Richard Woodcock, MD

Our business has changed substantially in recent years. Ours was a practice that was primarily hospital-based. However, it underwent a paradigm shift, and the group has added a substantial amount of teleradiology and non-hospital based business. In so doing we have made several philosophical decisions and must continue to consider those.

Leaders in our practice started looking critically at our operations. We wanted to find out how well our billing and administrative operations function. Radiology profitability, as with most physician practices and businesses, is as much about keeping your overhead down as it is about increasing your income. I’ve learned that as long as revenue comes in and physicians’ paychecks are as big as-or bigger than-last year, most partners believe that all is well.

Radiology groups often describe themselves as being lifestyle-driven or financially driven. This distinction is helpful in describing a group’s philosophy, and in terms of workflow, these approaches can coexist.

When times get tight, we start to hear complaints about overhead costs and nonphysician staff costs. That’s natural. But don’t let folks jump to conclusions. Just because you don’t know or understand a process doesn’t mean it’s superfluous. When I hear our radiologists mumble “what do all those people do?” I tell them it is time for them to find out. But don’t stick all the work on one person. Use the perceived “crisis” or gripe-fest to educate the staff on processes in the back office.

A great deal of our time has been spent trying to find ways to make ourselves more efficient. One of those ways we began looking at several years ago was reducing the time we spend in nonbillable activities and in performing procedures that our hospital affiliation requires but that are relatively time-intensive for their reimbursement. To do this, we looked into hiring physician extenders.

Too often radiologists are far removed from the billing and collections process. Giving them a better understanding of the process, and the role their reports play in it, can improve collections and streamline the work that takes place in the back office.

Is it time to add another physician? We have asked this question quite a bit recently, especially on busy days, which seem to be happening more often. Because adding another full-time physician would be expensive-especially if we guessed wrong-we wanted to make sure that it really was time to expand.

Until we broke down the numbers, we didn’t realize that our practice’s overnight call coverage cost had increased by 200% in just three years. We had to take a close look at the root causes before we could agree on the solution.

Like many groups, we feel like we are always in the midst of negotiations with our hospital. During each renegotiation, it seems that the hospital starts by describing our deficiencies. Often, the barrage would start before the negotiations commenced. Missed cases were brought up, as were issues related to personnel conflicts. Irregularities in report turnaround might be mentioned, and unhappy clinicians seemed to suddenly surface.