Gaining an Edge

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Geodax Imaging solved their PET and other subspecialty modality needs by contracting Franklin & Seidelmann Subspecialty Radiology. (Geodax Imaging)

Judith Stern Waxman, director of marketing for Geodax Imaging LLC, faced a choice that seemed unattractive at best. Her company operates several imaging centers that are located outside of major metropolitan areas, with procedure volume levels that are typical; yet she needed an "edge" to attract referring physicians who were sending patients to her competition.

While it seemed that every hospital and other nearby imaging center employed general radiologists, Waxman understood that her target audience of referring physicians would be most attracted by the high-quality reports associated with subspecialists. She knew that it would not be feasible to retain an entire in-house team of subspecialty radiologists, even if Geodax was able to attract them to their sites located in suburban locations in Avon, Ohio; Las Cruces, N.M., and, soon, Yakima, Wash.

Geodax management opted for an alternative – a subspecialty teleradiology group that interprets all of the imaging centers' studies. By utilizing a network of subspecialty teleradiologists, Geodax can market its imaging center services to niche physicians, while still preserving a variable cost structure by paying a fee per study for the professional read. Also, Geodax does not have to support full-time subspecialists' salaries that may be underutilized due to varying levels in procedure volume.

"Our marketing plan called for increasing our penetration among podiatrists, neurosurgeons, oncologists and orthopedists," Waxman says. "With this structure, I could present a very strong case to each of them that we'd be able to go beyond the traditional report to provide definitive interpretations that support their medical specialties."

Imaging facilities have been struggling for recent years with how to staff radiologists to adequately support procedure volume and mix, as well as meet the needs of referring and on-staff physicians. Several options are available, such as on-site full-time radiologists, local group practice, locum tenens, subspecialty teleradiology and traditional nighttime teleradiology service providers. Still, it's getting harder to rely solely on a single model.

Geodax Imaging found the solution right for them by contracting with Franklin & Seidelmann Subspecialty Radiology (F&S), Beachwood, Ohio, as their radiology partner that provides all the reads and modality protocol development support for many of their imaging centers. The F&S network includes more than 30 subspecialty radiologists, which when combined, are licensed in 50 states and utilize a teleradiology platform to distribute images and reports.

Significant trends in radiology have paved the way for the subspecialty teleradiology model to be utilized by all types of imaging providers. This type of model is flexible enough to be used as a single staffing resource or to complement existing expertise on staff.

At the core is the ability to optimize the staffing strategy through access to a subspecialty radiology network when it is needed. An imaging facility obtains access to multiple subspecialty experts and the quality reports without having to hire them all as full-time staff. This is seen by many as a solution that addresses many of the financial and technological issues driving radiology:

• Increasing modality complexity and limited annual subspecialty case volume presents a challenge to radiology. The knowledge base that today's radiologist must maintain across all modalities and medical specialties is far too difficult for any one radiologist to achieve expertise in everything. This, in turn, has created the demand for subspecialists who are experts in specific areas of clinical specialties, modalities, anatomies and pathologies. Most imaging facilities do not generate enough subspecialty volume to merit hiring multiple subspecialists on staff. This can result in a single subspecialist who may be experienced in musculoskeletal MRI who has to read everything from X-ray, CT and ultrasound, to neuroradiology and body studies, or a general radiologist who must read everything, as well.
• Meeting demands from physicians is becoming more difficult as medicine specializes. Physicians require decisive, directive, definitive, detailed reports from radiologists who have a better understanding of their specific pathology and surgical/medical options.
• The shortage of radiologists is even more noticeable with subspecialists, who are few to begin with. Staffing challenges and increasing competitive pressures are driving imaging facilities to utilize new radiology staffing models in order to obtain the radiology expertise that supports their procedure mix and interpretation needs. F&S addressed the staffing shortage barrier in part through its teleradiology model, which also allows it to attract the top subspecialists available, regardless of where they're located. The teleradiology solution, coupled with subspecialty expertise, worked well for Geodax. "What difference does it make if the radiologist is down the hall or in another state when he or she is going to consult with the referrer over the phone, anyway?" Waxman asks.
• Subspecialty reports are the primary differentiator for building a competitive advantage and increasing referrals. "We asked ourselves what role subspecialty radiology plays for us, Waxman says. "Is it a primary deliverable, a complementary service provided when required or a luxury considered as a "nice to have?' Our growth strategy calls for it to be a primary deliverable." Waxman has effectively used sample radiology reports and radiologists' bios in conjunction with lectures to educate her referrers on the value of subspecialty radiology reports.

