Radiology Business Management Association | volume 50 | issue 3 | may-june 2015
departments
9
President’s Message
President Keith Chew writes his last president’s letter for the RBMA,
addressing anticipation toward a permanent SGR fix, changes to the
business of medical imaging, the RBMA itself, and introduces new
RBMA President Suzanne Taylor.
By Keith Chew, MHA, CMPE
26
HUMAN RESOURCES
30
ASSOCIATION NEWS
32
MARKETING
34
DATA
38
REGULATORY/LEGISLATIVE
40
THOUGHT LEADER
Developing Good Job Descriptions (and the Risks of Having Bad Ones)
A look into the importance of good job descriptions in radiology business
management, the risks involved in having bad ones, and the elements of
a good job description. By Carol Hamilton, MBA, SPHR, FACMPE
RBMA Membership: Bullet Point Benefits
RBMA Launches New Radiology Management Articles Section of Website
The RBMA is pleased to offer a library of articles created by RBMA
members that support domains under the RBMA Common Body of
Knowledge.
contents
features
10
To Fee or Not to Fee: What Was the Question?
14
The Art and Science of Imaging Center Management
After making the change from daily responsibilities with an
imaging center to managing the professional services portion of
the organization, this radiology leader reflects on her years of
managing imaging centers for three different groups.
By Darlene Molenaar , CMPE, CRA
HR’s 2015 Challenge
Exploring how the recent economic recovery, combined with
healthcare reform, could pose problems for radiology businesses
seeking to add specialized staff.
By Lena Kauffman
22
Overcoming the “Dirty Little Secret” – Part 2
How three fundamental questions every radiology group needs to
ask and answer can lead to an effective system of governance and
implementation of group decisions.
By Will Latham
R.I.P. SGR; Hello MIPS
What can be expected under MIPS now that MACRA has done away
with sustainable growth rate, and how the medical community can stay
involved in the success of its implementation. By Michael R. Mabry
Thought Leader: Sam Khashman
An RBMA visit with ImagineSoftware CEO Sam Khashman.
RBMA BULLETIN | may-june 2015 | www.rbma.org
An experienced leader in practice management compares the
advantages and challenges of implementing one fee schedule versus
multiple fee schedules in imaging center practice management.
By Pat Kroken, FACMPE, CRA, FRBMA
What’s Your Story?
How you choose to market your business will determine what your
business becomes. A look at how telling your business story through
blogging can increase your marketing success.
By Kim Longeteig, FRBMA
3
RBMA leadership
BOARD OF DIRECTORS
President
Keith E. Chew, MHA, CMPE
Integrated Medical Partners
18 Hawks Nest
Chatham, IL 62629
(414) 359-5520
(888) 349-5754 Fax
keith.chew@Integratedmp.com
Immediate Past-President
Wendy Lomers, CPA, MBA
Acclaim Radiology Management
4777 U.S. Highway 259
Longview, TX 75605
(903) 663-4800
(903) 663-9018 Fax
wendy@acclaimrad.com
President-Elect & Director-At-Large
Suzanne Taylor, BS, FRBMA
Management Services Network, LLC
717 20th St.
Columbus, GA 31904
(706) 653-0196
(706) 653-1230 Fax
staylor@msnllc.com
RBMA BULLETIN | may-june 2015 | www.rbma.org
Secretary
Kimberly Longeteig, FRBMA
Ali`i Marketing & Design
3107 N. Franklin Ave.
Loveland, CO 80538
(970) 800-3678
kim@aliidesign.com
4
Treasurer & Director-At-Large
Jim Hamilton, MHA, CMM, FRBMA
Medical Imaging Physicians
2591 Miamisburg Centerville Road, Suite 302
Dayton, OH 45459
(937) 433-7622 ext. 108
jhamilton@mipimaging.com
Parliamentarian & Southern Director
Fred Downs
Diagnostic Imaging Specialists
6000 Lake Forrest Drive, Suite 475
Atlanta, GA 30328
(404) 459-8440
(404) 459-8441 Fax
fdowns@radiologyatlanta.com
ACR Director
Mark O. Bernardy, MD, FACR
1031 Jimson Drive S.E.
Conyers, GA 30013-2064
(770) 860-8581
mobmd@plantationcable.net
Eastern Director
Worth M. Saunders, MHA, FACHE, FRBMA
Greensboro Radiology
1317 N. Elm St.
Greensboro, NC 27401
(336) 274-4285
wsaunders@gsorad.com
Midwestern Director
Charles McRae, MBA
Columbus Radiology Corporation
471 E. Broad St.
Columbus, OH 43215
(614) 221-3303
(614) 654-1723 Fax
cmcrae@columbusrad.com
Western Director
David Monaghan, MHA
Intermountain Healthcare
36 S. State St.
Salt Lake City, UT 84111
(801) 442-3772
Director-At-Large
Sarah Mountford, RCC, CPC
Zotec Partners
11460 Meridian St., Suite 200
Carmel, IN 46032
(770) 880-8744
(317) 705-5055 Fax
smountford@zotecpartners.com
Director-At-Large
Chad Wiggins, MHSA, LNHA
Radiology Associates of Northern Kentucky, PLLC
523 Centre View Blvd.
Crestview Hills, KY 51017
(859) 331-4369
(859) 331-4319 Fax
ccwiggins@radassociatesnky.com
Executive Office
10300 Eaton Place, Suite 460
Fairfax, VA 22030
(888) 224-7262
(703) 621-3355
(703) 621-3356 Fax
info@rbma.org
www.rbma.org
Medical Billing Experts
32 W. 200 S., Suite 205
Salt Lake City, UT 84101
(435) 249-0269
dmonaghan@mbxperts.com
Director-At-Large
Brian Barbeito, MBA, MSHA, FACHE
Mid-South Imaging & Therapeutics, P.A.
6305 Humphreys Blvd., Suite 205
Memphis, TN 38120
(901) 473-6406
(901) 359-0907 Fax
bbarbeito@msit.com
Director-At-Large
Tom Dickerson, MA, FACHE
Clinical Radiologists, S.C.
3050 Montvale Drive, Suite A
Springfield, IL 62704
(217) 222-9302
(217) 257-1902 Fax
dickersont@clinicalradiologist.com
For more information about
RBMA Leadership, visit
www.rbma.org then click
About RBMA located at the
right of the page.
2015 RLI Leadership Summit
Thriving in Changing Times
August 6–9, 2015 | Babson College | Wellesley, MA
Changes in health care continue to increase in speed and scope.
Is your practice prepared for the new business of health care and
to capitalize on the changing environment?
In-depth, hands-on sessions, with facilitated breakouts, provide
for maximum interaction with both faculty and fellow attendees.
The 2015 RLI Leadership Summit will help you:
• Identify opportunities for practice growth using core
marketing concepts
• Generate a strategy, make the optimal choice for your
business and create a road map for execution
• Make financially sound investments in your practice that
will help you operate capital-intensive practices in an
increasingly demanding environment
• Connect with relevant parties to negotiate and create
lasting agreements for both sides
“
™
BEST RADIOLOGY TRAINING PROGRAM
2014
“The format of the RLI Summit was really ideal. During the breakout
sessions, we had the ability to network, which was terrific, but we also got
to see how a lot of times your biases are anchored in a certain point of
view and if you just listen and are open to some other ideas, the
intelligence of the group turns out to be more than you would think of
on your own.” – Michael H. Lev, MD, FACR
Learn more and register today at radiologyleaders.org/leadership-summit
BILLING
AND
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ANALYTICS
COMPLIANCE
SEE US AT THE 2015 RADIOLOGY SUMMIT > BOOTH 206
RADIOLOGY BUSINESS MANAGEMENT SOLUTIONS
AHSRCM.COM 877 501 1611 PERFORMANCE THAT MATTERS
contents
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25 Imagine Software
27 Medical Billing & Management Services
28 Professional Finance Company
29 Integrated Radiology Partners
33 APS Medical Billing Services
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41RCCB
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7
President’s Message
The time has come for me to write my last president’s message for the
RBMA. It has been a year filled with challenges for medical imaging,
the RBMA, and healthcare just to name a few.
