Practice Management

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats? 

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

Hi Dustin

Unless your practice is one in which the skill sets and case mix are pretty consistent across all rads and seats, equality in terms of procedures or RVU's may not be a realistic or desireable goal.

In our group, we find that the main driver of variation isn't who you are, but where you're sitting.  There are varying case/procedure mixes, varying amounts of interruptions, and varying systems, among other things.  To that end, we look at work RVU's per shift by individual and by seat, and we're happy with +/- 10% from the median in any given seat that an individual is regularly assigned to.  We know that if someone goes to a place once in a blue moon, he or she will likely be less productive.

We also know that work RVU's are a very crude measure of work effort or production.  If they were accurate, it wouldn't be possible to cherry pick.  Some groups have created their own RVU's to address this problem.

There other thing that has to be taken into consideration is duties that don't produce billable RVU's...consultations with referring clinicians, administrative duties, etc.  Some groups have set up systems to measure those activities.

Our group has a subcommittee of the Board that reviews production stats, and weighs all of these issues with a goal of achieving more or less equal effort and contribution.  They don't look at the productivity numbers in isolation.

The other thing to think carefully about is what to do with the data once you pull it together.  I think it's important to have a well defined practice culture that recognizes the value of RVU production vs. other contributions.  Without that framework, focus on production can be extremely divisive.

------------------------------
David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
------------------------------

Original Message:
Sent: 06-03-2020 13:17
From: Dustin Ledgerwood
Subject: Radiologist production

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats?

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

Dustin,

 I strongly echo David's comments.  Be very careful going down this path.  I believe your group is relatively small (your website).  I also guess that although you are not highly subspecialized, but you are still likely have some rads who read more mammograms or perform more interventional studies than others.   Also, you need to find a way to recognize the non-RVU value of attending meetings or fostering the the necessary (and important) interpersonal relations with the hospital, referring physicians, and patients. 

 In my experience, most asking this question have either

1. A  high producer who is feeling aggrieved at a perceived (but in the end an acceptable) difference; or
2. A low producer the group is frustrated with.

 There will always be discrepancies between radiologists.  Some work faster than others, and there is nothing inherently wrong with that.  A faster radiologist is just going to do more work than someone who reads slower.  It's as simple as that, and this needs to be accepted. 

 I've seen/heard of too many groups that want to use RVUs to solve an issue related to what I described above, rather than address the HR issue that is directly.  That is a poor use of RVUs and will lead the group into the proverbial rat hole. 

 The solution is often a little simpler.  It needs to be recognized that in a traditional readiology group that shares revenues equally, each person should be expected to have a reasonably similar approach to the job.  First, show up on time and get to work; second, go home on time (or certainly not early); third, don't take an inordinate amount of breaks, overly-long lunches, or conduct personal business, etc. during the work day.  If everyone is arriving at work, leaving work at the end of the day, and working reasonably similarly throughout the day, then RVUs get you nowhere. 

 Here is some info that is interesting.  CMS assigns estimated time it takes to interpret each study.  These times are used in the formula to determine the Work RVU.  (Times can be found in the CMS Physician Fee Schedule published every year each year).   For example, CMS's says it takes 37 minutes to interpret CPT 70553, MRI Brain w/o contrast.  Contrast that with a Chest X-ray which CMS says takes 5 minutes.  (FYI – screening mammography is about 10 minutes.)  Intra-modality times are probably reasonably consistent.  However, intermodality times aren't too consistent, making it difficult to use them.  Anyone doing more mammography will end up on the top; anyone doing more interventional will end up toward the bottom.  This means that unless your group distributes its workload nearly evenly across the modalities, you will have artificially distorted comparisons.  If you do, you're a rarity. 

 In the end, using RVUs to review workloads can be done, but as Dave says, it is one of several metrics you would need to present.  In most cases, it wouldn't be the most important, and even then it is more often than not, confounding to the larger discussion. 

 If everyone is seen as putting forth similar efforts, don't worry about RVUs.  If someone is perceived as not putting forth the effort, treat it like the HR issue it is and find a way to appropriately address that. 

