Tide of managed care brings challenges to radiology administrators nationwide

Imaging managers are taking up expanded responsibilities

Changesunder way in the U.S. health-care marketplace are shaking up thelives of radiology administrators. The provision of more practiceinformation and a broadening of skills is key for these administratorsas they cope with the new challenges of managed care and the potentialchanges involved with health-care reform.

Radiology administrators, once focused on processing volumesof referral imaging business, are seeing their role shift to oneof cost-containment authority and multitalented hospital managementguru, said Brenda Holden, administrative director of radiologyat Loma Linda University Medical Center in Loma Linda, CA. Holden,who is also outgoing AHRA president, spoke with SCAN earlier thismonth.

The escalating need for training and data that impact capitatedradiology services may be why a record attendance is already assuredfor this month's annual meeting of the American Healthcare RadiologyAdministrators (AHRA) to be held in Las Vegas, she said.

"We are seeing a flattening of (hospital) organizations,"Holden said. "Radiology administrators are often asked totake on other departments, which can involve almost anything fromlaundry to housekeeping to another ancillary service. We wantour members to have the tools and education that they need totake on any management job that is needed in addition to radiology."

Radiology administrators are well positioned to expand responsibilitieswithin the hospital since their traditional role usually involvesmultiple imaging-related departments, such as cardiology, nuclearmedicine and ultrasound. They are accustomed to dealing with differentgroups within the hospital and sometimes have multiple reportingrelationships to upper administration, she said.

In a capitated radiology environment, pressure is growing toreduce cost and decrease utilization. This means administratorsneed to keep imaging down to the minimum level that ensures adequatepatient care.

"The most profitable hospital in the world would get capitationchecks every month and do absolutely no procedures," Holdensaid. "If you are in strict capitation, the less you do themore you make."

Most radiology administrators are not yet in a fully capitatedenvironment, but the trend, which started at Kaiser Permanentein California, is well entrenched in that state and spreadingacross the country, she said.

Radiology administrators are making a transition from theirpast role of keeping referring physicians satisfied by providingrequested tests to being a gatekeeper and determining what proceduresshould be performed, said Kenneth C. Johnson, president of KennethJohnson & Associates of Columbus, OH.

These administrators are in the middle of the gatekeeper processand must make sure that all relevant parties participate in ateam decision aimed at the same goals, agreed Scott M. Raymond,director of The MR Cooperative of Solana Beach, CA. In particular,the radiology administrator must be aware when dealing with radiologygroups still working with a fee-for-service mind set.

"They (imaging administrators) need to pull all the entitiestogether and make it work," he said. "If you have divergententities like radiology groups that are simply contracting forservices, they need to be on that same ship or (capitated operations)will be frustrated."

Radiology administrators must ensure that they provide adequatescheduling flexibility and staff time allocation in order to matchresources and work flow, thus keeping costs down, Holden said.

The key to providing efficient yet clinically adequate radiologyservices under capitation is to obtain sufficient practice statisticsand benchmark standards so that administrators stand on firm groundwhen dealing with managed-care forces, she said.

"Utilization (of radiology services) is going down. Thereis no question of that," she said. "That is fine ifit occurs in a well planned and clinically safe way. What is badis when bureaucrats make clinical decisions that affect patientoutcome."

AHRA completed the first phase of a project this year to gatherclinical practice-pattern data and will move into developing benchmarksin the coming year, Holden said. This will enable facilities acrossthe country to compare their operations.

Seven years ago, the AHRA was the principal force behind thefounding of the Summit of Manpower to deal with a technologistshortage. With that shortage largely solved, this group has evolvedinto the Summit on Radiological Sciences and Sonography, she said.The new summit has an expanded mandate, which includes lookingat government issues and lobbying.

An issue of great concern to radiology administrators is talkby some reformers of abolishing licensing requirements and variousstate regulations for radiology-related fields. The belief thatcompromising certification standards will help reduce staffingcosts would likely end up compromising patient safety, Holdensaid.

"We are making sure our views are heard in Washingtonabout the safety of patients and potential risks if they throwaway the baby with the bath water," she said.