Menu Expand
Radiology Business Practice E-Book

Radiology Business Practice E-Book

David M. Yousem | Norman J. Beauchamp

(2007)

Additional Information

Book Details

Abstract

To succeed in radiology, you not only need to be able to interpret diagnostic images accurately and efficiently; you also need to make wise decisions about managing your practice at every level. Whether you work in a private, group, hospital, and/or university setting, this practical resource delivers the real-world advice you need to effectively navigate day-to-day financial decisions, equipment and computer systems choices, and interactions with your partners and staff.

  • Equips you to make the best possible decisions on assessing your equipment needs · dealing with manufacturers · purchasing versus leasing · and anticipating maintenance costs and depreciation.
  • Helps you to identify your most appropriate options for picture archiving systems and radiology information systems · security issues · high-speed lines · storage issues · workstation assessments · and paperless filmless flow.
  • Offers advice on dealing with departments/clinicians who wish to perform radiological procedures and provides strategies for win-win compromises, drawing the line, inpatient-versus-outpatient considerations, cost and revenue sharing, and more.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Radiology Business Practice: How to Succeed i
Copyright Page iv
CONTENTS xvii
CONTRIBUTORS v
FOREWORD vii
EDITORS’ PREFACE ix
EDITORS’ ACKNOWLEDGMENTS xi
AUTHORS’ ACKNOWLEDGMENTS xiii
Chapter 1. Introduction 1
APPLICATION OF THIS BOOK TO ACADEMIC VERSUS PRIVATE PRACTICE 2
ORGANIZATION OF THIS BOOK 3
REFERENCES 4
PART 1: LEADERSHIP IN A RADIOLOGY PRACTICE 5
Chapter 2. Organizational Structure and Governance: Academic, Solo, and Group Practice 6
THEORY OF GOVERNANCE IN ACADEMIC PRACTICE 6
ORGANIZATIONAL COMPLEXITY 7
PRIVATE PRACTICE GROUP MANAGEMENT 14
THE GOVERNANCE OF GROUP PRACTICE 14
CONCLUSIONS 17
REFERENCES 18
Chapter 3. Leadership 19
ARE GREAT LEADERS BORN OR CREATED? 19
WHAT IS A LEADER? 20
LEADERSHIP DEVELOPMENT 20
LEADERSHIP TRAITS 21
LEADERSHIP SKILLS 23
MISSION, VISION, GOALS, AND TACTICS 24
TIME MANAGEMENT 24
THE ROLE OF COMMUNICATION 25
MANAGING CHANGE 28
ACQUIRING LEADERSHIP TRAITS AND SKILLS 29
SUMMARY 31
REFERENCES 32
SUGGESTED READINGS 32
Chapter 4. Strategic Planning 34
INTRODUCTION TO STRATEGIC PLANNING IN RADIOLOGY 34
WHAT ROLE DOES STRATEGY PLAY IN THE FUTURE OF RADIOLOGY? 36
BASIC STEPS IN THE CORPORATE STRATEGIC PLANNING PROCESS 37
THE VISION OF THE FIRM 39
A FIRM’S STRATEGIC POSTURE AND HOW TO GET THERE 39
DEVELOP A MISSION STATEMENT FOR THE BUSINESS 39
FORMULATE BUSINESS STRATEGY AND BROAD ACTION PROGRAMS 40
FORMULATE FUNCTIONAL STRATEGY 40
CONSOLIDATE BUSINESS AND FUNCTIONAL STRATEGIES 40
DEFINE AND EVALUATE SPECIFIC ACTION PROGRAMS AT THE BUSINESS AND FUNCTIONAL LEVELS 42
ALLOCATE RESOURCES AND DEFINE PERFORMANCE MEASUREMENTS FOR MANAGEMENT CONTROL 42