Mike Bohl

 

------------------------------
Michael Bohl FRBMA
Strategic Advisor
Radiology Group, PC, SC
Bettendorf IA
(563) 484-0488
------------------------------

Original Message:
Sent: 06-03-2020 14:44
From: David Smith
Subject: Radiologist production

Hi Dustin

Unless your practice is one in which the skill sets and case mix are pretty consistent across all rads and seats, equality in terms of procedures or RVU's may not be a realistic or desireable goal.

In our group, we find that the main driver of variation isn't who you are, but where you're sitting.  There are varying case/procedure mixes, varying amounts of interruptions, and varying systems, among other things.  To that end, we look at work RVU's per shift by individual and by seat, and we're happy with +/- 10% from the median in any given seat that an individual is regularly assigned to.  We know that if someone goes to a place once in a blue moon, he or she will likely be less productive.

We also know that work RVU's are a very crude measure of work effort or production.  If they were accurate, it wouldn't be possible to cherry pick.  Some groups have created their own RVU's to address this problem.

There other thing that has to be taken into consideration is duties that don't produce billable RVU's...consultations with referring clinicians, administrative duties, etc.  Some groups have set up systems to measure those activities.

Our group has a subcommittee of the Board that reviews production stats, and weighs all of these issues with a goal of achieving more or less equal effort and contribution.  They don't look at the productivity numbers in isolation.

The other thing to think carefully about is what to do with the data once you pull it together.  I think it's important to have a well defined practice culture that recognizes the value of RVU production vs. other contributions.  Without that framework, focus on production can be extremely divisive.

------------------------------
David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387

Original Message:
Sent: 06-03-2020 13:17
From: Dustin Ledgerwood
Subject: Radiologist production

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats?

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

I agree with David regarding the limits of RVUs.    The math behind RVU calculation is tied to comparing procedures (notably Medicare services) to dollars.  Over the years, the notion of wRVUs became a quasi-benchmark used in productivity measurements, however, is more of an adjusted allocation of revenue than it is measuring work.   Unfortunately, many practices adopted a radiology compensation program tied directly RVU production which can unknowingly incentivize the wrong behavior, i.e. "cherry-picking".

Measuring "Work" and dividing by Cost over a measurable period (shift, day, week or month) is a much more worthwhile endeavor, especially with volumes and revenues underwater during the Covid slowdown.  In other words, "Time is Money", as Michael just illustrated.

Since revenue is highly correlated to volume of studies, where they sit matters just as much as who they are.  In an age of sub-specialization, radiologists preferentially focus in their area of expertise and comfort. Ironically, most slots within a radiology group are defined by the "seat" and less about "who" is in the seat (the specialty of the radiologist), even though they would likely be much more productive reading within the Fellowship training.  

The hard part is deciding what work you want your radiologists 'to-do', and how much time they should be consuming to do it.  While this is just a generic, high-level average of total annual volumes, it does illustrate the relationship between seat (or setting) and volume.

Estimating Partner Radiologist Cost Per RVU
		Annual Rad Comp (including Benefits & Med Mal)
Radiologist Profile/Setting	Ave Annual # of exams per Rad	$425,000	$475,000	$525,000	$575,000	$625,000
Sub Specialty Academic	10,000	$47.22	$52.78	$58.33	$63.89	$69.44
Hospital Employed	12,000	$39.35	$43.98	$48.61	$53.24	$57.87
National Avg	14,000	$33.73	$37.70	$41.67	$45.63	$49.60
Private Practice	16,000	$29.51	$32.99	$36.46	$39.93	$43.40
Private Practice (Imaging Center Focus)	18,000	$26.23	$29.32	$32.41	$35.49	$38.58
2019 CMS Reimbursement/RVU	$36.03

------------------------------
Dave Stalder
Vice President, Business Developoment
Aligned Imaging Solutions
New York
(412) 973-6503
------------------------------

Original Message:
Sent: 06-03-2020 15:46
From: Michael Bohl
Subject: Radiologist production

Dustin,

 I strongly echo David's comments.  Be very careful going down this path.  I believe your group is relatively small (your website).  I also guess that although you are not highly subspecialized, but you are still likely have some rads who read more mammograms or perform more interventional studies than others.   Also, you need to find a way to recognize the non-RVU value of attending meetings or fostering the the necessary (and important) interpersonal relations with the hospital, referring physicians, and patients. 

 In my experience, most asking this question have either

1. A  high producer who is feeling aggrieved at a perceived (but in the end an acceptable) difference; or
2. A low producer the group is frustrated with.