As I write this, anticipation is
At the June RBMA Radiology Summit in Las Vegas, the
high that a permanent SGR
RBMA will transition its leadership team and welcome
fix will finally be a reality. By
Suzanne Taylor as the new president. Suzanne has been
publication, we will know if
involved as the president-elect in all the activities the
that reality has come to pass,
RBMA had this year, and I know she will be a strong leader
ending roughly 10 years of
for this organization. I will remain a part of the leadership
annual stress for not only
team for another year as the immediate past-president
healthcare, but Congress and CMS. I, and I am certain
to provide insight when and if necessary. Truly, the RBMA
everyone reading this, am hoping that the permanent SGR
is headed in the best possible direction. Due in part to
fix has come to pass, so that we can focus on other pivotal
the board, but mostly by the efforts of a dedicated staff
matters within the U.S. healthcare system.
always here working for RBMA members, strengthening
The big teleradiology companies that were forces in
the position of the RBMA in medical imaging advocacy and
the commoditization of medical imaging have seen great
management/leadership/operations training. Additionally,
changes this year. Radisphere was purchased by AmSurg
RBMA is focusing resources on DataMAXX to ascertain if
and became a part of Sheridan. vRad was for sale and,
the approach strategically initiated a number of years past,
recently acquired by MEDNAX. Does the “fall” (I use that term
still is valid for our organization today. Anticipate more
for dramatics and not in its true meaning of demise) from inde-
insights after the RBMA Radiology Summit and the Data
pendence of these two giants signal a ‘change in the winds,’
Strategic Planning Session, which will be held just prior to
moving medical imaging away from the ragged rocks of
the Radiology Summit.
commoditization and possibly toward ‘calmer seas’ as a
I have appreciated the input, support, and joy of getting
truly valued member of the patient care team? Are the
to know this organization and so many of its members at a
efforts we have been discussing here in these messages,
deeper level this past year. I always plan on living the RBMA
and through the efforts of the ACR Imaging 3.0 program,
dream of Progress Through Sharing, because it benefited
having an impact? It is hard to say, but it is a nice thought,
me greatly during my career, so that living that dream only
and a great dream to believe we have been able to positively
seems right. Please, continue to reach out to me, the RBMA
impact the future of medical imaging.
staff, other volunteers, and members of RBMA. We are all
The RBMA has been undergoing change as well. By reexattempt to fully and truly demonstrate our value, just as
medical imaging is working to demonstrate its value to, for,
and in healthcare. The RBMA board, upon recommenda-
Through Sharing.
Thank you for a truly enjoyable experience as your
president.
Thank you – Respectfully and Appreciatively….
tions from the Membership Committee and RBMA staff, has
approved contracting with an acclaimed firm in the field
of membership, development, and association strategic
positioning, to work with the RBMA staff and members to
reestablish RBMA’s value proposition. The efforts of this
strategic repositioning will allow RBMA to continue in its
position as the premier resource for information, advocacy,
RBMA PRESIDENT | KEITH E. CHEW
and education within the medical imaging management
arena; establishing new approaches to achieve this vision
so that RBMA will be able to reach more individuals within
the field and successfully demonstrate the value of RBMA
to past and future members.
KEITH E. CHEW, MHA, CMPE,
is with Integrated Medical Partners. He can be reached at 18 Hawks Nest,
Chatham, IL 62629, (414) 359-5520, or keith.chew@integratedmp.com.
RBMA BULLETIN | may-june 2015 | www.rbma.org
amining our value proposition to, and for, our members, we
here to help each other and live the dream of Progress
9
To Fee or
Not
to
Fee
What Was the Question?
BY PAT KROKEN, FACMPE, CRA, FRBMA
RBMA BULLETIN | may-june 2015 | www.rbma.org
A
10
s a person whose job frequently involves
began charging at different rates based on the various
initiating change, it can be tiresome to
contracted fee schedules—Medicare was billed at Medi-
hear the often used phrase, “We tried
care rates, Blue Cross at our negotiated rate, and so on. As
that once and it didn’t work.” However,
a result, our adjusted collection rate soared (since theo-
I was recently asked about the wisdom
retically everyone paid at 100 percent) and the days in
of using one fee schedule versus multiple fee schedules, based
A/R dropped like a rock—because the A/R didn’t have all
on contracted provider rates. The latter appears to be
those messy contractual adjustments stacked in. That
occurring more frequently and was being extolled as
predecessor could look at the A/R and be able to estimate
it improved key indicator performance. I found myself
what revenue would be without going through a bunch of
thinking, “We tried that once and it didn’t work.”
calculations. It sounded perfectly logical, and as a rookie,
I sometimes feel that I’ve been in practice management
I didn’t think to question the rationale.
for so long, I was there to see the lone T-Rex wave his little
In reality, it was an excellent example of why you
arms one last time before he expired with the rest of his
should not attempt to impose logic on the insane world
kind. The question made me reflect back on my time in
we live in. And I learned that in stages.
practice management, and a few of my experiences came
back like bad Mexican food. While some developments
Stage I—“I’m reporting you for fraud”
never went away, there are always things to learn from
Since we had different fee schedules for different
history. Bear with me on this story; it will benefit those
payors, it was only a matter of time before a patient
of you who will be living through one of my early experi-
received an EOB denying charges for “incorrect insurance/
ences as a practice manager, and I hope to save you a few
not our patient,” and a subsequent EOB from the correct
knots on your head as you bang it against the wall.
carrier—with a different (higher) rate. The patient then
When I took over management of the group, my
predecessor had changed a key billing practice, and
accused us of fraud since our fees were inconsistent, and
so was her copayment.
The ICD-10 deadline is here.
Don’t panic. Call McKesson.
Has your practice underestimated the impact
of the ICD-10 transition on your clinicians?
Your administrative staff ? Your finances?
Here’s your chance to regroup.
At McKesson, we’ll help you develop a comprehensive strategy designed to identify gaps in
coding and workflow and develop plans to address them. These include:
Training on ICD-10 code sets for
clinical and administrative staff
Analysis of potential cash flow
implications and assessment of
mitigation strategies
Analysis of your practice’s
top 50 ICD-9 codes by volume
and charge amount with a
comparison to ICD-10
Analysis of physician documentation
with reporting on ICD-10 deficiencies;
feedback and education before
October 1
As an industry leader in radiology billing, McKesson has the strength, financial stability and
expertise needed to help your practice navigate the transition to ICD-10 and so much more.
For more information, visit us at RBMA Booth #308. Not attending RBMA, contact us at
radiologyinfo@mckesson.com or 866.217.4184.
TO FEE OR NOT TO FEE WHAT WAS THE QUESTION?