STRATEGIC AND OPERATIONAL BUDGETING: THE FINAL CYCLE OF STRATEGIC PLANNING 42
ADVANTAGES OF STRATEGIC PLANNING 43
PITFALLS OF STRATEGIC PLANNING 43
RIVALRY AMONG EXISTING FIRMS 44
THREAT OF NEW ENTRANTS 44
PRESSURE FROM SUBSTITUTE PRODUCTS 45
BARGAINING POWER OF BUYERS 45
BARGAINING POWER OF SUPPLIERS 46
INTRODUCTION TO BUDGETING IN RADIOLOGY 46
THE BUDGETING PROCESS 47
NET REVENUES 47
NET REVENUES SUMMARY STATEMENT 48
EXPENSES 51
EXPENSES SUMMARY STATEMENT 52
CAPITAL EXPENDITURES (CAPEX) BUDGET 52
BUDGET REVIEW PROCESS 53
CAPACITY ANALYSIS 53
CAPACITY ANALYSIS SUMMARY STATEMENT 53
SHORT-TERM INITIATIVES 53
REFERENCES 56
Chapter 5. Research Mission 57
INTRODUCTION 57
RADIOLOGY RESEARCH 57
HIERARCHY OF CLINICAL RESEARCH AND EVIDENCE 59
RESEARCH FINANCE 60
OPPORTUNITIES 62
CHALLENGES AND PERSPECTIVES 65
CONCLUSION 69
REFERENCES 69
Chapter 6. Turf Issues in Radiology 70
INTRODUCTION 70
TURF ISSUES AND THE IMPACT ON QUALITY, SAFETY, AND SERVICE 71
TURF ISSUES AS AN UNNECESSARY DRIVER OF COST 73
STRATEGIES FOR MINIMIZING THE DETRIMENTAL IMPACT OF TURF WARS 76
APPENDIX 6-1. UW MEDICINE CENTER FOR ENDOVASCULAR THERAPY 83
REFERENCES 85
PART 2: ACCOUNTING BASICS AND FINANCIAL PRINCIPLES 87
Chapter 7. The Vernacular of Accounting 88
STATEMENT OF FINANCIAL CONDITION: THE BALANCE SHEET 89
INCOME STATEMENT 93
STATEMENT OF CASH FLOWS 93
BUDGETS 93
ACCOUNTING ENTITIES 95
INSURANCE 96
RETIREMENT PLANS 96
PRACTICE VALUATION 97
DISCOUNTED FUTURE EARNINGS VALUE 98
SUMMARY 98
REFERENCES 98
Chapter 8. The Resource-Based Relative Value Scale 99
INTRODUCTION 99
HISTORY OF MEDICAL CARE REIMBURSEMENT IN THE UNITED STATES 99
RVU DERIVATION 102
UNDERSTANDING THE RESOURCE-BASED RELATIVE VALUE SCALE (RBRVS) 105
SUMMARY 115
REFERENCES 116
SUGGESTED READINGS 116
Chapter 9. Accounts Receivable 118
INTRODUCTION 118
DEFINITION AND ACCOUNTING REVIEW 119
LIQUIDITY 119
COST OF ACCOUNTS RECEIVABLE (NONCASH SALES) 119
REVENUE CYCLE/AR PROCESS OVERVIEW 121
MEASURING AR 122
AR SYSTEMS 124
AR OUTSOURCING 125
AUDITING AR SYSTEMS 125
DECREASING AR 125
DENIALS 127
NONPAYMENT AND PAYMENT DELAYS 128
BAD DEBT 128
SELF-PAY PATIENTS 128
WRITE-OFFS/CHARITY 129
COLLECTION AGENCIES8 129
SELLING AR (FACTORING) 130
BORROWING AND LINES OF CREDIT 131
AR SECURITIZATION 131
CONCLUSION 131
REFERENCES 132
FURTHER READING 132
Chapter 10. Managing Expenses 133
INTRODUCTION 133
REDUCING EXPENSES 138
CONCLUSION 142
REFERENCES 143
Chapter 11. Purchasing Capital Equipment 144
RADIOLOGY AS AN OVERALL HOSPITAL COMPONENT 144
PURCHASING STRATEGY 145
CAPITAL BUDGET VERSUS OPERATING BUDGET 145
EQUIPMENT ASSESSMENT 152
TIMEFRAME FOR CAPITAL EQUIPMENT 153
BIGGEST MISTAKES IN PURCHASING CAPITAL EQUIPMENT 153
CONCLUSION 154
REFERENCES 155
APPENDIX 11-1. CAPITAL EQUIPMENT 155
APPENDIX 11-2. SPECIFICATIONS 158
APPENDIX 11-3. EXAMPLE OF SPECIFICATIONS FOR RADIOGRAPHIC ROOM 159
APPENDIX 11-4. INTERVENTIONAL RADIOLOGY RFP 160
Chapter 12. Making Cents of Metrics 163
INTRODUCTION 163
GOALS 163
METRICS AT A GLANCE 164
ASSUMPTIONS 164
METRIC TYPES 164
KNOW AND BELIEVE IN YOUR BUSINESS 169