 There will always be discrepancies between radiologists.  Some work faster than others, and there is nothing inherently wrong with that.  A faster radiologist is just going to do more work than someone who reads slower.  It's as simple as that, and this needs to be accepted. 

 I've seen/heard of too many groups that want to use RVUs to solve an issue related to what I described above, rather than address the HR issue that is directly.  That is a poor use of RVUs and will lead the group into the proverbial rat hole. 

 The solution is often a little simpler.  It needs to be recognized that in a traditional readiology group that shares revenues equally, each person should be expected to have a reasonably similar approach to the job.  First, show up on time and get to work; second, go home on time (or certainly not early); third, don't take an inordinate amount of breaks, overly-long lunches, or conduct personal business, etc. during the work day.  If everyone is arriving at work, leaving work at the end of the day, and working reasonably similarly throughout the day, then RVUs get you nowhere. 

 Here is some info that is interesting.  CMS assigns estimated time it takes to interpret each study.  These times are used in the formula to determine the Work RVU.  (Times can be found in the CMS Physician Fee Schedule published every year each year).   For example, CMS's says it takes 37 minutes to interpret CPT 70553, MRI Brain w/o contrast.  Contrast that with a Chest X-ray which CMS says takes 5 minutes.  (FYI – screening mammography is about 10 minutes.)  Intra-modality times are probably reasonably consistent.  However, intermodality times aren't too consistent, making it difficult to use them.  Anyone doing more mammography will end up on the top; anyone doing more interventional will end up toward the bottom.  This means that unless your group distributes its workload nearly evenly across the modalities, you will have artificially distorted comparisons.  If you do, you're a rarity. 

 In the end, using RVUs to review workloads can be done, but as Dave says, it is one of several metrics you would need to present.  In most cases, it wouldn't be the most important, and even then it is more often than not, confounding to the larger discussion. 

 If everyone is seen as putting forth similar efforts, don't worry about RVUs.  If someone is perceived as not putting forth the effort, treat it like the HR issue it is and find a way to appropriately address that. 

Mike Bohl

 

------------------------------
Michael Bohl FRBMA
Strategic Advisor
Radiology Group, PC, SC
Bettendorf IA
(563) 484-0488

Original Message:
Sent: 06-03-2020 14:44
From: David Smith
Subject: Radiologist production

Hi Dustin

Unless your practice is one in which the skill sets and case mix are pretty consistent across all rads and seats, equality in terms of procedures or RVU's may not be a realistic or desireable goal.

In our group, we find that the main driver of variation isn't who you are, but where you're sitting.  There are varying case/procedure mixes, varying amounts of interruptions, and varying systems, among other things.  To that end, we look at work RVU's per shift by individual and by seat, and we're happy with +/- 10% from the median in any given seat that an individual is regularly assigned to.  We know that if someone goes to a place once in a blue moon, he or she will likely be less productive.

We also know that work RVU's are a very crude measure of work effort or production.  If they were accurate, it wouldn't be possible to cherry pick.  Some groups have created their own RVU's to address this problem.

There other thing that has to be taken into consideration is duties that don't produce billable RVU's...consultations with referring clinicians, administrative duties, etc.  Some groups have set up systems to measure those activities.

Our group has a subcommittee of the Board that reviews production stats, and weighs all of these issues with a goal of achieving more or less equal effort and contribution.  They don't look at the productivity numbers in isolation.

The other thing to think carefully about is what to do with the data once you pull it together.  I think it's important to have a well defined practice culture that recognizes the value of RVU production vs. other contributions.  Without that framework, focus on production can be extremely divisive.

------------------------------
David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387

Original Message:
Sent: 06-03-2020 13:17
From: Dustin Ledgerwood
Subject: Radiologist production

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats?

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

While I completely agree that the RVU, in isolation, is a very poor metric, I also believe that many radiologists require management for the practice to achieve its maximum success. It's just good business to assure very expensive resources are performing optimally.  

It is no small thing if your highest producing radiologists are unhappy because they feel the group is not managing its overall physician productivity well. Losing a high producer to another practice wherein he or she feels his or her accomplishments are better respected, can substantially impact a practice's profitability. When one of the "best" leaves it pushes the door wide open for the next best and so on...  just think of your practice's overall bottom line and operational challenges if you lose the top performing rads? What are the chances you can recruit a like for like? Now what happens if you lose your lowest performing radiologists? What are the chances in each scenario that you can recruit a like for like? 

