Interventional Radiology Service Line Business and Practice Building

Focus: Arterial Disease

Raj P. Shah MD, MBA

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Objectives-Gain an understanding of the business environment in which interventional radiologists practice.-Learn about various market forces, and different entities that contribute to delivery of interventional radiology services.-Learn about the important aspects of a practice, and factors one must consider when developing a strategic business plan.-Develop a marketing strategy for your future practice.-Learn about resources/initiatives to effectively manage change.-Learn how to ‘create value’, and structure one’s practice to compete and succeed in this dynamic environment.

Business Environment- Increasing Competition/Diminishing Reimbursements Disruption of traditional referral practices, as physicians have felt compelled to acquire minimally invasive skills/procedures that they once referred ‘Turf Wars’

- IR has felt this competition at multiple levels, due to the coverage of procedures across many specialties

How to Prepare for the Future?

- Create/implement a strategic business plan that defines your practice’s core purpose, outlines the principles that it gives importance to, and focuses on specific objectives/goals. - Strategy integrates vision, policies, and action sequences into an organized plan.

- Goals – Mission and Vision- Basic Market Analysis- Service Lines Operations Analysis- Marketing Overview- Tools for Success- Financial Overview

Components to Develop Strategy for a Successful IR Service Line

Organizational StructureMission Statement: Defines the overriding purpose of the organization; it provides a framework for implementing specific objectives. They are generally culture/business dependent.

Vision Statement: Outlines the core values of the organization; it helps define the characteristics of the organization and its people. It represents an image of what the organization wishes to become, as they accomplish their mission.

Service Line Market Analysis

-Is there a need for this product/device or service? -Who will be a customer? (Considering the wide variety of customers is helpful, eg - patients, referring physicians, hospital organizations, insurance companies)-What value does the practice bring to its product/service? -What competitive forces are in play?

The 5 C’s of Market Analysis

Customers .Patients .Referring Physicians .Hospitals .Insurance Companies

Competencieseg- Arterial disease service line- carotid artery disease, aortic dissection, peripheral artery disease, aortic/peripheral aneurysms, renal artery disease, mesenteric artery disease, vasculitis, medical management of comorbidities.

The 5 C’s of Market Analysis

The 5 C’s of Market Analysis

Competitors .Vascular surgeons, Interventional Cardiologists

Changing Context.Turf wars.Decreasing reimbursements.Change in payment model, from fee-for-service to flat-fee (based on admitting diagnoses/comorbidities)

The SWOT analysis aims to identify the key internal and external factors seen as important to achieving an

objective

Customer Value Proposition-The way we propose to help customers treat a condition, including the benefits we claim they will receive and the costs we ask them to pay.

-How we plan to address their ‘clinical need’, and do better than our competitors (in terms of achieving goals of treatment, long-term clinical outcomes, providing reliable follow-up care, staying up-to-date with the latest techniques and therapies) at a comparable cost.

Positioning- Targeted Value Proposition

For (our target segment), our (product/procedure/therapy/treatment) is (single most differentiating element of value proposition) among all

(competing ways of solving targeted problem) because (single most important “supporting

evidence”)

Service Line Operations

-What is required to operate? -Are there specific infrastructure or milestone requirements that must exist to introduce the product/service? -How will the quality be controlled and value assessed?

Value Analysis-Do we provide value beyond ‘catheter skills’?.Patient outcome?.Patient satisfaction?.Referral satisfaction?.Institutional satisfaction?

A value analysis is important for all IR practitioners; in most circumstances, results will directly relate to financial performance of service line.

Marketing

-Product – Procedures relevant to a particular service line. What gives you a competitive advantage? .Is it a shorter, less invasive procedure? .Does it involve a shorter stay at the hospital? .Is it less painful than other techniques to treat the same condition?.Is it your breadth of experience which such cases/therapies? .Does your technique result in better long-term clinical outcomes? .Is it your reputation for exceptional follow-up care?

Marketing

-Promotion – (Acknowledgement: Dr. Mark Lessne of JHU). “Brand Yourself” – Distinguish your services in hospital records; eg – title-specific notes/consults

. Follow-up with EVERYONE– Keep referring providers in the loop; keep yourself “visible”. -Pre-procedure Plan (eg – medical management)-Post-procedure Plan (eg – follow-up plan)

Marketing

. Speak with Provider Organizations (eg – Connecticut Podiatric Medical Association, Connecticut Academy of Family Physicians) – Explain capabilities, services: What happens when you refer a patient?

Marketing

Provider identifies patient who

needs vascular service referral

At my VIR clinic, non-invasive testing and

procedures are performed (if

indicated)

A complete report of findings and

procedures performed is generated.

