Imaging Healthcare Specialists (“IHS”), a 30-radiologist practice based in San Diego, California, has a simple ethos driving its business decisions. “We view ourselves, first and foremost, as a medical practice,” Thomas Cleary, president and COO of Imaging Health- care Specialists, explains. “Every day, every employee who works for us is making an impact on patients’ lives.”

Medical practices have arrived at a juncture where the importance of business intelligence to strategic planning and growth cannot be ignored, says Scott Law, founder and CEO of Zotec Partners. “Physicians are, first and foremost, scientists, and historically they have focused on the science of their discipline as opposed to the business side of medicine,” he says. “In the current environment of evolving health care delivery and reimbursement models, the key to survival is finding ways to differentiate yourself—not only through productivity and efficiency, but also through quality and improved outcomes, which we are really beginning to be able to measure for the first time.”

Of all the outsourcing decisions that radiology practices must make, none might take as long as deciding whether to outsource medical billing and coding. This is due, in part, to the fact that billing is the company’s cash register, so to speak, and is therefore more likely to be scrutinized —even agonized over—than are other services.

The federal meaningful-use program has been particularly challenging for imaging, both in its inception and in its execution. Initially, it seemed as though radiology would be exempt from the system of incentives and penalties devised to increase electronic health record (EHR) adoption; a rule change reversed that, making 90% of practicing radiologists eligible providers. For specialists, however, the menu set of requirements can be puzzling, at best, and prohibitive to participation, at worst.

The theme of 2012’s annual RSNA meeting in Chicago, Illinois, was Patients First, reflecting a question on the minds of many in the imaging community: How can a specialty with very little patient interaction built into its workflow improve its service to patients? As an emerging practice model, patient-centered radiology has a nice ring to it, but as Greg Thomson, CPA, executive vice president with Medical Management Professionals (MMP), notes, “This represents a major cultural leap for radiology. Radiologists have long had multiple customers—including referring physicians and hospitals—along with patients, and because they often do not interact with patients, their focus has been on the referring physicians, not the patients. It is a mindset shift for the specialty.”

The diagnostic-imaging industry continues to face significant reimbursement headwinds as a result of recent Medicare reimbursement cuts. Industry-specific cuts recently enacted include the Multiple Procedure Payment Reduction (MPPR), which was introduced in the 2012 Medicare Physician Fee Schedule (MPFS) and expanded in the 2013 MPFS, and the increased equipment-utilization rate (used to calculate Medicare reimbursement) contained in the American Taxpayer Relief Act (ATRA), passed in January 2013.

One of the most emotionally loaded conversations in imaging is that concerning efficiency and productivity. In recent years, these considerations have become increasingly vital to groups’ survival, according to Chad Calendine, MD, CMO of Optimal Radiology Partners and President of Premier Radiology (Nashville, Tennessee). “As peoples’ incomes began to decrease with decreasing reimbursement, they became more focused on how to regain that lost income, and the way to do that is through additional efficiencies and productivity,” he says. “It’s an emotional issue because it strikes to the heart of whether you are a good radiologist and a good partner. Are you pulling your weight?”

Managing emergency-department volume is a perennial challenge for hospitals, and at St. Mary’s Regional Medical Center (SMRMC) in Reno, Nevada, emergency-department volume is only expected to grow, according to Helen Lidholm, CEO. “We’re assessing what our emergency-department volume is going to look like, based on what we know about our community and how our local patient population will be affected by the Patient Protection and Affordable Care Act,” she says. “Every community is different, but we’re anticipating higher volume in the emergency department.”