While I completely agree that a physician's productivity must be examined in the context of a "seat" or in the case of virtual workplace, a "role",  I also believe that non revenue producing work, not just tumor boards and conferences, but also phone calls, consults and other duties for which we are not financially recognized, but are most definitely "work", should be seen and calculated, as opportunity lost. Additionally these non revenue producing tasks should be managed as well.

Further, even in the same role, some physician's skill sets result in a less favorable modality mix as described above. For example even a very "productive" plain film reader cannot generate more than about 35 RVUs/day. Contrasted with a modestly productive rad reading brain MRIs will generate 70 RVUs at an overall slower pace. That aberrancy of the RVU can and should be considered in evaluating performance.

Productivity and Quality are like weights on opposing arms of a scale; they have to be kept in relative balance. When initiating a more robust productivity management system one must also evaluate and possibly improve its efforts in managing quality. Be prepared to address your low producers assertions that their "better" quality excuses them from adequate production.  I use the scale analogy and show them what would happen to the shareholder income if theirs was the expected performance.

I believe that productivity must be managed in all but perhaps the smallest, most uniform groups. Further, the best and most rewarding way to manage physician productivity is with real time feedback. The Hawthorne effect in radiology has been proven by several authors to add 15-20% productivity across an enterprise. The resulting analytics of such an robust management effort can be used to negotiate subsidies and support HR initiatives. When I hear people say that there is no way to manage physician productivity fairly, I know they just really aren't aware of potential strategies and solutions.  

------------------------------
Elizabeth Bergey
President and CEO
Quantum
Lewisberry, PA
717 932-5200
EBergey@qita.com
------------------------------

Original Message:
Sent: 06-03-2020 13:17
From: Dustin Ledgerwood
Subject: Radiologist production

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats?

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

Radiology of Huntville has benchmarks established for each shift rotation ... our PACS has a real time RVU tracker that is viewable by every Radiologist.  This tool worked has worked well for the practice for last 6+ years.

------------------------------
Parke Keith
Radiology of Huntsville, P.C.
Huntsville, AL
256.539.0457
------------------------------

Original Message:
Sent: 06-03-2020 13:17
From: Dustin Ledgerwood
Subject: Radiologist production

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats?

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

This is a great thread and an "age-old" challenge in radiology groups. Unlike specialties like Anesthesiology, Orthopedics, or Emergency Medicine, radiologists are not fungible. I spent 20 years working with radiology groups on "boxes and wires" solutions to connect disparate systems (PACS, workflow orchestration, etc.) so they can get economies of scale and skill to enable reading with subspecialty and avoid cherry-picking, etc. I do not claim to have all the answers, but I can certainly share some insights into what has worked and has not worked for groups over the past couple of decades:

• Using RVUs in isolation (to the point from Dr. Bergey) leads to all sorts of challenges.
• When radiologists know their productivity is being measured, it yields a 10% bump across the board. (displaying it overtly like Parke just mentioned will likely increase that gain)
• Many groups focus on the "what" and "how" before agreeing on the "why" (operating plan goal). Radiologists who do not want to change are always eager to blame IT limitations as to why they cannot change.
  • You can spend lots of money on IT (Clario, Medicals, Primordial) to prevent "cherry-picking, etc.," but make sure you have 100% alignment on the operating plan before investing in "boxes and wires."
• Too many groups build their schedule based on the "seat" and not enough on "who is in the seat."
  • COVID has finally forced hospitals to loosen their onsite requirements, which is a good thing, but it likely requires changes to schedule rationale in things like QGenda
• Having the RVU or "cherry-picking" discussion is impossible at the monthly partner meeting without data.
• If the real "why" behind the productivity discussion is to make sure everyone is working equal, your top performers will leave.
• "Sticky tasks" like consults, boards, and being active with hospital administration is what gets and keeps PSA's for groups.
• COVID was a "wobble event" and groups that revert to "this is the way we have always done things" will be at a disadvantage against groups that measure things like productivity and adapt their group to take advantage of the "new normal" coming out of COVID.
• A "no regret" move would be investing in a simple solution that measures productivity, including "sticky tasks" and allows for additional RVU scales for things like working "overnight." I would suggest ingesting a few months of historical data and normalizing everything before measuring the "after." There are several out there from different perspectives (billing companies, PACS, RIS, scheduling, Speech Req), but the ones build by radiology groups for radiology groups have advantages for obvious reasons.
  • https://q-itsolutions.com/products/pace/

