’s perspective.

How Radiology Groups and Imaging Services Providers can Leverage Real-Time, Self-Service Analytics; The Leadership Perspective

In our last blog post, we discussed how targeted analytics can help your department become more efficient, yielding higher quality outcomes. It’s time to take a deeper dive into how radiology groups and imaging services providers can benefit from real-time, self-service analytics, starting with the leadership perspective.

The challenges facing the leaders of these organizations have remained tremendously complex over the past decade. Reimbursement rates are under pressure, alternative payment models are popping up, requiring new and detailed measurements, all while competition is increasing from every direction. In order to be effective the leadership of radiology groups and imaging services providers must fully understand both non-clinical and clinical operations, including non-diagnostic clinical activities, and their collective impact on cost, quality of care and reimbursement.

Diverse Leadership Challenges

The entire leadership team must monitor a range of financial, operational and clinical metrics, with the goal of optimizing available resources and maximizing profit margins and revenue, despite the uncertainty caused by new payment models and value-based imaging. Here are some examples of critical areas that must understood so the entire organization can be aligned to support their achievement:

    • Emphasizing activities that lower costs and improve quality
    • Empowering the organization to understand the impact of non-diagnostic activities on costs and reimbursement
    • Ensuring that the group’s clients understand the full clinical and financial value the group provides
    • Implementing tools that build trust across the organization, enabling the organization to quickly improve performance
    • Compliance with registry reporting guidelines
    • Adopting Clinical Decision Support (CDS)
    • Reducing unnecessary imaging

    Accomplishing these requires a detailed, in-depth understanding of the current state of the business and the ability to monitor the organizations progress towards achieving the interim milestones that indicate the organization is moving in the right direction. This is where real-time, self-service analytics comes in, to facilitate immediate insights that bolster timely course corrections, organizational alignment and the requisite behavioral change. Using an independent solution like Foundations™ Radiology allows all users to easily monitor metrics such as:

    • Overall CDS utilization by specialty
    • Referrer or patient follow-up rates by radiologist
    • Prevalence of inappropriate exams by modality and ordering physician
    • Screening exam callback rates by exam type, location or technologist

    Foundations™ Radiology simplifies insights to many other operational and financial trends in easy-to-view formats, giving the radiology practice leadership team a leg up to stay ahead.

    In our next blog post we’ll explore how real-time, self-service analytics can benefit cardiology service line leaders.

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Everyone Claims Analytics are Helpful; But How Can I Use Them?

In our last blog post we discussed the importance of using the right analytics tool for the job, and clarified the important roles of enterprise versus departmental analytics. Now that we understand they both play vital but separate roles in healthcare organizations, how will targeted analytics help my department become more efficient and yield higher quality outcomes?

As you know, private radiology groups are independent service businesses that provide reading services for a wide range of in-patient and outpatient customers. Hospital-based cardiology groups provide critical, high margin inpatient services for healthcare organizations. Both groups are facing reimbursement cuts and must comply with and manage new quality reporting requirements that will further affect reimbursement and profit margins. Additionally, since cardiology patients usually skew older and often are paid by Medicare or Medicaid, they create additional reimbursement challenges that further reduce margins.

An old adage is that you can’t manage what you can’t measure. In order to survive in the new order where reimbursements continue to shift from volume to value, quantifying the productivity, quality and financial measures is critical. Departmental analytics must be flexible and user-friendly enough to enable a wide range of constituents to understand and manage their department’s financial, operational and clinical performance. Beyond reporting on quantities of procedures, quality indicators such as radiation exposure, and efficiency measures like turnaround time,

Radiology groups also demand:

  • Registry reporting compliance;
  • Understanding costs and what controls them;
  • Identification of revenue drivers.

Cardiology departments further require systems to:

  • Monitor impact on patient readmissions and 90 day costs;
  • Track DME inventory and deduce margins;
  • Optimize resource utilization.

It’s essential to have a strategic plan for adopting and implementing such a platform. It’s important given that many stakeholders will benefit from using this type of analytics tool, and it requires integration with numerous IT systems to ensure access to useful data. That’s why it’s imperative early in the process to gather input from all affected constituents, recognizing questions the organization needs to answer, and identifying the IT systems to integrate. This effort also facilitates buy-in, to ensure successful technology adoption by those with a vested interest, so the analytics tools will address their needs.

In upcoming blog posts, we take a deeper dive into how private radiology groups and cardiology departments, along with their practice leadership, can benefit from real-time, self-service analytics.

