About four years ago, Presbyterian decided to self-disrupt, and they opened three freestanding emergency rooms in a very novel concept. Basically they see and triage the patient and take care of them in an urgent care setting or an emergency setting. It is a very good model that has been very successful and good for the community.
Earlier this year, Radiology Associates of Albuquerque, PA (RAA), the largest independent private practice radiology group in New Mexico with 38 Radiologists, became a member of Strategic Radiology. RAA brings its unique Southwestern experience to the collective’s group DNA, and theirs is a success story that has tracked closely with its health system partner, marked by growth and collaboration in the service of patients.
The practice was founded over 40 years ago, marking the beginning of a long and productive relationship with Presbyterian Healthcare Services as its exclusive radiology provider. “The health system has grown tremendously during the course of our partnership,” explains Daniel Fuentes-Bernardo, MD, an interventional radiologist who has served as president since 2018. “RAA has also continued to advance and grow over the years to fully support our hospital partner and the communities we serve.”
The health system currently consists of 9 hospitals, including the 500-bed flagship Presbyterian Hospital, Presbyterian Kaseman Hospital, Rust Hospital, a recent new build in Santa Fe, and a network of hospitals in the outlying, smaller, peripheral communities and cities located throughout the state. The health system also offers an insurance plan. RAA provides comprehensive radiology services for all locations.
Serving a large, lightly populated state offers opportunities and challenges that both health system and radiology practice have met with verve. “About four years ago, Presbyterian decided to self-disrupt, and they opened three freestanding emergency rooms in a very novel concept,” explains Dr. Fuentes. “Basically, they see and triage the patient, and then they take care of that patient in an urgent care setting or an emergency care setting. It is a very good model that has been very successful and good for the community.”
RAA reads those studies for the health system, and as a result, ED studies represent about 38% of volume for the practice. “We do have a very large emergency care division to cover that volume,” Dr. Fuentes says.
RAA also works closely with Presbyterian Health Plan to provide outpatient breast imaging services. High Resolution was founded in medical imaging’s pre-digital days and ensures that its enrollees have access to high quality breast imaging services in ACR–accredited Breast Imaging Centers of Excellence (BICOE).
“We consolidated all the hospital mammography services into High Resolution, which includes two breast centers of excellence. High Resolution-Main is a beautiful facility built about 18 years ago, which provides full-service, comprehensive mammography services including breast MRI; and High Resolution Rust, where mammography and breast surgery consultations are performed concurrently. Dr. Fuentes shares. RAA has its own imaging center (RAA Imaging), which is adjacent to High Resolution-Main, that provides all diagnostic imaging modalities not included in High Resolution. RAA had the first ACR accredited Diagnostic Imaging Center of Excellence (DICOE) in New Mexico.
“The ACR DICOE and BICOE designation underscores RAA’s commitment to imaging quality and safety, “says Rhonda Mayorga, PhD, COO of RAA. “Further, it delineates our focus on providing imaging best practices for patients, partners, and referrers in our local community.
Challenges in Serving a Largely Rural State
Of course, there also are challenges in the New Mexico market that are unique to serving a large state in which half of the population is concentrated in the three largest cities— Albuquerque, Las Cruces, and Santa Fe—and payor mix, and delivery of care lead the list.
“Payor mix is always an issue in the state,” Dr. Fuentes notes. “We are a somewhat rural state, low in population, and there is not as much commercial insurance in New Mexico as in other states.
Delivery of care to patients who must travel hours for diagnostics and treatment is another challenge. “As an interventionalist, for example, my rural patients may get their primary care and basic imaging at one of our rural hospitals that is three hours from here,” he begins. “Then, if they need a procedure, they have to drive three hours to Albuquerque to get it done.”
By virtue of geography, a significant number of patients travel to Albuquerque as they might to MD Anderson for cancer workup and biopsy to be completed within a short admission. “Follow-up is also a challenge,” Dr. Fuentes notes. “In interventional, for example, if your patient lives in town and you drain an abscess, you can tell them to go home and come back in three days. When they live four hours away, that can be difficult to do, so they are hospitalized while we try to heal the abscess and pull the drain so that they can drive four hours home.”
As might be expected, RAA has deployed a sophisticated information technology solution to facilitate serving all nine hospitals throughout the state and an assortment of outpatient sites. ‘Ten years ago, we read from hospital workstations in our office, and since then we have built our own parallel PACS with the ability to read from home, from out-of-state, from within the hospital, or from our offices.”
Aligning with a National Coalition
In aligning with Strategic Radiology, RAA found a community of like-minded independent groups interested in maintaining independence and developing initiatives to support independent practice. “Strategic Radiology reached out to us, so we started a conversation,” Dr. Fuentes shares. “As the largest independent private practice in the state, we have always been motivated to remain independent and foster a culture that resists selling to private equity.”
“Strategic Radiology provides tremendous resources to us. Besides the knowledge base, it is an amazing organization. The expertise, the camaraderie, the ability to share notes with other practices on how they solved a particular problem, the fact that we have all these forums for our CFO and operations is very helpful.”
“In the short term,” he adds, “we are looking toward leveraging our insurance products with the Strategic Radiology health care offering. We also are very interested in collaborating with SR on an internal teleradiology network.”
Hub is the monthly newsletter published for the membership of Strategic Radiology practices. It includes coalition and practice news as well as news and commentary of interest to radiology professionals.
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