USING YOUR ORGANIZATION’S MISSION TO SELECT ACHIEVEMENT DRIVERS AND RELEVANT METRICS 170
DIFFERENCES BETWEEN PRIVATE AND ACADEMIC PRACTICES 172
CONCLUSION 172
REFERENCES 173
SUGGESTED READINGS 173
PART 3A: BUILDING AND MANAGING A PRACTICE: NUTS AND BOLTS 195
Chapter 13. Information Technology Systems 196
INTRODUCTION 196
RADIOLOGY WORK FLOW 197
ROLE OF THE RIS AND THE HIS 198
ORDER ENTRY 200
SCHEDULING PROGRAM 202
PATIENT INTERVIEW 203
DICOM WORK LISTS 203
STUDY INFORMATION 203
RADIOLOGIST REPORT GENERATION AND REVIEW 204
REPORTS 205
BILLING AND CODING 205
BIRTH OF PACS 205
CURRENT PACS 207
RIS-PACS INTERFACE 207
IMAGE TRANSFER FROM THE MODALITIES 208
IMAGE STORAGE 209
STUDY SELECTION 210
IMAGE ANNOTATION 211
IMAGE EXPORT 211
MONITORS 212
WORKSTATIONS CONFIGURATION 212
INTEGRATING RIS AND PACS 213
PRACTICE CONSEQUENCES OF PACS 216
COMPLEX WORK FLOW AND WORK LIST STRATEGIES 218
AGGREGATE STUDIES AND APPROPRIATE COMPARISONS 218
REMOTE ACCESS AND REMOTE READING 218
SELECTING AND IMPLEMENTING A PACS SYSTEM 220
PACS PROJECT TEAM 220
DEFINE THE VISION FOR YOUR PROJECT 221
WHO WILL RUN THE SYSTEM? 222
VENDOR SELECTION 222
FINANCING PACS 223
PACS CONTRACT 224
IMPLEMENTING PACS 225
PACS AND HEALTH INFORMATION EXCHANGE (HIE) IN THE FUTURE 226
CONCLUSION 227
LIST OF ABBREVIATIONS AND GLOSSARY 228
Chapter 14. Voice Recognition Dictation 231
INTRODUCTION 231
DEFINITION OF VRD 231
THE IMPORTANCE OF THE RADIOLOGIST’S REPORT 231
USE OF VRD 232
THE NUTS AND BOLTS OF VRD 232
OPTIONS FOR USE OF VRD 234
BENEFITS OF VRD 237
DOWNSTREAM EFFECTS 239
VENDORS OF CORE SPEECH ENGINE TECHNOLOGY 241
VENDORS OF COMMERCIAL SOFTWARE PACKAGES 241
CONCLUSION 244
REFERENCES 245
APPENDIX 245
Chapter 15. Quality Improvement Programs 246
INTRODUCTION 247
HOW QUALITY MANAGEMENT BEGAN 247
QUALITY INITIATIVES IN MEDICINE 249
THE PDSA CYCLE 254
CQI AT NYU RADIOLOGY 255
CONCLUSION 270
REFERENCES 271
Chapter 16. Performance Measurements and Incentive Systems for Radiology Practices 273
PERFORMANCE MEASUREMENTS 273
EFFECTIVE PERFORMANCE MEASUREMENTS 273
PERFORMANCE MEASUREMENTS FOR RADIOLOGISTS 274
PERFORMANCE MEASUREMENTS FOR NONRADIOLOGIST PERSONNEL 280
INCENTIVE SYSTEMS 280
GOOD INCENTIVE SYSTEMS 281
BAD INCENTIVE SYSTEMS 282
WHY INCENTIVE PLANS CANNOT WORK 283
WHAT MOTIVATES PEOPLE? 283
MOTIVATING RADIOLOGISTS 285
MOTIVATING NONRADIOLOGIST PERSONNEL 285
CONCLUSION 286
REFERENCES 287
PART 3B: BUILDING AND MANAGING A PRACTICE: GROWING THE PRACTICE 289
Chapter 17. Assessing Growth Opportunities for Your Imaging Practice 290
INTRODUCTION 290
CONCLUSION 300
REFERENCES 301
Chapter 18. Marketing 303
INTRODUCTION 303
DO YOU NEED ANYTHING BEYOND MEDICAL EXPERTISE AND GREAT TECHNOLOGY? 303
HOW MUCH DOES TECHNOLOGY MATTER? 304
WHAT SEPARATES THE WINNERS FROM THE LOSERS IN THE MARKETPLACE? 305
SELLING VERSUS MARKETING– WHAT’S THE DIFFERENCE? 307
KEYS TO SUCCESSFUL OUTPATIENT IMAGING CENTER MARKETING 309
WHAT TO DO TO INCREASE YOUR CHANCES OF SUCCESS 311
HOW TO BUILD A MARKETING GROUP 314
