Issues ranging from the reading room lighting, vacation amount and holiday shift scheduling, the need for incremental hires, investing in equipment and facilities, growth, to productivity expectations are pervasive in many practices. It is important to remember that large groups can have many of the same issues as small groups, in addition to the challenges that come with scale and growth.
A team of radiologists from Wichita Radiological Group (WRC) and Michigan State University College of Medicine laid out a thoughtful series of strengths, opportunities, and threats associated with private practice radiology in a paper published in the June issue of the Journal of the American College of Radiology. In doing so, they provided a compelling apologia for the private practice model itself.
Kamran Ali, MD, and John Lohnes, MD, President and CEO of the Wichita practice, and Andrew Moriarity, MD, Michigan State University College of Human Medicine, conjecture that half of the estimated 36,000 radiologists today practice in private practice partnerships, a model historically viewed as an efficient and cost-effective method of delivering radiology services. Yet, the authors remind, a 2016 survey from the ACR Committee on Economics of the Commission on General, Small, Emergency and/or Rural Practices found that many practices of 30 or fewer radiologists had planned to reorganize in response to the changing health care terrain.
Citing the trend of consolidation in radiology, the authors identify the following players who are actively competing with private practice for the $18 billion radiology services market:
“In this era of declining reimbursements, ballooning payor reporting mandates, rapidly emerging technologies, increasing demand for expanded coverage, shorter turnaround time expectations, and increasing demand for subspecialty interpretations, how does a private practice remain successful and independent?” the authors ask. Here is what they suggest:
Maximize your local visibility. Private practices have the need to leverage their community presence, and non-RVU generating activities that support the hospital are a critical component of local presence.
Support your singular mission by building and empowering a strong management team. Mitigate the pitfalls that like-mindedness can engender by setting specific goals and ensuring robust engagement and dialogue.
Enumerate the added value your practice provides to the hospital and communicate these activities to hospital leadership at every opportunity. The authors provide the following examples: hospital committee participation, help in implementing hospital strategic initiatives (such as CDS), progress toward quality-improvement initiatives, reports on referring physician relationship building and patient outreach activities, and practice improvements that impact service including shift changes, in-house coverage, ED communications, and staffing a subspecialty tumor board. In short, take every opportunity to educate hospital administration on the many activities your practice undertakes to improve patient care with no hospital funding. The authors offered the “radiology value-added matrix” described by Patel et al in an ACR Imaging 3.0 case study as an example.
Aim to be all things to all stakeholders. While this may seem more than anyone could deliver, the authors suggest it is a great place to start because it forces analysis of what stakeholders need and opportunities for growth if you are not currently fulfilling those needs. Also, understand that you likely have more financial flexibility to help fuel growth than the typical practice allows. “Most independent groups find themselves in the category of midsized businesses as defined by the Ohio State University’s National Center for the Middle Market, with annual revenues between $10 million and $1 billion,” they write.
Engage with early-career radiologists. The authors cite research that suggests most early-career radiologists believe corporatization is harming the specialty, and recommend that groups emphasize self-determination as a private practice benefit, and making sure they are included in various decision-making committees.
Align with other radiology practices. Declining reimbursement, infrastructure deficiencies, and opportunities for quality improvement are cited by small and mid-sized groups considering acquisition by corporate entities, but private practices can achieve similar results through local and regional alliances, suggest Ali et al, by consolidating IT infrastructure, billing and revenue cycle management, and retirement plan administration. Shared subspecialists, human resources, and investments in quality can be shared, they suggest.
Ali et al identify two primary threats to private practice radiology and they are uncannily similar to the threats menacing our broader society—internal politics and burnout. "Issues ranging from the reading room lighting, vacation amount and holiday shift scheduling, the need for incremental hires, investing in equipment and facilities, growth, to productivity expectations are pervasive in many practices," write Ali et al. "It is important to remember that large groups can have many of the same issues as small groups, in addition to the challenges that come with scale and growth."
Concrete steps practices can take to mitigate these threats are offered by the authors.
“Practices that establish core values of the highest commitment to patient care and physician and staff inclusivity, foster personal and professional engagement, respond to referral sources while demonstrating value, and show genuine concern for the emotional well-being of individuals in the practice will be the ones best suited to remain successful and independent,” they conclude.
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