------------------------------
Jordan Halter
VP of Business Development
Aligned Imaging Solutions
New York
(412) 780-1665
jordan.halter@alignedimaging.com
https://www.alignedimaging.com/
------------------------------

Original Message:
Sent: 06-04-2020 12:04
From: Parke Keith
Subject: Radiologist production

Radiology of Huntville has benchmarks established for each shift rotation ... our PACS has a real time RVU tracker that is viewable by every Radiologist.  This tool worked has worked well for the practice for last 6+ years.

------------------------------
Parke Keith
Radiology of Huntsville, P.C.
Huntsville, AL
256.539.0457

Original Message:
Sent: 06-03-2020 13:17
From: Dustin Ledgerwood
Subject: Radiologist production

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats?

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

Thanks everybody, for the great input! it is much appreciated!

I want to provide some specific details about our group. We are a small group (currently 8 radiologists) that is not very subspecialized. All of our radiologists read everything, and do so from a common worklist. All radiologists rotate through our various locations a fairly equal amount. We are strictly a diagnostic radiology group, as a separate interventional performs almost all (except breast intervention) interventional procedures. Given all of these facts, we have historically chosen to keep an eye on procedure counts and RVU to compare radiologist's production, while also taking into account the amount of "time away from the worklist" for vacations, meetings, conferences, etc.

Given these facts, at what point (greater than 10%, 15%, 20%.....below the group median) would you feel there is a real need for corrective action in the case of a low producing radiologist?

Thanks in advance for your time and consideration,

Dustin Ledgerwood
Lincoln Radiology Group, PC

------------------------------
Dustin Ledgerwood RT
Business Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

Original Message:
Sent: 06-04-2020 12:16
From: Jordan Halter
Subject: Radiologist production

This is a great thread and an "age-old" challenge in radiology groups. Unlike specialties like Anesthesiology, Orthopedics, or Emergency Medicine, radiologists are not fungible. I spent 20 years working with radiology groups on "boxes and wires" solutions to connect disparate systems (PACS, workflow orchestration, etc.) so they can get economies of scale and skill to enable reading with subspecialty and avoid cherry-picking, etc. I do not claim to have all the answers, but I can certainly share some insights into what has worked and has not worked for groups over the past couple of decades:

• Using RVUs in isolation (to the point from Dr. Bergey) leads to all sorts of challenges.
• When radiologists know their productivity is being measured, it yields a 10% bump across the board. (displaying it overtly like Parke just mentioned will likely increase that gain)
• Many groups focus on the "what" and "how" before agreeing on the "why" (operating plan goal). Radiologists who do not want to change are always eager to blame IT limitations as to why they cannot change.
  • You can spend lots of money on IT (Clario, Medicals, Primordial) to prevent "cherry-picking, etc.," but make sure you have 100% alignment on the operating plan before investing in "boxes and wires."
• Too many groups build their schedule based on the "seat" and not enough on "who is in the seat."
  • COVID has finally forced hospitals to loosen their onsite requirements, which is a good thing, but it likely requires changes to schedule rationale in things like QGenda
• Having the RVU or "cherry-picking" discussion is impossible at the monthly partner meeting without data.
• If the real "why" behind the productivity discussion is to make sure everyone is working equal, your top performers will leave.
• "Sticky tasks" like consults, boards, and being active with hospital administration is what gets and keeps PSA's for groups.
• COVID was a "wobble event" and groups that revert to "this is the way we have always done things" will be at a disadvantage against groups that measure things like productivity and adapt their group to take advantage of the "new normal" coming out of COVID.
• A "no regret" move would be investing in a simple solution that measures productivity, including "sticky tasks" and allows for additional RVU scales for things like working "overnight." I would suggest ingesting a few months of historical data and normalizing everything before measuring the "after." There are several out there from different perspectives (billing companies, PACS, RIS, scheduling, Speech Req), but the ones build by radiology groups for radiology groups have advantages for obvious reasons.
  • https://q-itsolutions.com/products/pace/

------------------------------
Jordan Halter
VP of Business Development
Aligned Imaging Solutions
New York
(412) 780-1665
jordan.halter@alignedimaging.com
https://www.alignedimaging.com/

Original Message:
Sent: 06-04-2020 12:04
From: Parke Keith
Subject: Radiologist production

Radiology of Huntville has benchmarks established for each shift rotation ... our PACS has a real time RVU tracker that is viewable by every Radiologist.  This tool worked has worked well for the practice for last 6+ years.

