Interventional Radiology Service Line Business and Practice Building

Interventional Radiology Service Line Business and Practice Building Focus: Arterial Disease http: //www. streamlinemd. com/Data/Sites/58/assets/ir_image. png 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 Radio. Graphics 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