If you think it’s a challenge trying to explain what a
Moving from a traditional “marked up” fee schedule
radiologist does to someone outside the field of medi-
that allowed for contractual adjustments, to one directly
cine and practice, or how and why someone is getting
based on anticipated reimbursement, effectively lowered
billed by a doctor they never met, just compound that
the UCR in our market area. As a consequence, we could
with trying to explain our brilliant fee strategy. I would
expect to be presented with a further reduced fee schedule
have to reply to our frustrated patients, “Yes, it’s exactly
when the insurance companies took the UCR charges,
the same procedure but we charge different amounts for
calculated what they felt was an acceptable discount
it to different insurance companies (and sorry about your
from the prevailing fee schedules, and then presented us
increased co-pay by the way).”
with our proposed new rates. Who knew?
The only good thing about that experience was the
time period, and fact that there weren’t a dozen “report
healthcare fraud” phone lines and websites available,
Do your homework—or at least test your theories
as there are now. If your practice is charging different
for downstream impact. At the time of my experience,
fees based on different fee schedules, you can probably
it seemed pretty simple at first: get rid of contractual
expect a fraud report in the future; hopefully that phone
adjustments, improve key indicators, provide a clearer
call will come to your office and you already have the
picture of what’s in the accounts receivable without doing
practice of employing an excellent, patient-friendly script
calculations, and demonstrate just how well you’re doing
to explain the differing fees, rather than right to a hotline.
running the practice with improved adjusted collection
Although it should be noted, there’s a pretty good chance
rates and days in A/R.
the complaint will go to both.
Stage II—“What do you mean you want
a fee increase?”
some time and perspective to get the full picture of the
multiple fee schedule decision. But if you’re currently
billing payors based on their contracted rates, check
with your staff on the ‘fraud reporting thing’ first; see if
to negotiate a fee increase with a local health plan that
any patients have complained about getting EOBs with
represented our largest single insurance contract. I had
different charge amounts for the same procedures. Today,
all of my utilization stats and the “go forth and conquer”
patients are encouraged to be more aggressive in reporting
encouragement of the physicians who agreed we needed
fraud, and if you’re going to continue with multiple fee
to be paid more as this plan continued to grow.
schedules, it would be a good idea to have a very brief,
I was ready. I presented our trends and asked for the
logical, and coherent explanation of what you’re doing
business—in the form of a small percentage increase for
and why. The patients aren’t likely to understand it, but
the following year.
hopefully the insurance companies, fraud units, and
Their response? “What do you mean you need a fee
what you’re billing.”
RBMA BULLETIN | may-june 2015 | www.rbma.org
What could possibly go wrong? In all fairness, it took
Like a lamb to the slaughter, I headed into a meeting
increase? We’re already paying you at 100 percent of
12
Final Comments
The “mic drop” and silent exit off stage left was not
to be mine. But the small victory of going back to one
investigative reporters in your area will.
P.S. In that last piece of advice, I myself don’t have the
satisfactory language to suggest. It’s simply a tough explanation to communicate; consider how you would feel as
a patient getting that message!
fee schedule was—and it took a couple of years to build
justification for negotiating again.
Stage III—Usual and Customary
Usual and Customary fees (UCR) are less obvious than
they were during my painful learning curve, but you can
bet they still provide underlying support for the contract
fee schedule updates you receive periodically. Basically,
UCR enables an insurance company to develop a profile of
rates for a specific market area by tracking what physician
groups charge. Fee schedules are then developed based
on what is considered a “usual and customary” range of
fees for the market.
PAT KROKEN, FACMPE, CRA, FRBMA,
is a principal in Healthcare Resource Providers, a
­radiology business consulting firm. She is a regular
contributor to industry publications and a frequent
speaker on topics related to radiology practice
management and HIPAA. Pat can be reached
at Healthcare Resource Providers, LLC, P.O.
Box 90190, Albuquerque, NM 87199;
(505) 856-6128 or pkroken@comcast.net.
AIMS
IS Now MobIle!
HR’s 2015
Challenge
THE RECENT ECONOMIC
RECOVERY, COMBINED WITH
HEALTHCARE REFORM, COULD
POSE PROBLEMS FOR RADIOLOGY
BUSINESSES SEEKING TO ADD
SPECIALIZED STAFF.
BY LENA KAUFFMAN
RBMA BULLETIN | may-june 2015 | www.rbma.org
As the U.S. economic
14
For the healthcare sector, which
Kim Sisk, PHR, SHRM-CP, is the HR/
did continue to add positions
credentialing manager for Canopy
throughout the recession, economic
Partners, a radiology management
recovery means that organizations
service organization that was spun
used to fairly ample pools of job
off from Greensboro Radiology in
applicants may find increased
Greensboro, N.C. Last year, she grew
competition for top talent in 2015.
her own organization’s staff by
reported job gains were
For radiology businesses that seek
nearly 20 percent and her firm also
above 200,000.
to expand staff, there also is concern
helps other radiology businesses
about finding the right people with
with HR issues.
recovery grows, jobs have
been added at a brisk pace.
February marked the 12th
month straight that the U.S.
Bureau of Labor Statistics
radiology-specific knowledge. How
So far, the pool of candidates with
to respond to increased competition
the hard and soft skills necessary
for talent, find the best people, and
for customer service positions
retain them once hired is therefore
remains adequate in her area, she
top priority for many radiology
reports. However, she is finding
business owners and human
that filling positions for physician
resources managers at this time.
credentialing coordinators and
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HR’S 2015 CHALLENGE
certified coders is proving tricky.
has personally not tried recruiting a health data analyst
“Radiology is a very specialized area,” she explains.
yet because the advanced business software programs
“It was very difficult to find the people who had the
currently available are meeting her group’s need for
radiology coding certification (RCC). We ended up having
business intelligence.
to branch out and just get someone with a general coding
“Quite honestly, the software that is available to go with
certification. We ultimately ended up finding a good
either different practice management systems or that you
candidate, but it took several months to get the candidate
can buy on your own are so amazing these days that it is
in the door.”
better in those cases to get someone who is a bit more
With the coming need not just for the RCC, but also
forward thinking within the group up and trained to look
expertise in International Classification of Diseases
at that,” she says. “But if you don’t have someone within
and Related Health Problems, 10th edition (ICD-10)
the group with that forward thinking for data analysis and
coding, the shortage of credentialed coders may only
who is able to read reports and look at trends to figure out
get worse, predicted Kathleen G. Bailey, CPA, MBA, CPC,
what is going to be happening in the future, then you are
CPMA, CPC-I, CCS-P, an RBMA U faculty member who
much better off looking outside.”
teaches traditional and online coding, health IT, and
administration subjects.
Practices that do need to hire a health data analyst
or engage a data analysis firm may find themselves in
“There are a lot of people out there who are going to
competition with big hospital and health system networks
need good coders trained in ICD-10, and the training for
that have a growing need for business intelligence and
ICD-10 is not cheap,” she says.
quality reporting as they begin participating in population
Data and IT Skills Are In Demand
health models and various systems that link care quality
to reimbursement.
Hiring of an IT specialist can also prove tricky. Sisk
“People who can take information and turn it into
stated that her company ended up enlisting the help of a
business intelligence are in high demand because what
professional recruiting firm to fill its need for IT specialists.
is happening right now is that hospitals need a lot of data
Healthcare, and particularly radiology, is a very
analysis to look at things like length of stay and quality
specialized area of IT with numerous concerns not
initiatives,” Bailey says.
common to general business IT, says Carol Hamilton, MBA,
Furthermore, the analysts can’t just be number
SPHR, FACMPE, and chief administrative officer of West
crunchers with generic skills and no background in
County Radiological Group, Inc., in St. Louis, Mo.
medicine, Bailey adds. “These analysts need to understand
According to Hamilton, who also teaches HR topics for
healthcare in order to understand the data they are looking
RBMA U, one example of how health IT differs from regular
at, otherwise it is going to be garbage in and garbage out.”