------------------------------
Parke Keith
Radiology of Huntsville, P.C.
Huntsville, AL
256.539.0457

Original Message:
Sent: 06-03-2020 13:17
From: Dustin Ledgerwood
Subject: Radiologist production

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats?

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

Dustin

As I mentioned, we generally consider +/- 10% from the median.  I have worked with other groups that use 2 standard deviations from the mean as a threshold.  Honestly, if someone really isn't making an effort to carry their share of the load, everyone knows it (especially on a unified worklist).  You really don't need numbers for that.

Whatever threshold you choose, I would suggest that it not be the threshold for corrective action, but for asking questions and studying the reasons for the variance.  That may lead to a need for corrective action, or a better understanding of what's driving the variance.

Also, don't overlook those who are way above the median.  It has been my experience that those who prioritize speed are more likely to have quality/compliance issues.  Everyone probably knows who those people are too.

------------------------------
David Smith FACMPE
Executive Director
United Imaging Consultants
Mission
(785) 393-8387
------------------------------

Original Message:
Sent: 06-05-2020 12:49
From: Dustin Ledgerwood
Subject: Radiologist production

Thanks everybody, for the great input! it is much appreciated!

I want to provide some specific details about our group. We are a small group (currently 8 radiologists) that is not very subspecialized. All of our radiologists read everything, and do so from a common worklist. All radiologists rotate through our various locations a fairly equal amount. We are strictly a diagnostic radiology group, as a separate interventional performs almost all (except breast intervention) interventional procedures. Given all of these facts, we have historically chosen to keep an eye on procedure counts and RVU to compare radiologist's production, while also taking into account the amount of "time away from the worklist" for vacations, meetings, conferences, etc.

Given these facts, at what point (greater than 10%, 15%, 20%.....below the group median) would you feel there is a real need for corrective action in the case of a low producing radiologist?

Thanks in advance for your time and consideration,

Dustin Ledgerwood
Lincoln Radiology Group, PC

------------------------------
Dustin Ledgerwood RT
Business Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512

Original Message:
Sent: 06-04-2020 12:16
From: Jordan Halter
Subject: Radiologist production

This is a great thread and an "age-old" challenge in radiology groups. Unlike specialties like Anesthesiology, Orthopedics, or Emergency Medicine, radiologists are not fungible. I spent 20 years working with radiology groups on "boxes and wires" solutions to connect disparate systems (PACS, workflow orchestration, etc.) so they can get economies of scale and skill to enable reading with subspecialty and avoid cherry-picking, etc. I do not claim to have all the answers, but I can certainly share some insights into what has worked and has not worked for groups over the past couple of decades:

• Using RVUs in isolation (to the point from Dr. Bergey) leads to all sorts of challenges.
• When radiologists know their productivity is being measured, it yields a 10% bump across the board. (displaying it overtly like Parke just mentioned will likely increase that gain)
• Many groups focus on the "what" and "how" before agreeing on the "why" (operating plan goal). Radiologists who do not want to change are always eager to blame IT limitations as to why they cannot change.
  • You can spend lots of money on IT (Clario, Medicals, Primordial) to prevent "cherry-picking, etc.," but make sure you have 100% alignment on the operating plan before investing in "boxes and wires."
• Too many groups build their schedule based on the "seat" and not enough on "who is in the seat."
  • COVID has finally forced hospitals to loosen their onsite requirements, which is a good thing, but it likely requires changes to schedule rationale in things like QGenda
• Having the RVU or "cherry-picking" discussion is impossible at the monthly partner meeting without data.
• If the real "why" behind the productivity discussion is to make sure everyone is working equal, your top performers will leave.
• "Sticky tasks" like consults, boards, and being active with hospital administration is what gets and keeps PSA's for groups.
• COVID was a "wobble event" and groups that revert to "this is the way we have always done things" will be at a disadvantage against groups that measure things like productivity and adapt their group to take advantage of the "new normal" coming out of COVID.
• A "no regret" move would be investing in a simple solution that measures productivity, including "sticky tasks" and allows for additional RVU scales for things like working "overnight." I would suggest ingesting a few months of historical data and normalizing everything before measuring the "after." There are several out there from different perspectives (billing companies, PACS, RIS, scheduling, Speech Req), but the ones build by radiology groups for radiology groups have advantages for obvious reasons.
  • https://q-itsolutions.com/products/pace/