Patient returns to your care, with

recommendations for disease

management.

. Write articles in referring providers’ non-peer reviewed journals (educate providers and focus on patient care)

. Patient Education –-Speak at public institutions (places of worship, YMCA, Rotary International, etc.) to educate potential patients on common medical conditions.-Screen patients at public places or events (malls, parks, fairs, concerts, sports games)-Provide information pamphlets, flyers, ‘email list’ option.-Follow-up with patients’ PCPs, and provide explanation of services.

Marketing

Marketing

.Use Existing Hospital Resources-give lectures (to other departments within the hospital), through multidisciplinary conferences – case presentations, medical management, follow-up care, relevant literature.

-write an article in the hospital newspaper/magazine to distribute into the community (to providers + patients)

-Price – Competitive; negotiated to ensure that procedure reimbursement exceeds variable cost and contribute to overhead (concept of contribution margin).

-Place – Diagnostic radiology office, referring providers’ offices, public places, television/radio/highway billboard advertisements, SOCIAL MEDIA (Facebook Pages)

Marketing

MarketingImportant: -Take ownership of your patients!-Understand the value that you provide! -Be able to articulate this to appropriate stakeholders, eg -non-interventional colleagues, the hospital, an academic institution, a private practice, the insurance companies, and the patients themselves!

Building A Service Line – Tools for SuccessKaizen

-Mindset of continuous improvement -Ownership of one’s role and focused effort on making the role better. -Kaizen ‘event’: A collection of resources (dedicated people, money, and time resources) that are pulled with a targeted problem project in mind.

Kaizen – The 5 Elements1. Teamwork

2. Personal Discipline

3. Improved Morale

4. Quality Circles

5. Suggestions for Improvement

Building A Service Line – Tools for Success

Lean- A management philosophy focused on improving process speed and quality through reduction of process wastes. - Reduce activities that drive up cycle times or cost; make processes more efficient and more predictable. 

Lean – Basic Principles to Implement a Lean Process

RadioGraphics March-April 2012 Vol. 32 No. 2 573-587

Lean

-Particularly relevant to radiology departments, which depend on a smooth flow of patients and uninterrupted equipment function for efficient operation

-Vital to institute a gradual but continuous and comprehensive “lean transformation” of work philosophy and workplace culture

Six Sigma

-Key pieces of Six Sigma are consistent output, stability, and accuracy. -Six Sigma aims to reduce output variation through the use of statistical analysis and root cause analysis.

Six Sigma

Example- Nebraska Medical Center IR Department’s use of Six Sigma Problems: -Process inefficiencies were causing patient volumes to decline.-Dissatisfied referring physicians were sending patients to other hospitals. -Patients who remained were experiencing delays in their treatments

Six SigmaSolutions:-Collaborating with referring clinics, and strengthening relationships. -Improving job satisfaction amongst employees, by establishing clear expectations about each individual’s role. (eg – for the scheduler, this involved clarifying what type of lab testing was required prior to each procedure, obtaining timely clearance/approval from other providers, and knowing the precise time that had to be scheduled) -Improving communication between employees, to better understand what each individual required to perform his/her job better.

Six SigmaResults: - The Nebraska Medical Center interventional radiology department saw a 21% increase in patients from the previous fiscal year; it reflected improvements in patient and referring physician satisfaction as well as process efficiencies.

1) When presented with an issue, transition to a Kaizen mindset and ask “What is the problem we are looking to solve?”

2) Lean principles are the first set of tools applicable to any scenario. Generally, we are addressing a problem in which there is a complete lack of process standardization and optimization.

3) Six Sigma is a strong methodology after processes are standardized and optimized. At that point, the process is looking for improved process outputs and consistent performance.

The Approach

Financials

Trends-A decrease in fee for service payments-An expansion of the ‘flat fee’ model (single payment based on admitting and comorbid diagnoses)The IR community should help the hospital by ensuring that indications for procedures are evidence-based and appropriate.

ReferencesYousem, DM.,Beauchamp, NJ. Radiology Business Practice: How to Succeed. Philadelphia: Saunders Elsevier; 2008. Muroff, LR. Implementing an effective organization and governance structure for a radiology practice. J Am Coll Radiol 2004;1:26-32Volland, J. Case Study: Now that’s Lean. Medical Imaging Magazing 2005Kruskal, JB. Quality Initiatives:Lean Approach to Improving Performance and Efficiency in a Radiology Department. March 2012 Radiographics; 32; 573-587Beheshti, MV. The interventional radiology business plan. J Vasc Interv Radiol 2012;23;1181-1186