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small practices working together

  • 1.  small practices working together

    Posted 07-17-2024 13:10

    We are a small hospital based, private practice of 6 rads.  Like so many small practices, we struggle to recruit, compete with salaries and keep up with the hospital demands for turn around times.  We've put certain Band-Aids in place which have really helped us to continue forward and remain independent.  So far so good.  But almost weekly, I hear stories of groups just like ours, and often times twice the size, closing their doors.  Former employees have reached out to say their new practice is closing or thinking about closing or that their hospital wants to employ them.  I feel like there should be ways for groups like ours to help each other.  The overall concept is simple but the logistics of actually making it happen are very complicated.  Does anyone have experience in successfully collaborating with other groups?  I would love to speak with you about your experience.  Our industry in changing and we (small practices) all need to think outside the box in order to move forward.

    Thank you!

    Linda



    ------------------------------
    Linda Bush
    Business Manager
    Radiology Associates of Wyoming Valley
    Dallas PA
    ------------------------------
    DeepHealth May25 Post


  • 2.  RE: small practices working together

    Posted 07-17-2024 13:53

    Linda – Yes. There are a number of practices across the country that have successfully established collaboration activities. I am not trying to sell my consulting services here, but I want you to know there are approaches that have been proven successful. I am happy to talk with you in the spirit of "Progress Through Sharing" if you would like. Just let me know.

     

    Keith E. Chew, MHA, CMPE, FRBMA

    Principal

    Consulting with Integrity

    217-971-5293

     




    DeepHealth May25 Post


  • 3.  RE: small practices working together

    Posted 07-17-2024 17:22
    Edited by Joseph Verderaime 07-17-2024 17:24

    Linda,

    This is a great post.  We also are a small practice who work to serve our community with excellence and personalized services.  There are a couple of groups we have come into contact with locally and beyond who often have larger affiliations.  I often think the collaboration and common opportunities small practice like each of ours face is not necessarily solved by large conglomerates in a manner conducive to preserving what matters most to our practices.  Often, the collaboration really depends on a common pain point. Solving for one pain point at a time in a methodical collaboration seems prudent.  I would love to connect with more small practices of single physicians up to 12 radiologists.  Let's establish a small think tank of opportunists who are out to beat the status quo of conglomeration.  We are in a day and age where innovative thinking may provide plenty of opportunity to maintain our respective identities.  Please let me know if you are interested. Linda and Keith what are your thoughts on us all working together to bring small independent practices together?



    ------------------------------
    Joseph Verderaime
    CEO/COO
    Cheyenne Radiology Group
    Cheyenne CO

    307-631-8519
    ------------------------------

    DeepHealth May25 Post


  • 4.  RE: small practices working together

    Posted 07-19-2024 19:47

    We have been successful in certain areas which could potentially help other groups, like using third party vendors to negotiate increases in our commercial rates. I've contemplated the idea of setting up some kind of quarterly or semiannual call among similarly situated professionals to share ideas and approaches to common shared problems or novel issues. I personally believe that specifically with regard to commercial reimbursement, a rising tide lifts all boats. If rates generally increase among small-medium sized groups (we're about 25 rads), then there's more overall leverage to push for increased rates elsewhere. I have several colleagues who might be willing to participate in a call like this, though I'm not sure I currently have the bandwidth to administer this personally. I'd think that we could have a point person who would aggregate submitted agenda items and then leave some room at the end for open dialogue for topical issues. If there was too much interest that made a call like this unwieldy from too many participants (I know, good problem to have), then perhaps we could host and record multiple calls among smaller participant groups, and then interested folks could listen to the call they were unable to join. Could rotate participants randomly then. These are just some preliminary thoughts. Many of us are on islands managing our own little kingdoms, and it would be great to have increased engagement among similarly situated folks to help creatively solve problems. I also think there's an opportunity to move the needle politically on critical matters of importance to our industry. Never underestimate the power of the white coated folks (or their representatives) talking to lawmakers about the clear and evident problems in the healthcare system that could obviously be better addressed. We could probably have a more coordinated effort on that front than we do (RPAN acknowledged). I personally believe that RBMA should have a more focused experience tailored toward smaller groups dealing with common problems, and perhaps a forum like this could be a catalyst. What do you all think about these ideas?