------------------------------
Jordan Halter
VP of Business Development
Aligned Imaging Solutions
New York
(412) 780-1665
jordan.halter@alignedimaging.com
https://www.alignedimaging.com/

Original Message:
Sent: 06-04-2020 12:04
From: Parke Keith
Subject: Radiologist production

Radiology of Huntville has benchmarks established for each shift rotation ... our PACS has a real time RVU tracker that is viewable by every Radiologist.  This tool worked has worked well for the practice for last 6+ years.

------------------------------
Parke Keith
Radiology of Huntsville, P.C.
Huntsville, AL
256.539.0457

Original Message:
Sent: 06-03-2020 13:17
From: Dustin Ledgerwood
Subject: Radiologist production

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats?

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

Hello to all!

I've taken the time to read all of your exceedingly valuable insight on the topic of productivity driven by data and common sense.  One of the practices I am working with is looking into the workflow management system by GE using Centricity Workflow Manager. Another group I have worked with has always used Primordial (which they deem to have similar functionalities to Clario).  Being that these are all high dollar investments I wanted to benchmark with you to find out what are your thoughts/experience with any of these or others.  I know that some of you also market your proprietary software management systems. Overall...any recommendations? Word to the wise?  General feedback? Thank you to all!! 

It takes a village....

------------------------------
Barbara Deppman
Prinicipal
Deppman Healthcare Consultancy
Santa Fe NM
305-505-5669
------------------------------

Original Message:
Sent: 06-03-2020 13:17
From: Dustin Ledgerwood
Subject: Radiologist production

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats?

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

Dustin - I would reach out to Jeff Maze at Quinsite. He has a very solid approach to tracking productivity that is both revenue producing and non-revenue producing...

------------------------------
Keith Chew, MHA, CMPE, FRBMA
Principal
Consulting with Integrity
Chatham, Illinois
217-971-5293
------------------------------

Original Message:
Sent: 04-27-2021 12:43
From: Barbara Deppman
Subject: Radiologist production

Hello to all!

I've taken the time to read all of your exceedingly valuable insight on the topic of productivity driven by data and common sense.  One of the practices I am working with is looking into the workflow management system by GE using Centricity Workflow Manager. Another group I have worked with has always used Primordial (which they deem to have similar functionalities to Clario).  Being that these are all high dollar investments I wanted to benchmark with you to find out what are your thoughts/experience with any of these or others.  I know that some of you also market your proprietary software management systems. Overall...any recommendations? Word to the wise?  General feedback? Thank you to all!!

It takes a village....

------------------------------
Barbara Deppman
Prinicipal
Deppman Healthcare Consultancy
Santa Fe NM
305-505-5669

Original Message:
Sent: 06-03-2020 13:17
From: Dustin Ledgerwood
Subject: Radiologist production

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats?

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

Hi Barbara

The word to the wise that I would offer is that the first step is to achieve consensus on a well defined set of objectives, consistent with the mission and values of the group, for what you want the system to do.  Is it improved productivity?  Improved TAT?  Equalization of load?  Unified worklist?  Directing the right study to the right rad? Something else?  You can use these systems for many different things, but not all at the same time because there will be conflicts.

Without that consensus, you will waste a lot of time and money.  It's very easy for each radiologist to see his or her optimal solution in a workflow management system, which is at odds with what others need or want.  Worst case, implementing a system which is at odds with the established culture could have severe unintended consequences.

Also, be sure to see real life integrations, not just demos.  Somethings real life is way clunkier than a demo.