"We chose this radiology staffing strategy for our imaging facilities in order to gain access to several subspecialists in F&S's network," Waxman says. "For example, Richard Black, DO, is widely regarded as one of the country's premier experts in PET technology. For us, to tell referring physicians we offer his level of interpretation expertise in conjunction with our state-of-the-art modalities and stellar technologists dramatically solidifies our own image as leaders in nuclear medicine. It's a level of expertise not commonly available to imaging centers, and certainly not to those located in the rural areas in which some of our centers are located."

Geodax's other staffing option was to hire a full-time, on-site generalist for all reads. "With F&S, we gain access to industry leaders – a nuclear medicine specialist, for instance, who only practices nuclear medicine," Waxman says. "This is going to make the difference to the physician and improve patient care and outcomes."

Still, determining the appropriate staffing strategy for an imaging facility requires serious thought and analysis to fully understand physician needs and referral opportunities, procedure type and volume, business goals and radiologist staffing options available.

Physician Needs

The key to increasing physician satisfaction levels is to understand your referring physicians' specific report and consultation needs and then effectively delivering them. Does the report provide enough detail and direction in order for your physicians to treat their patients?

Typically, physicians look for specific anatomy, pathology, utilization of medical terms that relate to their area of clinical specialty, fast turnaround time and easy access to radiologists for consultations.

Radiology Metrics

Medicine today is, arguably, as much of a numbers game as any other profession. If you understand the numbers, your referral business and revenue grows, but the practitioner who doesn't have a detailed understanding of these key metrics will not be able to make sound business decisions. Therefore, it is critical to understand key radiology metrics, such as:

• Exam counts by modality, procedure type and area of subspecialty – to help you understand which radiologists types (generalist vs. subspecialist) and how many are needed in order to support current and expected procedure mix and volume; and understand existing staff's needs such as night time, vacation coverage or interventional support
• Exams from most to least profitable – to help you maximize the most profitable exam categories by targeting the most profitable physician referrer groups
• Referral trends by individual physicians and medical specialty group types – How have your physician referrals grown and declined, and do you know why? Are you meeting the needs of your largest physician groups?
• Referral/business growth opportunities and goals – Which new high-end modalities are planned for purchase and do you have the radiologists to support these interpretations? What is your expected imaging volume increase? What new specialty physician groups can be targeted? Are subspecialty reports a way to gain a competitive advantage? How will you measure the success of your imaging services?

Staffing Models

Make an apples-to-apples comparison so that you and your associates understand the benefits and differentiators between each type of radiologist staffing model. Make sure you review the radiologists' CVs and ask questions to pinpoint their level of expertise such as the number of subspecialty cases interpreted, academic experience and fellowships. Also, have your physicians review samples of their reports to confirm they will meet your organization's needs.

If a teleradiology system will be utilized by an individual or group, it's important to understand the level of scalability, security and the report and image distribution processes. Current staffing models include the following:

• On-site, full-time general radiologist
• On-site, full-time subspecialist
• Contracted local radiology group
• Locum tenens
• Subspecialty teleradiology
• Traditional teleradiology (i.e., nighthawk)

In conclusion, by first understanding your referring physicians' report needs, key radiology metrics and radiologist staffing resources available you can then determine the best way to develop your staffing model for your imaging facility. Alternative models, such as subspecialty teleradiology groups, have emerged as market conditions affecting radiology, such as advanced modalities requiring specialization of the radiologist's knowledge base, referring physicians' need for detailed, clinically focused interpretations and the radiologist shortage, have been working in parallel to increase the demand for cost-effective, efficient ways to access subspecialty expertise.

With the options available today, you can find the appropriate strategy between on-site experts and virtual subspecialty coverage or an integrated approach.

— Christine Boehm is vice president of marketing at Franklin & Seidelmann Subspecialty Radiology (www.franklin-seidelmann.com), Beachwood, Ohio. Questions and comments can be directed to editorial@rt-image.com.