IT is the care that must be taken to safeguard Health InsurRBMA BULLETIN | may-june 2015 | www.rbma.org
ance Portability and Accountability Act (HIPAA) protected
16
What Attracts Job Candidates
personal health information (PHI). Her practice has its own
With more competition for talent even as reimbursement
IT person on staff, and given the growth in using electronic
is cut, what can radiology businesses do to effectively
medical records with advanced functionalities — which
recruit and retain people with specialized skills?
1
doubled between 2009 and 2013 —has made his services
The good news is that while offering a competitive
so sought after that the practice actually encourages him
salary and benefits package with health insurance, paid
to help other organizations as long as they are not other
time off, and a strong retirement plan (very important),
radiology businesses.
these types of traditional compensation are not the
“I’m seeing that there are more requests for actually
only things employees are looking for. Sisk, Bailey, and
having IT people on staff,” Hamilton says. “It is much more
Hamilton were in agreement that potential employees
so than days past when it was perfectly acceptable just
also value environments where they can grow and
to outsource that need and have someone come in on
advance in their careers.
occasion when a computer wasn’t working.”
Sisk is proud of Canopy Partners’ low turnover rate,
Hiring of business analysts with radiology knowledge
which she says is only 7 to 8 percent. “A lot of what keeps
is less of a concern at an individual radiology practice
people here is our culture,” she says. “We highly encourage
level than hiring IT specialists. Hamilton notes that she
teamwork, we highly encourage communication. Even
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though we have separate departments, all of our depart-
Bailey says. This is especially true for higher-level people
ments work cohesively together to problem solve and
with very specialized skills.
to innovate and to come up with solutions to help our
clients.”
type of training we provide, but it made him that much
for everyone in the company to have a voice in decision
more aware of things to look for on our system and, if
making and bring forward suggestions. This creates
he was going to go help another group, things to look for
a feeling of ownership, Sisk says. In addition, Canopy
on their systems. We are open to new areas if employees
Partners has a mandatory program that trains mangers
want to go into something that expands their knowledge
in effectively leading employees.
rather than just continuing education to keep the same
certifications.”
are happy and they are heard and if they feel like they are
She adds that all of her group’s coders have already
part of the team,” Sisk says. “To retain you have to look
earned their RCC and they are now working on earning
at your culture. Be honest about it and if your culture is
their Certified Professional Coder (CPC) credentials in
not where you think it needs to be, start addressing it.”
order to be able to do even more types of coding. In addi-
Sisk says that Canopy Partners views efforts to
tion, the benefits of helping employees earn additional
create and maintain a positive company culture as an
certifications and become more skilled far outweighs
investment that pays off “tenfold.” Their culture was not
concerns that they might take those skills and move on
an accident. They spent countless hours meeting with
employees and managers to learn as much as they could
about what was working and what was not within their
organization. Then they developed a plan that addressed
the top opportunities for improvement.
“You need to talk,” Sisk says. “You need to have an open
and honest conversation with your staff.”
Supporting Education as a Strategy
Offering continuing education is another area that
to an outside opportunity in Hamilton’s view.
“I really don’t have any fear that anyone is going to
be able to offer the same work environment that we can
offer,” she says.
Finally, consider ways you may help your most
in-demand talents achieve a better work-life balance.
When it comes to the fields of credentialing coordinators, coders, and IT personnel, some of the work can often
be done remotely and many employees appreciate the
can set a radiology business apart when recruiting for
benefit of being able to do some of their work from home,
coding, IT, and other in-demand skills that may require
says Sisk.
maintaining certifications and learning new information
each year to keep up with the field.
RBMA BULLETIN | may-june 2015 | www.rbma.org
all about hacking,” noted Hamilton. “It was not the usual
Through regular staff meetings, there are avenues
“The way you are going to retain employees is if they
18
“Our IT person wanted to go to a conference that was
Through Canopy Partners’ work-from-home program,
employees have the option of working regularly from
“If you have somebody you want to retain, one of the
home once they’ve passed a 6-month long period of
important things I’ve found is that you provide continuing
working exclusively in the office as a new hire. The proba-
education,” Bailey says. “We are tight-fisted in radiology,
tionary period allows them to become fully trained in their
and as radiology reimbursements have gone down over
job so that when the transition to working from home
the past few years, I’m seeing that is kind of a continuing
happens, it is seamless and invisible from the customer’s
trend. However, you need make sure your people get the
perspective, Sisk says.
continuing education necessary to stay current in the
Working from home allows employees to avoid time
field. You need them to have that skill as much as they
spent commuting to work and avoid taking time off for
need to maintain that skill for themselves.”
life’s minor inconveniences, including everything from a
Education benefits can take the form of traditional
cold, to waiting for a package delivery, or a school snow
tuition support as well as paid time for taking classes.
day. The system also has advantages for Canopy Partners
Using online options, like RBMA U, can make funding
—although there is a small investment in the technology
continuing education more affordable. In addition,
necessary for employees to work from home, the company
don’t neglect paying for certain employees’ association
is saving money by reducing the need for office space,
memberships, re-certifications, and relevant conferences,
says Sisk.
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Retaining Your Recruits
The elements of a positive company culture, career
growth support, and non-traditional supplementary
RBMA BULLETIN | may-june 2015 | www.rbma.org
ties to learn those skills,” adds Hamilton. “That doesn’t
always happen.”
benefits like work from home are also key to retaining
The key to making this work is to know exactly what
talented people. The last thing a hiring manager wants
your skill need is and your timeline. Depending on what is
after spending months filling a position with the right
needed, it can take months and a considerable investment
candidate is for that person leave for an even better
to train the employee for the new job. On the other hand,
opportunity within a year.
it can take months and a similar considerable investment
The risk of losing someone is quite real, notes Bailey.
in job ads and professional recruiter support to land a
She trains about 80 to 100 people at a time in her classes
qualified outside candidate and then get them on board.
and many do not have a healthcare industry background.
“It is what is going be most efficient,” Hamilton says.
These students need to get their foot in the door at a
One thing that does give radiology employers pause
healthcare organization, but once they do and amass a
when considering paying for training an existing employee
year or more worth of healthcare experience, they are
for a new position is the issue of retention, says Bailey,
going to be recruited, Bailey says.
who herself managed radiology practices for 15 years
In professional HR circles, the passive recruiting trend
before going into education and consulting. What she did
is hot. Passive recruiting, where recruiters approach
as a radiology manager was ask her employees interested
people who are employed and not actively looking for a
in gaining specific coding certifications and moving up
new job to see if they would be interested in switching
within the organization to sign an agreement that they
companies or know of someone who is, has long been
would reimburse her for the cost of their training at a
used to fill executive and other leadership positions with
graduated rate if they decided to leave the organization
highly specialized skills. Now, career networking social
within two years. If they left immediately after having
media tools are enabling easier and faster recruiting of
earned their certification, they had to repay the full cost
passive job candidates in non-executive roles. Recruiters
of their training, but if they stayed close to the two-year
simply search online profiles for specific certifications
mark, they only had to repay a portion.
and message people whose profiles reflect skill sets they
People with highly specialized skills have always been
are searching for. LinkedIn’s Talent Solutions even offers
hard to find, and radiology businesses will certainly adapt
employers “recruiting tools to expand your candidate
to increased competition for skilled employees. To find
search and find and engage the best passive talent.”
the right combination of strategies for your business, take
In addition, you want to make sure your salaries do not
stock of the resources available to you, and be clear about
fall behind the market, which can happen in positions
what specialized skills you need and pursue the options
where demand for qualified candidates is rising sharply.
that will work best for you.