------------------------------
David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
------------------------------

Original Message:
Sent: 04-27-2021 12:43
From: Barbara Deppman
Subject: Radiologist production

Hello to all!

I've taken the time to read all of your exceedingly valuable insight on the topic of productivity driven by data and common sense.  One of the practices I am working with is looking into the workflow management system by GE using Centricity Workflow Manager. Another group I have worked with has always used Primordial (which they deem to have similar functionalities to Clario).  Being that these are all high dollar investments I wanted to benchmark with you to find out what are your thoughts/experience with any of these or others.  I know that some of you also market your proprietary software management systems. Overall...any recommendations? Word to the wise?  General feedback? Thank you to all!!

It takes a village....

------------------------------
Barbara Deppman
Prinicipal
Deppman Healthcare Consultancy
Santa Fe NM
305-505-5669

Original Message:
Sent: 06-03-2020 13:17
From: Dustin Ledgerwood
Subject: Radiologist production

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats?

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

Original Message:
Sent: 4/27/2021 1:14:00 PM
From: David Smith
Subject: RE: Radiologist production

Hi Barbara

The word to the wise that I would offer is that the first step is to achieve consensus on a well defined set of objectives, consistent with the mission and values of the group, for what you want the system to do.  Is it improved productivity?  Improved TAT?  Equalization of load?  Unified worklist?  Directing the right study to the right rad? Something else?  You can use these systems for many different things, but not all at the same time because there will be conflicts.

Without that consensus, you will waste a lot of time and money.  It's very easy for each radiologist to see his or her optimal solution in a workflow management system, which is at odds with what others need or want.  Worst case, implementing a system which is at odds with the established culture could have severe unintended consequences.

Also, be sure to see real life integrations, not just demos.  Somethings real life is way clunkier than a demo.


------------------------------
David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
------------------------------

Original Message:
Sent: 04-27-2021 12:43
From: Barbara Deppman
Subject: Radiologist production

Hello to all!

I've taken the time to read all of your exceedingly valuable insight on the topic of productivity driven by data and common sense.  One of the practices I am working with is looking into the workflow management system by GE using Centricity Workflow Manager. Another group I have worked with has always used Primordial (which they deem to have similar functionalities to Clario).  Being that these are all high dollar investments I wanted to benchmark with you to find out what are your thoughts/experience with any of these or others.  I know that some of you also market your proprietary software management systems. Overall...any recommendations? Word to the wise?  General feedback? Thank you to all!!

It takes a village....

------------------------------
Barbara Deppman
Prinicipal
Deppman Healthcare Consultancy
Santa Fe NM
305-505-5669

Original Message:
Sent: 06-03-2020 13:17
From: Dustin Ledgerwood
Subject: Radiologist production

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats?

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------

ROH uses a real time RVU tracker from FINAO Solutions ... with established benchmark RVU goals for each rotation. PK

------------------------------
Parke Keith
Radiology of Huntsville, P.C.
Huntsville, AL
256.539.0457
------------------------------

Original Message:
Sent: 04-27-2021 12:43
From: Barbara Deppman
Subject: Radiologist production

Hello to all!

I've taken the time to read all of your exceedingly valuable insight on the topic of productivity driven by data and common sense.  One of the practices I am working with is looking into the workflow management system by GE using Centricity Workflow Manager. Another group I have worked with has always used Primordial (which they deem to have similar functionalities to Clario).  Being that these are all high dollar investments I wanted to benchmark with you to find out what are your thoughts/experience with any of these or others.  I know that some of you also market your proprietary software management systems. Overall...any recommendations? Word to the wise?  General feedback? Thank you to all!!

It takes a village....

------------------------------
Barbara Deppman
Prinicipal
Deppman Healthcare Consultancy
Santa Fe NM
305-505-5669

Original Message:
Sent: 06-03-2020 13:17
From: Dustin Ledgerwood
Subject: Radiologist production

Hello all,

I am wondering what methods other practices have come up with to keep track of individual radiologist production to make sure all radiologists in a group are interpreting similar volumes (i.e. within an acceptable range of the group average), while also discouraging "cherry picking" to improve one's production stats?

Thanks in advance for any input you all wish to share.

------------------------------
Dustin Ledgerwood RT
Practice Manager
Lincoln Radiology Group, PC
Lincoln NE
(402) 420-3512
------------------------------