WHAT IS ‘‘STRATEGIC MARKETING’’ AND HOW CAN IT WORK FOR YOU? 315
THE POWER OF INFORMATION 316
CREATING YOUR GROWTH PLAN 317
INVEST IN THE RIGHT PEOPLE 318
CONCLUSION 320
APPENDIX 18-1. SAMPLE SURVEY QUESTIONNAIRE 321
APPENDIX 18-2. POSITION: PRACTICE LIAISON/SALES 323
APPENDIX 18-3. MARKETER’S BONUS PROJECTION (SAMPLE), 2007 TO YEAR END 324
Chapter 19. Teleradiology in Practice 325
INTRODUCTION 325
DEFINITIONS, PERSPECTIVES, AND MODELS 326
TECHNICAL CONSIDERATIONS IN TELERADIOLOGY 330
QUALITY OF SERVICE 336
MEDICOLEGAL CONSIDERATIONS 337
ECONOMICS 340
FUTURE DIRECTIONS AND CONCLUSIONS 343
SUGGESTED READINGS 344
Chapter 20. Medical Entrepreneurship in Diagnostic Imaging 346
INTRODUCTION 346
THE ENTREPRENEURIAL OPPORTUNITY 347
AN OVERVIEW OF THE ENTREPRENEURIAL PROCESS–HOW THE FUTURE IS CREATED 349
CAN YOU HANDLE THE TRUTH? ARE YOU AN ENTREPRENEUR? 356
SO YOU ARE READY TO START–TEN CRITICAL CHALLENGES 358
CONCLUSIONS 363
LIST OF ABBREVIATIONS AND GLOSSARY 364
REFERENCES 365
Chapter 21. Evidence-Based Imaging 367
INTRODUCTION 367
FORMULATING THE CLINICAL QUESTION 368
IDENTIFYING THE MEDICAL LITERATURE 368
CRITICALLY ASSESSING THE LITERATURE 370
APPLYING THE EVIDENCE 375
CHALLENGES 377
CONCLUSIONS 378
REFERENCES 378
PART 4: LEGAL AND LEGISLATIVE CONCERNS 381
Chapter 22. Contracting with Managed Care Organizations 382
PROCESS AND PREPARATION 383
CONTRACT REVIEW 388
NEGOTIATIONS 391
FOLLOWING UP 395
CONCLUSIONS 395
SUGGESTED READINGS 396
Chapter 23. Employment Contracts 397
WHAT A CONTRACT REALLY IS 398
WHEN A CONTRACT IS BROKEN 406
REMEDIES 409
ALTERNATIVE DISPUTE RESOLUTION 411
CONCLUSIONS 411
REFERENCES 412
Chapter 24. Policies and Procedures 414
INTRODUCTION 414
DEFINITIONS 416
DOCUMENTATION RECOMMENDATIONS 417
ENVIRONMENTAL ASSESSMENT 419
THE RESULT 423
CONCLUSIONS 425
REFERENCE 426
Chapter 25. Credentialing and Certification 427
CREDENTIALING 427
CERTIFICATION 433
THE POLITICS OF CREDENTIALING AND RECERTIFICATION 436
RISK MANAGEMENT AND OVERSIGHT 437
SITE ACCREDITATION AND PRIVILEGING 437
CONCLUSIONS 439
REFERENCES 440
APPENDIX 25-1. BYLAWS OF JOHNS HOPKINS HOSPITAL CREDENTIALS COMMITTEE 440
Chapter 26. The Legislative and Working Environment: Clearing the Muddied Waters 444
MEDICARE FRAUD 444
(IN)APPROPRIATE UTILIZATION OF IMAGING, SELF-REFERRAL, AND STARK LAW 447
TURF WARS 451
QUALITY 454
PAY FOR PERFORMANCE 454
OFFSHORE TELERADIOLOGY 456
CONCLUDING REMARKS 459
REFERENCES 460
Chapter 27. Medicolegal Issues 463
WHY ARE RADIOLOGISTS DISPROPORTIONATELY NAMED IN SUITS? 464
EXTENT OF LITIGATION PROBLEM IN RADIOLOGY 466
COMPONENTS OF A MALPRACTICE LAWSUIT 467
ANATOMY OF A SUIT 471
SOURCES OF SUITS 474
COMPLICATIONS OF RADIOLOGIC PROCEDURES 478
MITIGATION OF RISK TO MALPRACTICE SUITS 479
CONCLUSION 483
REFERENCES 483
APPENDIX 27-1: ACR GUIDELINES ON EXPERT WITNESSES 484
Chapter 28. Learning from Others’ Mistakes 486
PERSONNEL ISSUES 486
CONFLICT RESOLUTION 491
COMMUNICATION 493
CUSTOMER SATISFACTION 496
INFORMATION TECHNOLOGY ISSUES 498
LEADERSHIP 501
CONCLUSIONS 502
Index 505