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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 |