Hospital-Employment Model Not Hitting Radiology Groups

CHICAGO - Worried your private radiology practice will get swallowed up by a hospital? Perhaps there’s little need to fret. The hospital employment trend sweeping your primary care colleagues hasn’t - and likely won’t - hit radiology.

That’s according to Shay Pratt, managing director with the Advisory Board Company, who spoke at an RSNA session Tuesday. Payment cuts will impact practice profitability, “but that hasn’t really pushed groups toward hospital employment to date,” he said. “There’s no real urgency for them to employ radiologists.”

Hospitals prefer the private practice model for radiologists, Pratt said, because they don’t have to pay the higher salaries and can focus on aligning with referral-generating physicians. Radiologists for their part tend to be reluctant to give up the practice model, too.

Patricia Kroken, a consultant and principal at Healthcare Resources Partners LLC, offered a case study during the session that helped explain why radiology practices are keeping their independence. Her composite case showed there’s not always security in the steady salary and covered overhead of hospital employment, as many physicians perceive. In fact, for one group she worked with the frustrations and downsides were enough for the hospital-employed group to break out back into private practice.

In her case, the hospital was wondering why the radiology department wasn’t more productive. The hospital was covering off-hour reads, which was costing them money.

On the radiologists’ side, they were frustrated by a legacy billing system and outsourced billing operations that showed them underperforming in terms of their collections. The base salaries were competitive, but not great, and other benefits were weaker than would be in private practice. Meanwhile, they had no control over their administrative staff, had a hard time recruiting, and struggled with an unsupportive IT department.

Returning to private practice turned out to work well for this group, explained Kroken, who works mainly with private practice radiology groups. They hit revenue targets ahead of schedule, compensation and benefits became more competitive, and they “felt like they had more control over their destiny in private practice.”

Hospitals might not be acquiring radiology practices, but there is a flurry around other partnerships and joint ventures between radiology groups and hospitals, Pratt said, particularly as new models emerge such as shared savings and bundled payments.

For example, the Accountable Care Organization model spurred by healthcare reform will require collaboration between radiology groups and hospitals for referrals and to help manage image utilization. But Pratt said radiology groups likely won’t be a part of the ACO, but rather a partner with an ACO. Still, groups should be involved in the planning stages of the ACO and get involved in ACO working groups. They might not be beating the ACO drum in the streets, as Kroken put it, but they should have a seat at the table, just not as an employed group.

“There are ways in which radiologists can get involved in those discussions,” Pratt said, “and think about how the imaging side of the house can get involved in the overall ACO incentive.”

Do you agree? Are you feeling the hospital-employement pressure?