    ------------------------------
    Anthony Dispenziere
    CEO
    Reno Radiological Associates
    ------------------------------

    DeepHealth May25 Post


  • 5.  RE: small practices working together

    Posted 07-21-2024 11:22

    Anthony you are spot on!  I would be happy to help organize this effort.  I am curious if we might meet up at the fall SYNC conference and begin collaborations there.  I will work to begin building our agenda topics.  Thank you all who may have interest.  

    https://www.surveymonkey.com/r/RadSmallPractice



    ------------------------------
    Joseph Verderaime
    CEO/COO
    Cheyenne Radiology Group
    Cheyenne CO
    ------------------------------

    DeepHealth May25 Post


  • 6.  RE: small practices working together

    Posted 07-22-2024 02:13

    I'm interested in joining a virtual meeting on this subject, but unfortunately I won't be attending SYNC this year. I responded to the SurveyMonkey questions (we use that tool as well). Thanks for taking the lead on this! I'm hopeful we'll have a solid group of participants.



    ------------------------------
    Anthony Dispenziere
    CEO
    Reno Radiological Associates
    ------------------------------

    DeepHealth May25 Post


  • 7.  RE: small practices working together

    Posted 08-27-2024 16:46

    All,

    Good afternoon.  In the spirit of our collaboration, I wanted to take a moment and share the results of our survey.  I will work to compile the detail.  More to come.  Ideally we will see if RBMA leaders would be open to allowing us some space to meet and touch on some of these topics.  I am happy to facilitate the discussion.  

    Radiology small practice collaborative is an effort to bring small practice leaders together for collaboration on topics that matter most in a small practice environment. This group will discuss effective strategies for managing the many challenges and strategies within small practice leadership. Please share your level of interest in being involved in a small practice leadership collaborative. (5 Stars Very Interested) Please share topics which you would like to come together to discuss as a collaborative? Please rate your topics in order as the first being the most important.
    Response Open-Ended Response
    5 Combatting Inflation - Costs and Fee Schedules  Contracting with Insurances that only want to deal with Hospitals or Conglomerates (BC Truli, Oscar Health, etc)  
    4 1) STAFFING!  2) Measuring FMV  3) Compensation & Benefits
    5 Balancing cost of investing in tech solutions for our practice vs cost of making no changes.  Recruitment & retainment challenges. Hospital stipends. Strengthening hospital partnerships. Nighthawk contracts. QPP participation.
    5 They are all important :)  However, maintaining our fight to keep independent.  Always appreciate discussing new vendors and streamlining practice operations, revenue cycle management,  hiring providers,  scheduling discussions.  I love this concept.
    5 Cyber security
    5 1. negotiating stipends for unreimbursed services  2. Managing/measuring radiologist wRVU and administrative work including variance/pay, satisfaction, work load  3. Bonusing employed radiologists   4. Hospital IR growth strategies/partnerships  5. Maximizing IR PA utilization and reimbursement
    5 Hospital Negotiations for Reimbursement.  Night and Weekend Call.  IR Coverage
    5 Hospital Support Negotiation & FMV Combat Strategies  Common Challenges - What New things are you facing? What's taking most of your effort? (most will likely say recruiting and retention)  Industry / Data Metrics - Establishing more helpful benchmarking info  Taking Action - What Can We Achieve Collectively?


    ------------------------------
    Joseph Verderaime
    CEO/COO
    Cheyenne Radiology Group
    Cheyenne CO
    ------------------------------

    DeepHealth May25 Post


  • 8.  RE: small practices working together

    Posted 08-27-2024 16:51
    Hi Joe,

    Thank you for sharing this info with the group. We did discuss this at our last program education committee meeting. @Jessica Struve was there a decision made on if there would be space/time for this type of small practice roundtable discussion session to happen? 