Canopy Partners does a bi-annual market analysis on
20
“You have to know if you have a person with the abili-
salaries to make sure the company is competitive in sala-
RESOURCE
ries in all of the areas it serves and for all of its positions,
1. Furukawa MF, King J, Patel V, Hsiao CJ, Adler-Milstein J, Jha AK. Despite substantial progress
Sisk says.
In EHR adoption, health information exchange and patient engagement remain low in office
If you cannot afford your own analysis, reach out to
settings. Health Aff . 2014 Sep;33(9):1672-9.
associations that track salaries in their fields, such as the
AAPC (American Academy of Professional Coders) annual
salary survey, adds Bailey.
LENA KAUFFMAN
Growing Your Own
Of course, another option in filling positions requiring
hard-to-find skills is to train someone already within your
organization for the job. There is not always someone
available that has the interest in getting the additional
training necessary to fill the position, but when there is,
it can be a good option says Bailey.
is a freelance writer and editor based in Ann Arbor,
Mich. A graduate of the Medill School of Journalism at
Northwestern University, she has served as a reporter
and editor on multiple medical trade publications
over the past 12 years. In addition, she has worked
in public affairs and communications for the Palo
Alto Medical Foundation in California and for Sutter
Health. She is a contributing writer for the RBMA.
Lena can be reached at lena_kauffman@yahoo.com.
Overcoming the
“Dirty Little
Secret”
Part 2
RBMA BULLETIN | may-june 2015 | www.rbma.org
BY WILL LATHAM
22
In a previous article
I discussed the “dirty
little secret” that many
medical groups suffer
from, and recommended
that all medical groups
ask and answer the
following questions:
1
How will the group make decisions?
2
What is expected of each physician
(Best answer: discuss and vote).
once a decision has been made?
(Best answer: adhere to and support
the decision).
3
What are a physician’s options if he
or she doesn’t like the decision?
(Three options only: a. Do it anyway,
that’s group practice; b. Try to get it
changed in the proper forum, but keep
adhering to the decision until it is
changed; or c. Self elect yourself out of
the group).
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OVERCOMING THE “DIRTY LITTLE SECRET” — PART 2
Groups whose members commit to supporting group
decisions function more effectively than those that suffer
from the “dirty little secret.”
The answers to these questions determine whether or
3. Avoids wasting time “making pasta”: How do you
not a group will be able to build an effective system of
know when pasta is ready to eat? Throw it against
governance.
the wall and see if it sticks. Unfortunately, that’s how
Additionally, there are four important reasons why
groups should ask and answer these questions:
1. Leads to real discussions: In our experience, physicians tend to avoid conflict when it comes to physi-
why waste time struggling with decisions if adherence
is going to be perceived as optional?
4. Many issues/little time: Group governance and
discussed in future articles. In many groups an indi-
internal meetings can consume a substantial amount
vidual physician may assume that he or she will not
of time. It is exhausting, frustrating, and excessively
be held accountable to adhering to group decisions. If
time consuming to have to anticipate whether or
this is the case, the physician may avoid talking about
not people will support each and every decision.
an issue in a group meeting, relying on the assump-
Groups whose members commit to supporting group
tion that no one will challenge non-adherence to
decisions function more effectively than those that
group decisions at a later time. Thought processes
suffer from the “dirty little secret.”
and I can probably avoid it later because everyone else
will want to avoid conflict too. However, if each group
member commits to adhering to group decisions, it is
more likely that they will raise dissenting opinions as
part of the discussion. This means that the group will
RBMA BULLETIN | may-june 2015 | www.rbma.org
be hopeful that people adhere to it. From my perspective,
cian-to-physician related issues; a topic that will be
tend to be: I can avoid conflict now by not speaking up,
24
many medical groups operate – let’s make a decision and
have a richer, and more complete, discussion about
the issue.
2. Eliminates the fiction of unanimity: Many groups
It is true that not everyone will live up to their individual
commitments from group decisions. As James Madison
said, “If men were angels, no governance would be
necessary.” However, asking the aforementioned questions
will help to eliminate non-adherence and support conflict
resolution, versus avoidance. In later articles, we will
discuss how to deal with those who do not follow group
policies, but as an important first step, ask people to
commit to adhering to group decisions.
spend hours and hours trying to get everyone to
vote for an issue, relying on the assumption that if
everyone votes unanimously for a decision, then it
will be much easier to implement that decision. In
reality, it’s more likely that everyone won’t agree,
and will vote for an issue just to avoid conflict in the
meeting, and then turn right around and ignore the
decision they just voted for. Stop wasting time by
pursuing unrealistic unanimity. Get your people to
commit to supporting group decisions.
WILL LATHAM
has worked with medical groups to help them make
decisions, resolve conflict, and move forward for more
than 25 years. Will has an MBA from the University
of North Carolina in Charlotte and is a certified
public accountant. He is a frequent speaker at local,
state, and national levels, and with specialty-specific
healthcare conferences. Will can be reached at
Latham Consulting Group, (704) 365-8889 or
wlatham@lathamconsulting.com.
H U M A N R E S O U R C E S
Developing Good Job Descriptions
(and the Risks of Having Bad Ones)
BY CAROL HAMILTON, MBA, SPHR, FACMPE
w
hile there are no federal statutes requiring
them, good job descriptions are an important
tool in the effective and legal management
of any business organization, and radiology is
no exception. Good job descriptions are extremely beneficial in a
myriad of ways; however, poorly written or outdated job descriptions
can put the company at risk, as they are one of the most widely used
pieces of evidence in employment claims.
Elements of a Good Job Description
The standard job description consists of the following general
elements:
1. The job title—This is probably one of the most misleading and
misrepresented parts of a job description. When looking for
salary surveys to determine pay ranges, it is difficult to know
if you are comparing apples to apples. Hopefully a basic job
summary is available, but even this may not give adequate
information to know if the comparison is valid.
RBMA BULLETIN | may-june 2015 | www.rbma.org
2. The job summary or purpose—This is a short description
providing reasons why the job exists within the company. It
may include the basic essential functions of the position.
26
3. The essential job functions—According to the Equal Employment Opportunity Commission (EEOC), essential functions are
the duties that an employee must be able to perform, with
or without reasonable accommodation. These key responsibilities should make up the majority of the position’s overall
duties. It is also helpful to determine the estimated time spent
on each of these activities (when using percentages, all activities should equal to 100 percent) and the frequency of the
activity (daily, weekly, monthly, annually, and so on). Don’t
forget to list regular attendance and timeliness as essential
job functions for positions that require this.
4. Knowledge, skills, and abilities—These are the detailed qualifications required by the individual to be successful in the job.
Some of these qualifications may include education, work
experience, ability to communicate at a certain level, mathematical skills, reasoning ability, ability to travel, ability to work
certain hours or overtime hours, and the physical demands
of the position.
5. T he work environment—Describe the physical environment
the individual will be working in. This might be working in an
office environment at a desk, a hospital or imaging center with
direct patient contact, working remotely, or in a small reading
room environment.
Job descriptions should have clear, concise language and should
avoid using unnecessary words. Common phrases should be consistent across all job descriptions. If words have multiple interpretations, it is helpful to define the terminology. Racial requirements
are never lawful in job descriptions. Job requirements based on
gender, national origin, religion, or age can be used in very limited
circumstances when the employer can demonstrate a “bona fide
occupational qualification” (BFOQ) that is reasonably necessary for
the normal operation of business. This would be extremely difficult
to justify within any radiology business practice. The EEOC also
encourages employers to assess whether their job requirements or
duties, although neutral and evenly applied, would possibly cause
an adverse impact based on protected characteristics, including
disabilities. For this reason, it is advisable to have your attorney
review your job descriptions.