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Fishing From the Queen Mary

Self-Service analytics in healthcareAs Parag mentioned in our last blog post, monolithic enterprise analytics platforms are not designed  to empower departmental end users to quickly pose questions and get timely answers. Rather, the  process of identifying sufficiently detailed and actionable information is an iterative one, benefitting  from a short time span between receiving reports and gathering new information. The optimal  approach is to complement these top-down enterprise platforms with real-time, self-service  departmental analytics.

Healthcare systems are finding success letting departments use independent solutions that provide  the unique depth and breadth of insight they need, while still complementing enterprise analytics.  Enterprise platforms are not optimized to rapidly provide custom and useful insights for each  department. Without a complementary departmental analytics platform, some IT executives are  questioning the value and utility of the enterprise platforms themselves. As one hospital IT executive  expressed – “12 months and 12 million dollars for 12 reports is silly.” Using an enterprise system for  its appropriate functions (e.g. risk stratification, population health, revenue cycle management,  supply chain optimization), and supplementing it with a customized departmental solution, ensures  everyone gets what they need.

You might ask, what is the difference between a departmental analytic solution and an enterprise  platform for healthcare? Here are a few key differences:

  • Enterprise healthcare analytics put a lot of emphasis on retrospective claims data, whereas  departmental solutions tend to go deep into clinical data.
  • Enterprise solutions use data warehouses and data lakes that are loaded during non-peak  hours, whereas departmental solutions often are real-time or near real-time.
  • Enterprise solutions often require a data scientist or IT specialist to create a report, adding  distance between the creator of the data and the creator of the report.

At the other extreme, many end user applications and imaging systems now also include some kind  of analytics and reporting – it has become fashionable to have and advertise that as part of a  healthcare application. Please realize, though, that these clinical or operational applications are not  designed to share data with other programs – there is no technical or business case for those vendors  to share or aggregate their data. Typically, proprietary designs and competitive positioning interfere  with the opportunities for these systems to interrogate and report on this data in a unified manner.

Departmental and solution-specific analytics platforms must be vendor agnostic and integrate  information from all IT systems necessary to provide actionable insights. They must support the  iterative and individualized process of inquiry necessary to uncover meaningful and sufficiently  detailed information. And they need to do this quickly. So it’s not a question of choosing between  an enterprise platform or department analytics – they are different tools solving different problems.  The optimal solution is using both. You are not going to try to fish a river from the Queen Mary,  and you are not going to cruise to England in a Boston Whaler – you need the appropriate tool for  the job. So if your organization already has enterprise analytics, then you’re a step ahead. But don’t  be fooled into thinking that’s all your clinical departments will need. Analytics solutions like  Foundations™ complement the enterprise analytics system your organization is already using,  providing your departments with the insight necessary to succeed!

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The Role of Real-Time, Self-Service Analytics in Healthcare

Self-Service analytics in healthcareEnterprise analytic platforms play a valuable role because of their ability to collect big data that can be warehoused and mined across the healthcare organization. They are often used successfully to solve complex problems, such as:

• Risk stratify capitated patient populations,
• Provide insight into supply chain improvements, and
• Ferret out revenue cycle bottlenecks,

to name a few. One has to ask why, despite the power and capabilities of these centralized, top-down platforms are hospital departments still missing sufficiently actionable, data-driven insights?

One of the main reasons is that monolithic enterprise platforms are not typically designed to empower departmental end users to quickly pose questions and get answers. Instead, these complex, centrally managed systems can impart significant lag times between requesting a report and obtaining results, lengthening a key usability metric called “time to initial insight”. Moreover, the initial reports produced by any analytics systems and the insights they may provide frequently prompts additional questions in order to uncover the actionable details necessary and sufficient for optimal decision-making, and that also build trust and organizational alignment. Unfortunately, obtaining such details via these systems often requires time consuming, iterative report changes that don’t support rapid and continuous clinical quality improvements.

One approach that has demonstrated effectiveness is complementing the enterprise analytic platforms top-down, strategic decision making capability with a cloud-based, departmental, self-service analytics solutions. This approach empowers service line leaders and clinical department staff to access the bottom-up understanding and real-time feedback needed to achieve continuous clinical quality improvement. Because both enterprise and departmental systems each have an important role to play, leveraging the strengths of both can ensure the entire organization benefits. More about the hybrid departmental approach to data analytics in our next blog.

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