    Best,

    Janinne


    Janinne Walker
    SVP Business Development & Sales
    Cell: 206.293.6784




    DeepHealth May25 Post


  • 9.  RE: small practices working together

    Posted 08-28-2024 17:49

    @Janinne Walker - Yes, we have a Small Practice Roundtable on the 2025 PaRADigm agenda. 

    We also hosted a small practice focus group yesterday and had some really great conversations and takeaways. I appreciate the great connections happening here on the forum and the opportunity for RBMA to serve all facets of our broad membership.



    ------------------------------
    Jessica Struve, CAE
    Deputy Executive Director, RBMA
    Fairfax VA
    jessica.struve@rbma.org
    ------------------------------

    DeepHealth May25 Post


  • 10.  RE: small practices working together

    Posted 07-25-2024 10:31
    Hello:

    I've been working with independent radiology groups since 1989 nationally and yes, have witnessed numerous groups being forced to dissolve their corporations after going through the "death spiral" whereby key members of the group depart for higher-paying positions with a better lifestyle.  In the meantime, the group is unable to recruit since their comp/benefit package is no longer competitive, leading to more departures.  The death spiral can be swift and absolute.  Consequently, we've been working nonstop for the past 2-3 years with those surviving groups securing significant subsidies from their facilities (often in the millions) - often both for the diagnostic and IR components.  Sometimes, these subsidies take the form of the facility reimbursing the group for say, teleradiology coverage.

    My advice (and as in the case with my friend, Keith Chew, am not looking for any consulting work) is as follows:

    1.    Ensure your billing operation/vendor is operating optimally;
    2.    Ensure you are being paid accurately including when MPPR rules apply.  Payment inaccuracies are more common than one would think;
    3.    Attempt to negotiate higher rates with your commercial payers and you should ignore anyone who tells you payers are unwilling to offer at least minimal increases.           I've only done about 1,000 negotiations in my career and while the NSA has certainly made it more difficult to secure reasonable increases, payers are typically (but       not always) willing to offer at least nominal increases.
    3.    Develop a fact-based proposal for financial support from your facility(ies.

    That's it.

    Thanks.
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  • 11.  RE: small practices working together

    Posted 07-25-2024 12:22

    This is what RBMA is all about.  I would submit that there are very few challenges unique to smaller practices, though their options for addressing them may be different.  Of course, we have to be careful to stay within the law in terms of collaboration.

    If you're in a small practice, or a large one, post your issues here, or bring them to RBMA conferences to talk them over.  Chances are you will hear from someone who has dealt with it, or at a minimum you can connect with others who have the same challenge and collaborate to tackle it.  I can say that over the 24 years I've been an RBMA member, that approach has served me well.

    I would caution against creating too many different channels for communication and collaboration.  I believe that tends to limit collaboration and exposure to new information, which is generally not in keeping with the spirit of progress through sharing. 

    Dave



    ------------------------------
    David Smith FACMPE
    Executive Director
    United Imaging Consultants
    Mission KS
    ------------------------------

    DeepHealth May25 Post


  • 12.  RE: small practices working together

    Posted 08-01-2024 16:50

    I love seeing the excitement around small group collaboration, and I agree with David's caution to avoid splitting off into a new entity or separate collaborative which will ultimately limit our communication further. Over the years I've found that we've got some amazing resources within this group who are willing to share ideas while keeping us in line on compliance issues.

    I think Anthony had a great idea looking to RBMA to provide some more focus in this area.  Our group has 19 radiologists in rural MS, and I'd be interested in what ideas this group has as to what that might look like.  Should national events have a "small group" roundtable or specific networking event? Are we interested in quarterly roundtable webinars? "How to" toolkits?  etc.