Performing a Job Analysis to Formulate
a Job Description
A job analysis is an investigative process used to formulate a job
description. The data can be collected in various ways, and may
involve observing and/or interviewing an individual who is actually doing the job, observing or interviewing co-workers, having an
individual keep a job duty journal, or using task-related surveys
and questionnaires. Other resources include salary surveys or the
Occupational Outlook Handbook (U.S. Bureau of Labor Statistics).
The job analysis can help determine the job’s purpose, as well as
the day-to-day structure and job setting of the position. The EEOC
encourages this process to help determine what accommodations
can be made to assist an individual with disabilities in performing
the job.
A sample job description (analysis) questionnaire has been
uploaded to the RBMA Gateway to assist you in developing job
descriptions.
Legal Importance of Job Descriptions
The following statutes utilize job descriptions as part of the investigational process:
Fair Labor Standards Act (FLSA): Although the job description may
list that an employee is exempt or non-exempt from overtime pay
for hours worked, the list of essential duties is the key component
used to determine the employee’s status.
Americans with Disabilities Act (ADA) and the Americans with Disabilities Act Amendment Act (ADAAA): Within these statutes, the employer
has a duty to provide reasonable accommodations for a disabled
employee to perform the essential duties of the job. If a disabled
employee is unable to perform an essential function of the job,
HUMAN RESOURCES 4DEVELOPING GOOD JOB DESCRIPTIONS
even with an accommodation, the employer is not required to
retain the employee in that position.
Federal and State Discrimination Laws: A job description can
help support the employer in claims of discrimination related to
compensation, promotion, discipline, or termination.
Family and Medical Leave Act (FMLA): An employee requesting
FMLA leave for their own serious illness must have the medical
condition certified by a healthcare provider who attests that the
employee is unable to perform one or more of the essential job
functions. The job description can assist the healthcare provider
to give a more accurate assessment in this regard.
• If the job description is part of the performance review process,
make sure the employee has been made aware of any revisions
that might affect a future review.
• Job descriptions should be kept in a secure location and all
versions should be kept for a minimum of two years each.
RESOURCES
Job Description Writer: http://acinet.org/acinet/jobwriter/default.aspx
Career Onestop: http://www.careeronestop.org
Occupational Information Network: http://online.onetcenter.org
Occupational Outlook Handbook: http://bls.gov/ooh/
Other Considerations Regarding
Job Descriptions
RBMA BULLETIN | may-june 2015 | www.rbma.org
The following are some other helpful tips to keep in mind when
preparing job descriptions:
• Always include an effective date and make sure revision dates
are listed when changes are made.
• Develop or revise the job description prior to posting an open
position.
• Up-to-date job descriptions should be part of the interview
process.
• When developing a job description, a draft should first be
approved by management and then reapproved and signed
off on after revisions are made.
28
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is the practice administrator for West County
Radiological Group. She currently serves on the
RBMA Membership Committee and is the co-chair
on the RBMA Educational Materials and Products
Committee. Carol has been an RBMA member for
10 years. She has her MBA from the University of
Missouri at St. Louis. Carol can be reached at
chamilton@westcountyradiology.com
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A S S O C I A T I O N N E W S
RBMA Membership: Bullet Point Benefits
RBMA Launches New Radiology
Management Articles Section of Website
RBMA is pleased to offer a library of articles created by RBMA
RBMA BULLETIN | may-june
march-april2015
2015| www.rbma.org
| www.rbma.org
members that support domains under the RBMA Common Body
30
of Knowledge (CBOK). The CBOK represents a set of educational
domains and competencies necessary for radiology business
managers and is used as a guideline for developing RBMA programs
• Integrated Clinical Image Viewing and Sharing
by MERGE
• Rethink the Night: An Evidence-Based Discussion
on Teleradiology Partnerships by vRad
• Obstacles to Effective Medical Group Governance
by Will Latham
and products. Domains include: Financial Management; Gover-
• Meeting Meaningful Use: 10 Tips by MERGE
nance; Human Resources; Information Management; Leadership;
• And more!
Marketing, Business Development, and Communications; Operations Management; and Quality, Compliance, and Risk Management.
Articles are currently available in the following domains:
How to Access:
To access this members-only content, please visit
• Governance
www.rbma.org/Radiology_Management_Articles
• Operations Management
More to Come:
• Quality, Compliance, and Risk Management
Sample articles include:
• Physicians Are Conflict Avoiders? by Will Latham
• Eight Pitfalls That Impair a Practice’s Efficiency by
Benjamin W. Strong, MD (ABR, ABIM)
RBMA looks forward to expanding this section of the website
in the coming months! Watch RadCast for announcements of new
content added.
If you would like to contribute to the library, please contact
Daphne Gawronski at daphne.gawronski@rbma.org.
M A R K E T I N G
What’s Your Story?
BY KIM LONGETEIG, FRBMA
HOW YOU CHOOSE TO MARKET YOUR BUSINESS WILL DETERMINE WHAT YOUR BUSINESS BECOMES.
If you want your business to be ordinary, choose ordinary
marketing tactics. However, if you want your business to be
extraordinary, do something different—start telling your business
story through blogging.
What is blogging?
You’ve read blogs. You may not subscribe to blogs, but you’ve
definitely read them, perhaps without realizing it. Website blogs
are short, written pieces about a single, specific topic. They do not
go off topic and cover everything under the sun, and they typically
don’t run over 500 words in length. If the thought of writing makes
you shudder, just think to yourself ‘short and sweet,’ this is doable.
Why should you start blogging?
RBMA BULLETIN | may-june 2015 | www.rbma.org
In addition to establishing authority, building trust, and driving
traffic to your website, here are a few compelling reasons why you
should begin blogging.
1) D
o Google a favor. Search engines thrive on fresh content.
Posting topic-specific content to your website, followed by
maximizing your Web presence on social media, creates new
opportunities for Google and other search engines to index
your content. This increases your search engine visibility and
drives traffic to your website.
32
2) C
onnect with your customers. Your current and potential
customers have specific needs and interests. In addition to
learning through experience, blogging allows you to share a
more personal side of your business with your customers.
Corporate standards, vision, and the face and voice of your
business are sides that your customers don’t experience
through outbound (or push marketing) techniques.
3) B
ecome an industry leader. Sharing relevant, valuable,
expert information about your business allows you to build
trust and clout with your target audiences. Your customers
begin to associate your practice as a trusted resource
and brand for helpful, informative content. This increased
credibility cultivates an environment of trust around your
brand. Consequently, the more your customer trusts you to
supply the information they need, the more likely they are
to become brand advocates.
What’s your business story?
You have a story to tell—who you tell that story to and the way you
tell it sends a message about what you value, and will determine
what kind of business you want to build—ordinary or extraordinary.
Determine whom your story matters to and why. Think about
why your customers choose to do business with you, and what
makes them come back. Determine how they feel about your
business and how you can improve upon that feeling. Finally, what
do they need to know to be able to recommend your business to
someone else?
Need a story idea?
It may seem challenging to come up with an editorial calendar
of new blog post ideas, but in actuality, there is a lot you can write
about. Brainstorm connections between the ins and outs of your
services, or how your services relate to your customer’s lifestyle
choices, such as weekend warrior injuries, community involvement, or tie-ins to national events like Movember, employee/physician features, and new service announcements. Take for example
writing a blog post on SPG Blocks for migraine sufferers; this is
just one idea in an endless stream of possible content.
