ACR initiative aims to diffuse radiologist-hospital tensions

A new initiative by the American College of Radiology addresses growing tensions between hospitals and their contracted radiology groups, some of which have caused the relationship to end in a bitter breakup.

A year in the works, the report by the ACR’s Task Force on Relationships Between Radiologists and Hospitals and Other Healthcare Organizations is due to be published in the June issue of the Journal of the American College of Radiology.

The 10-member panel was headed by Dr. Cynthia S. Sherry, chair of the radiology department at the Presbyterian Hospital in Dallas and a former president of the American College of Physician Executives.

“Because of all these tensions, exclusive contracts are coming under dispute. That’s what we’ve seen across the country,” Sherry said in an interview with Diagnostic Imaging.

Radiologists are not alone in facing significant challenges in practice, said Dr. Barry Silbaugh, CEO of the American College of Physician Executives.

A key consideration for all physicians is how to balance their long-held preference for autonomy and independence with a new focus on multidisciplinary teamwork, he said. With payment reform likely to be based on outcomes of care, many physician groups and health systems are already exploring the idea of accountable care organizations that will aggregate financial risk for thousands of patients and consumers and will be accountable for outcomes of care.

“This concept requires us to ask how ‘focused factories,’ such as freestanding imaging or endoscopy centers or vascular labs will fit with capitated or bundled payment mechanisms for care across a horizontal continuum,” Silbaugh said.

The task force report examines sources of added tension in the radiologist-hospital relationship. These include increasing financial challenges and attempts by both sides to deal with them, sometimes in ways that are not mutually beneficial, Sherry said. A radiology group, seeking new revenues, might establish an imaging center independent of the hospital. A hospital, on the other hand, might lean on the radiology department to generate more revenue.

Turf battles also create tension. When imaging equipment is owned by the hospital, administrators and other specialists may think it can be used by any physician with the education and necessary skill. This problem may be growing because other specialties are trying to get more ancillary income, Sherry said.

Compounding this is the demand for greater efficiency, which makes radiologists want to limit interruptions. As a result of this and of their isolation due to PACS, radiologists interact less with referring physicians and administrators, Sherry said. Practice dynamics also plays a role, with many practices lacking skilled leaders or being unwilling to empower a member to speak for them and spend time dealing with administrative issues. To deal with these issues, the task force recommends that:

• Since radiologists are best served by aligning their goals with those of the hospital, they can do so by providing a high-level quality of service and making efforts toward building strong relationships with hospital administrators. They should also respond to the legitimate needs of referring clinicians, including providing subspecialty interpretations. They must develop the leadership and negotiation skills to interact effectively with hospital administrators.

• Hospitals provide an environment that enables radiologists to offer high-quality service. Hospitals can foster good business relationships by including radiologists on key committees and encourage good communication by including them in regular standing meetings. Hospitals should support radiologist recommendations to implement ACR appropriateness criteria.

• The ACR should formalize a process to gather more data. There was plenty of perspective from radiology, but more needs to be known from the hospital side, Sherry said. The ACR should also take a more active role in educating radiologist leaders. The college could be a consultant when groups are in trouble with their hospitals or want to avoid it. Finally, the college can collaborate with other organizations such as the American Hospital Association or the American College of Physician Executives. Similar collaborations can take place between state ACR chapters and their state hospital associations.

Silbaugh has recommendations for steps to deal with the changing environment as well.

“The questions all physicians should be asking include: Where does my specialty fit in this new landscape of teamwork, value-based payment, and consumerism? How can I become a more vital physician leader in both the physician and hospital communities, so that I’m involved in strategic discussions by senior leaders and boards? Where can I learn about the business of medicine that was never taught in my training, but which is increasingly important in today’s complex world of healthcare? Should I become a niche player in an independent radiology service, or should I seek a greater presence in an integrated healthcare organization? Can I do both, and if so, how do I balance conflict with cooperation? “

Also important will be adaptability and an understanding of new delivery models, such as the accountable care organization.

“Radiology leaders who understand these concepts and how to balance autonomy with shared values and teamwork with other physicians and health system leaders will be well positioned to keep their organizations at the center of action as these new models emerge,” Silbaugh said.