    I'm looking forward to hearing other ideas to keep this energy within our great organization.



    ------------------------------
    Schaeffer Smith, MPH, CPA
    MPH, CPA
    VP Finance & Operations
    Comprehensive Radiology Services, PLLC
    Hattiesburg MS
    ------------------------------

    DeepHealth May25 Post


  • 13.  RE: small practices working together

    Posted 08-01-2024 18:51
    Small group meetings at events are a great idea! RBMA is currently working on the speaker selection for Paradigm. It might be an excellent time to see if they can carve out some time for the small group meeting. I would be happy to help facilitate this happening. 

    Janinne Walker
    SVP Business Development & Sales
    Cell: 206.293.6784






    DeepHealth May25 Post


  • 14.  RE: small practices working together

    Posted 08-02-2024 10:08

    Hi Everyone -

    Shaeffer and group - yes, and great idea about national meetings.

    @Janinne- yes! - let's make this happen for April.

    We will discuss this idea in our Paradigm session planning meetings!  Thank you!



    ------------------------------
    Dianne Keen , FRBMA
    Vice President, Strategy & Growth
    AbbaDox
    cell 478-957-9777
    ------------------------------

    DeepHealth May25 Post


  • 15.  RE: small practices working together

    Posted 08-02-2024 10:27

    This thread is truly the RBMA community living out the value of progress through sharing! @Dianne Keen @Janinne Walker I would be happy to help collaborate on this representing multiple independent practices and participate from an RBMA board liaison perspective to see how the board can support!



    ------------------------------
    Nicole Jones-Gerbino
    RBMA Board Member
    President, PBS Radiology Business Experts
    (619) 301-1968
    ------------------------------

    DeepHealth May25 Post


  • 16.  RE: small practices working together

    Posted 08-06-2024 08:21

    Good morning.  I would be interested in joining small group resources and participate in those discussions. 

    Thank you

    Chris

     

    ____________________________________________________________________________________________________________________________________________________________________

     

    Christine C. Jargowsky

    Charlottesville Radiology Limited

    Radiology office phone - (434) 654-7114

    cjargowsky@crlsurgical.com

     

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  • 17.  RE: small practices working together

    Posted 07-29-2024 15:17

    Thank you to everyone who has offered advice and willingness to collaborate.  I wish there were quick fixes but I believe if the small practices can ride out this storm, eventually they will come into favor again.  One thing we have done is to rely heavily on teleradiology to fill the voids created by staff shortages.  Although the prices are high, it has allowed us to avoid the burn out factor and has been helpful.  I'm willing to participate in efforts to help each other.  I just don't really know what that looks like.  

     

    Linda

     




    DeepHealth May25 Post


  • 18.  RE: small practices working together

    Posted 07-29-2024 15:46

    Linda,

     

    This is an excellent topic.  As a small imaging center, I would like to be part of the Radiology Think Tank.   Please let me know when you would like to meet.

     

    Thank you,

     

     

    Karen Girven
    Chief Executive Officer
    --------------------------------------------------------------

                                                     

    45 Pine Grove Avenue
    Kingston, New York 12401
    Phone: 914-255-6181
    Fax: 845-340-4501
    [www.riverradiology.com]

    ____________________________________________

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  • 19.  RE: small practices working together

    Posted 07-30-2024 08:54
    Hello:

    We are a small practice of 5 radiologist covering 1 facility. We too face all the challenges mentioned. I would love to be included. I am interested to know how many groups are utilizing remote readers in their practice. The subject has come up in our group recently. There is some hesitation among a few of the partners.

    Danyle Conner
     



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  • 20.  RE: small practices working together

    Posted 07-30-2024 09:18

    Hi Danyle,

    Our group utilizes remote readers, and we would be happy to share our experience.  It's been a mixed bag but overall, I would say favorable.  The pay scales are different and currently all are employed.  However, we are considering remote partners but those too would be paid less.  We feel onsite deserves a premium incentive.  Its proven much easier to recruit and provides much needed help.  I would be happy to discuss everything in more detail if you wish to visit.