There are a plethora of resources online to help spur your
blog topics. Try this: The Ultimate List of Blog Post Ideas at
http://ow.ly/Lu0ml to give yourself a jumpstart.
Some final thoughts
Starting a blog will help you to become more intimately
involved in the details of your business. You’ll develop an ear for
potential topics and learn to produce meaningful, inspirational
content. Though it is true that while you may be an expert in your
business, you may not be an expert blogger, or have the time
to take advantage of the numerous benefits blogging creates.
There’s nothing wrong with seeking outside help to write, post
and amplify your content online. However you choose to proceed,
utilize blogging as a platform to tell your story as part of your
marketing strategy and success.
KIM LONGETEIG, FRBMA,
is the principal and creative director of Ali`i
Marketing & Design and has worked, collectively, in
marketing, advertising, graphic design, and social
media for over 20 years. Kim is an active member
of the RBMA and currently serves as secretary on
the RBMA Board of Directors. She is a Fellow of the
RBMA and is the recipient of the Special Recognition
Award for her work in rebranding the RBMA. Kim
recently relocated to Loveland, Colo. She can be
reached at (970) 800-3678 or kim@aliidesign.com.
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D A T A
The Art and Science of Imaging Center
Management
BY DARLENE MOLENAAR, CMPE, CRA
t
his is a significant article for me. For the first time in
3. Make
or buy? It depends on each situation, but I have become
over 18 years working in radiology management, I no
a proponent for finding business partners who have excel-
longer manage imaging centers. Our group recently
lent, cost effective solutions to offer. This enables the imaging
made the very difficult, but strategic, decision to sell the
center to remove its focus from having to constantly invest in
four imaging centers they owned and operated for over 30 years.
staff, hardware, and software to ‘keep up.’ Work with reputable
Our imaging centers are now owned by a joint venture between
companies for billing, payroll, marketing materials, creden-
the contracted hospital system and a highly regarded imaging
tialing, and other services. I do not believe the core business
center management firm. While I currently manage the profes-
of imaging centers should be their business support systems.
sional services portion of the organization, I no longer have daily
Imaging centers are in the business of providing excellent
responsibility for the imaging centers. I hope I have left behind a
imaging services; everything else is a support service.
legacy that will endure and thrive in this new healthcare environment, where independent, physician owned imaging centers are
becoming ever rarer.
As I reflect on my years of managing imaging centers for three
different groups, some essentials from my experience stand out. I
am happy to share them with those starting out in this field, or those
who want to revisit those essentials.
purchased or leased, but are the lifeblood of your organization. Contrary to other support services, I have found that
in-house IT is probably the best solution for multiple imaging
center organizations, given the high demand for an immediate response. At least one IT staff member should be a
strategist who can help select and maintain cost effective
No business professional can solely manage all aspects of
software solutions that affect patients and providers. Invest
a successful imaging center. Depending on the size and
in software that provides good business and quality analytics.
complexity of the center, there could be a center manager
These are the tools that will help you to thrive when payment
for site, or department managers such as Operations, IT,
systems are changed in a few years.
tion. I recommend that each site have a designated leader
that is part of the leadership team and reports directly to the
top administration. That person should be held accountable
for how the center runs, and will deal with the daily challenges
RBMA BULLETIN | may-june 2015 | www.rbma.org
PACS, voice recognition, and RIS software. These can be
1. C
reate a high performing, collaborative management team.
Marketing, Finance, and HR for a large multi-site organiza-
34
4. Imaging centers are information companies. Find the top
of providing customer service to patients, referring offices,
staffing, and troubleshooting. Don’t scrimp on hiring the best,
most capable people, even during tough economic times. The
success of your organization depends on them.
2. L
ook at all your contracts and agreements at least once
every two years. Because of the changing environment, try
not to extend purchased service agreements beyond three
years, at most. Work to negotiate early termination without
cause into the agreements, if possible. While vendors may
try to persuade you to go longer, declining reimbursement
and increasing vendor competition can make longer agreements less advantageous. If you end up needing to change
the ownership structure, longer contracts can work against
you. I learned this lesson during the recent purchase of our
imaging centers.
5. Invest in ways to communicate bi-directionally with referring doctors. Make it extremely easy for patients to reach
you. While electronic solutions can save money, make sure
they are convenient and user-friendly. Unless you have no
competition, patients and referring providers will look for the
path of least resistance.
6. If
you are large enough to invest in marketing staff, make
them educators. Make sure your marketing staff is knowledgeable enough to discuss what you do with referring
providers and their staff in way that enhances your reputation and solves problems. They should be able to discuss
your technology and imaging services with equal aplomb.
Ensure they can install your PACS viewer or set up your online
scheduling tools.
7. G
et feedback from patients and referring providers on how
you are doing. Give patients and referring providers a satisfaction survey and then share that information with your staff
and radiologists. Fix things that are fixable and be responsive
to the needs of your customers.
DATA 4THE ART AND SCIENCE OF IMAGING CENTER MANAGEMENT
8. E
ngage the radiologists. Whether owners, contracted physi-
Those that are able to contract directly with local government
cians, or employees, create processes to enhance their
agencies, big employer groups, or have some clout with the larger
productivity, but not at the expense of their communication
managed care carriers, I applaud you.
with patients or providers. Encourage them to participate
Managing imaging centers requires stamina, good EQ (emotional
in outreach efforts, whether CME dinners or visiting refer-
intelligence), financial management and IT skills, above average
ring providers. Tell patients (and staff) who the radiologist in
patience, and a big dose of humility and humor. Good luck to those
your facility is each day. Encourage quick report turn-around
who continue to pursue this interesting and rewarding responsibility.
times, but ensure that quality does not suffer for quantity.
I will really miss it!
9. E
quipment is important. But unless your competition is
intensely focused on having the newest and most innovative equipment, the bread and butter of an imaging center is
reliable equipment that is efficient, effective, and produces
good imaging quality in an efficient manner. Look into ways
to cost effectively service the equipment; OEMs may or may
not be the best solution. Consider self-insuring or contracting
with a risk vendor.
10. T he business of imaging center management is not dissimilar to other business management: cash is king. It has
been difficult in many markets to increase reimbursement,
so the focus has been on expense reduction for quite some
time. I hope to be involved in radiology management long
DARLENE MOLENAAR, CMPE, CRA
is the COO of Colorado Imaging Associates (CIA),
a 25 doctor professional organization that
provides diagnostic and interventional radiology
services. Currently working with four hospitals,
12 teleradiology clients, and soon to be seven
imaging centers, CIA intends to expand and thrive
in the coming years. Darlene has worked with
two other radiology organizations over more than
17 years and also has an extensive background
managing anesthesiology practices. She has
been an RBMA member since 1995. Darlene has
a master’s degree in organizational leadership.
Darlene can be reached at d.molenaar@ciapc.com;
(303) 416-1360, or (860) 989-6008.
enough to see the pendulum swing back.
RBMA BULLETIN | may-june 2015 | www.rbma.org
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R E G U L A T O R Y / L E G I S L A T I V E
R.I.P. SGR; Hello MIPS
BY MICHAEL R. MABRY
a
fter 17 “fixes” since 1997’s Balanced Budget
EP’s composite score compares to the mean or median
Act, the Medicare Access and CHIP Reauthoriza-
composite score for all EPs in MIPS (the so-called perfor-
tion Act (MACRA) of 2015 finally did away with
mance threshold).
the sustainable growth rate (SGR). In light of this
change one might ask—now what?
receive negative payment adjustments of:
• Four percent in 2019
Physician Fee Schedule (MPFS) conversion factor update starting
• Five percent in 2020
on July 1, 2015, through Dec. 31, 2015. This would be followed
• Seven percent in 2021
by annual updates of 0.5 percent each year from 2016 through
• Nine percent in 2022
2019. However, this does not necessarily mean that providers can
MPFS conversion factor may still be subject to budget neutrality,
 EPs
whose composite score is at the threshold will
receive zero payment adjustments.
