Interventional Radiology Service Line
Business and Practice Building
Focus: Arterial Disease
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Raj P. Shah MD, MBA
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.
Components to Develop Strategy for a
Successful IR Service Line
- Goals – Mission and Vision
- Basic Market Analysis
- Service Lines Operations Analysis
- Marketing Overview
- Tools for Success
- Financial Overview
Organizational Structure
Mission 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
The 5 C’s of Market Analysis
Customers
.Patients
.Referring Physicians
.Hospitals
.Insurance Companies
Competencies
eg- 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
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, longterm 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
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?
Provider identifies
patient who needs
vascular service
referral
At my VIR clinic,
non-invasive testing
and procedures are
performed (if
indicated)
Patient returns to
your care, with
recommendations
for disease
management.
A complete report
of findings and
procedures
performed is
generated.
Marketing
. 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
.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)
Marketing
-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)
Important:
Marketing
-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 Success
Kaizen
-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 Elements
1. 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 Sigma
Solutions:
-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 Sigma
Results:
- 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.
The Approach
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.
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.
References
Yousem, 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;1:26-32
Volland, J. Case Study: Now that’s Lean. Medical Imaging Magazing
2005
Kruskal, JB. Quality Initiatives:Lean Approach to Improving
Performance and Efficiency in a Radiology Department. March
2012 Radiographics; 32; 573-587
Beheshti, MV. The interventional radiology business plan. J Vasc
Interv Radiol 2012;23;1181-1186