    Gregg Daniels, Radiologists PA

    cell: 405.317.8959



    ------------------------------
    Gregg Daniels MBA
    Administrator
    Radiologists, PA
    Fort Smith AR
    (405) 359-5194
    ------------------------------

    DeepHealth May25 Post


  • 21.  RE: small practices working together

    Posted 07-30-2024 10:30

    We employ remote readers and have done so for many years.  I agree with Gregg that it is much easier to recruit a telerad, although lately we've seen unrealistic salary demands and/or schedule demands.  But overall, they provide much needed help to our practice, especially if you can get weekend help.  Keep in mind that workstations become an issue.  Our hospital requires that the radiologist is in network therefore we have to provide a hospital workstation to whomever we employ.  

     




    DeepHealth May25 Post


  • 22.  RE: small practices working together

    Posted 07-31-2024 12:25
    Hello everyone!

    We are also a very small privately owned imaging center with only 2 Radiologists. One may want to retire soon so we may be facing a new hire or a remote situation. I would also like to be included in the group.

    Heidi

    Heidi Simpson RT(R)(N) CNMT
    Operations Manager
    Advanced Diagnostic Radiology, LLC
    301-777-3829 (office)
    301-697-2169 (cell)

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  • 23.  RE: small practices working together

    Posted 07-31-2024 17:01
    I would love to be included as well! I work with groups who are experiencing the same struggles you all are mentioning. I also work with some groups who have capacity and are looking for more.

    Outside of nighthawk, 3 of the 4 groups I work with are utilizing remote readers. Some of those had the same hesitations you mentioned, Danyle, but it is just the direction the industry has been going and will continue to go to keep coverage in any form. 

    Julia Varner
    Director of Operations
    A: 5707 Jenny Lind Rd. Fort Smith, AR 72908

    P: 479.242.3321 F: 479.242.1990

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  • 24.  RE: small practices working together

    Posted 07-30-2024 10:33

    Big, and getting bigger payers, might be the biggest challenge to small practices.  Payers (especially public) are taking over whole regions of subscribers and are using their 'bigness' to drive payments down, especially in relation to real cost increases for providers.  Providers in those areas have two options 1) get paid less for more services 2) match the size of the payers and stop the decline in payments.   

    The increased M&A in the payer space (Molina buys Connecticare $350M on July 20 and this story about the race to cash in on increased government spending at the state levels, Molina eyes acquisitions as Medicaid enrollment rises) leaves providers no clear path forward to survive.  

    In the California market where IHS operates, the massive explosion of Medical along with the state regulations impacting small providers (including the medical workers minimum wage), coupled with the proposed rules to limit cost increases to 3% annually, feels like someone is stacking the deck against the small providers...and ultimately the patient. 

    Sounds like a problem too big to solve but what other options do small providers have in the near term.  Weathering the current storm needs to be coupled with meaningful and prudent strategies from the providers. 

     



    ------------------------------
    Ken Brande
    CIO
    Imaging Healthcare Specialists
    San Diego CA
    ------------------------------

    DeepHealth May25 Post


  • 25.  RE: small practices working together

    Posted 08-09-2024 12:58
    This is what RBMA is all about!  
    Leadership at RBMA is discussing how best to organize a focus group to discuss challenges unique to smaller and midsize radiology groups and allow RBMA to facilitate solutions.  
    Jessica and I appreciate the feedback and candor on the forum thread, and affirm our desire to meet all of our members unique needs.
    Your input matters, so please continue to watch your email for further updates or feel free to contact us at ED@rbma.org.


    ------------------------------
    Linda Wilgus CPA, CMPE, FRBMA
    Co-Executive Director
    Radiology Business Management Association (RBMA)
    Indianapolis IN
    (317) 507-6153
    ------------------------------

    DeepHealth May25 Post