results communication, chart/film track-
ing and detailed statistical reporting. The
module enables providers to link images
and reports with a single system that can
be accessed simultaneously by multiple
users in multiple departments, the ven-
dor says. “Radiology scheduling systems
tend to be separate in a lot of hospitals,”
adds Jess Jones, a senior director at Hu-
ron Healthcare, a Chicago-based consul-
tancy brought on during the Epic imple-
mentation to mitigate revenue cycle risk.
“With a single EHR, we will streamline
this approach.”
As the Resurrection hospitals deploy
the system, their billing will be driven by
a single charge master, rather than six dis-
crete ones, McDermott says. That move is
part of an overall revenue cycle standard-
ization effort aimed at minimizing any
disruptive effects of the EHR project and
setting the stage for easier accountability
in the department. Any radiology work
order initiated by a tech will pull a consis-
tent charge before dispatching claims to
payers, McDermott explains.
A temporary spike
McDermott says St. Francis Hospital, the
first hospital to go live with Epic, did wit-
ness a spike in unbilled claims as the or-
ganization purposefully held back on sub-
mitting any claims to assure the charges
were being captured and coded correctly.
The overall unbilled claims spiked to $33
million, or about 17 days worth of rev-
enue, but returned within two months to
a normal level of $10 million, represent-
ing about five days or less or revenue.
The sudden spike in unbilled claims was
expected, but getting it back to normal in
Keeping Score
Physician scorecards are rapidly become a common fixture at group practices and hospitals (see cover story, October issue). And these scorecards frequently measure imaging utilization on the part of referring physicians—if not the performance of the imaging
department itself. Scorecards are just another emerging tool in the arsenal of administrators looking to reduce excess utilization—a charge many level against radiology
procedures. Decatur, Ill.-based St. Mary’s Hospital uses a scorecard service from The
Advisory Board Company that enables it to compare utilization across other hospitals
in its parent, Hospital Sisters Health System, and measure them against national quality
benchmarks. “For utilization, I can go by physician or clinical service group and see who
may be ordering too many chest X-rays,” says Maria Granzotti, M.D., chief physician
executive at St. Mary’s. The scorecard also enables her to analyze services by DRG, and
determine if any individual contributors to cost—such as imaging—are out of line.
Even emergency department physicians are beginning to keep closer tabs on their
resource utilization. Emergency Physicians Medical Group provides physicians and
nurses to more than 30 hospitals across eight Midwestern states and recently deployed
a utilization scorecard, using technology from Emergency Medicine Business Intel-
ligence. The dashboard shows a number of key metrics, including patient turnaround
time, a main driver of patient satisfaction. The data can reveal the extent to which delays
in patient admissions or discharge are driven by bottlenecks in the imaging area, says
Rodney Smith, M.D. chief medical officer. The scorecard also shows how much imaging
is ordered by the emergency physicians, adds Scott Richards, CEO of EMBI. “We can
do deep dive analytics, including utilization of CT by physician, or utilization of CT by
diagnosis group. We can see how many tests were ordered and by whom.”
Utilization metrics will only grow in importance in the accountable care era, says
Zac Stillerman, executive director, revenue cycle solutions, at The Advisory Board
Company. “As providers adopt risk-based contracts, they will look at utilization—and
radiology can easily be over-utilized. These are expensive procedures. You will need to
know you are not going hog wild on a set of scans.”
60 days was “a huge success,” McDermott
says (he is uncertain about on the contribution of imaging to the total). “We had to
manage the AR on a daily, super-detailed
basis,” he adds.
At the group practice level, data inte-
gration can be difficult to achieve—largely
due to cost. Take Oklahoma Arthritis, an
Edmond-based group with three physi-
cians and three physician assistants. Led
by rheumatologist Craig Carson, M.D., the
group provides a number of clinical services
for arthritis patients—including imaging,
which constitutes about 10 percent of total
revenue. “We do our own X-ray, MRIs, ultra-
sound and dexa (bone density) scans,” says
Carson. “For arthritis service, that is critical.
The patients have trouble trapsing in across
town. We can give them an MRI and give
them immediate feedback.”
But running the operation—and the
I. T. needed to support it—is an expensive
proposition. Carson documents on an EHR,
from Allscripts, but could not afford a full-
bore PACS, “which is more expensive than
an EHR.” Instead, he opted for a no-frills
PACS/RIS, an open source product from a
Canadian company called Clear Canvas.
“They asked for a donation and I sent one
thousand dollars,” Carson says. Now, orders
are placed in the EHR, but related patient
information must be retyped by radiology
techs into the PACS.
The practice maintains two accreditations for its imaging work, including one
from the Intersocietal Accreditation Commission (IAC) and another from the American College of Radiology. Even a practice
with a small imaging component must
yield to increasing regulatory requirements
aimed at minimizing utilization, Carson explains. “I don’t want anyone saying we are
doing second-rate imaging and driving up
the cost. We’re not.” To keep up with the
ACR standards, the practice had to replace
its aging MRI machine, with a used replacement model that is five years old. “Am I
making money on imaging?” Carson asks
rhetorically. “No. It’s a service. That’s all it is
and I take pride in it. I am able to break even
and pay for the equipment.”