 EPs
whose composite score is above the threshold
relative value unit changes, code bundling, and the possibility of
will receive positive adjustments that increase with
new payment policies that we don’t yet know about.
higher performance scores; exceptional performers
Beginning in 2019, MACRA will usher in a new era of valuebased alternate payment incentives for physicians. First, there’s
the Merit-Based Incentive Payment System (MIPS). MIPS will apply
RBMA BULLETIN | may-june 2015 | www.rbma.org
whose composite score is below the threshold will
To begin with, MACRA is to provide a 0.5 percent Medicare
count on yearly increases in their Medicare payments because the
38
 EPs
are eligible for additional incentive payments.
• Professionals do have the flexibility to participate in the way
that best fits their practice.
to services furnished on, or after, Jan. 1, 2019. MIPS consoli-
Additionally, MACRA also encourages participation in alternate
dates Medicare’s three current incentive programs: (1) The Elec-
payment models (APMs). Professionals who receive a significant
tronic Health Record (EHR)/Meaningful Use Incentive Program,
share of their revenue through an APM that involves risk of finan-
(2) the Physician Quality Reporting System (PQRS), and (3) the
cial loss and a quality measurement component will receive a
Value-Based Modifier (VBM). These programs will remain in effect
5 percent payment bonus each year from 2019 through 2024.
through Dec. 31, 2018.
There are two tracks for APM participation for a professional who
Under MIPS:
receives: (1) A significant percent of his/her Medicare revenue
• Eligible professionals (EPs) include doctors of medicine or
through an APM, or (2) a significant percent of APM revenue
osteopathy, doctors of dental surgery or dental medicine,
from Medicare and other payors. In 2026 and subsequent years,
doctors of podiatric medicine, doctors of optometry, chiro-
APM participating professionals would receive annual updates of
practors, physician assistants, nurse practitioners, clinical
0.75 percent, while all other professionals would receive annual
nurse specialists, and certified nurse anesthetists.
updates of only 0.25 percent.
• EPs will be assessed according to four performance catego-
Few, if any, will mourn the passing of the SGR. What we
ries: (1) Quality measures (e.g., PQRS, VBM), (2) resource
shouldn’t forget, however, is that back in 1997, the SGR was
use (e.g., VBM), (3) Meaningful Use (i.e., demonstrated use
widely welcomed over the then despised Volume Performance
of certified EHR technology), and (4) clinical practice improve-
Standard (VPS). The medical community has been presented
ment activities (e.g., practice improvement, participation in
with an opportunity through MIPS, but we must stay involved in
alternate payment models).
its implementation, or risk the possibility of this latest payment
• EPs will receive a composite score on a scale of 0 to 100
reform becoming as dysfunctional and disliked as its predecessors
based on their performance in each performance category.
were. There is truth in the historical adage that those who cannot
• Payment adjustments will be based on how each individual
remember the past are condemned to repeat it.
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T H O U G H T L E A D E R S
ImagineSoftware, an RBMA Platinum Level
Thought Leader sponsor, celebrated its 15th
anniversary in April. The RBMA caught up with
company founder and CEO Sam Khashman.
u
When you founded the company, did you have a sense
of what it would grow into and that you would still be
running it today?
Thinking back to the beginning, our vision, endless ideas and
drive would have had us bigger and more successful in our
own minds. I think we always thought of super success without an end in sight. We probably didn’t quite think about
all the mountains we would have to climb and the hurdles
that we would have to overcome; and that endless ideas and
drive command an equal amount of resources. I am certain
that every entrepreneur firmly believes in their success and
the immortality of their idea, their company and their team.
In our case, we set nonnegotiable goals. Success and servant
leadership are on top, and we are grateful that they have
been well received for 15 years.
RBMA BULLETIN | may-june 2015 | www.rbma.org
u
How important has taking risks and innovating been
to your company’s overall success?
40
I believe that taking more risks than anyone else thinks
is practical and surrounding yourself with a very creative
team that can execute is key to any company’s success. The
French romantic Victor Hugo wrote, “nothing is as powerful
as an idea whose time has come.” In modern times we might
add “…and a strong team and likeminded partners that can
execute and maintain relationships.” Additionally, we believe
that servant leadership and continuous innovation of systems, processes and products play a vital role.
u
Data security is becoming a big challenge for
healthcare. Have you seen the need for security go
up since ImagineSoftware was launched?
The healthcare IT landscape has changed significantly and
the need for security has dramatically increased since we first
began our journey. Cybersecurity was a Star Trek, insider, geek
term in 2000. Today cyber-attack, -breach, -security are on the
minds of most Americans and front and center for any business with sensitive data. Particularly scary breaches are the
ones that involve PHI and surrounding information because
these constitute the most severe breach of privacy. It seems
that not a week goes by without news breaking of a healthcare
system, practice or cloud provider being breached. Unfortunately, most breaches are successful on the attacker’s end and
a failure on the side of the folks charged with safeguarding the
data. The short version is that if an individual actor, an organization or even a foreign government spends enough time and
resources, they will likely be able to get in.
Our company has implemented multilevel systems to include
intrusion prevention and intrusion detection at the n-point in
addition to putting in place the proper protocols for stop-ofservice and risk mitigation. We have added an entire department of high powered cyber folks headed up by our chief strategy officer, a veteran in the cyber field who has implemented
mission-critical systems for national interests. These folks are
available to our clients and assist in critical infrastructure design well beyond the Imagine system. Finally, we have built our
own data center to ensure that we provide clients who like the
convenience that cloud-based systems bring but don’t want to
take a gamble on a third party with a viable alternative.
u
What do you anticipate will happen to practice
collections and how will Imagine play a role?
The recent reimbursement cuts and the combination of
procedures that hit radiologists’ pocket books may have
been just a preview to what the mounting patient responsibility component will become. The theory was that true
self-pay would disappear, but the reality is that the dollar
volume simply shifted from one bucket to the next.
Deductible, self-pay after insurance, enrollment periods,
etc. impact collections more now than ever before. In
anticipation of this shift, we helped create a number of
patient payment solutions that assist our clients in the
collection effort while maintaining a healthy and positive
relationship with the patients. Imagine makes these options
and systems available to its clients without the need or cost
of additional software licensing. Our clients have had great
success in not just the mitigation but also the increase of
income on this journey.
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RBMA BULLETIN | may-june 2015 | www.rbma.org
RCCB
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Our Mission
RBMA is the leading professional
organization for radiology business
management, offering quality
education, resources, and solutions
for its members and the healthcare
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upcoming educational events
Visit the RBMA website at www.rbma.org for details and registration information.
2015
RBMA Radiology Summit
June 7-10, 2015
Caesars Palace • Las Vegas, Nev.
RBMA Georgia Chapter Annual Meeting
June 12, 2015
Hilton Head Island, S.C.
RBMA Florida Chapter Annual Meeting
July 17, 2015
The Ritz-Carlton • Key Biscayne, Fla.
Fall Educational Conference
Sept. 27-29, 2015
Hilton Austin • Austin, Texas
volume 50 | issue 3 | may-june 2015