Aligning Physicians and Enhancing the Value of Imaging Services

By optimizing radiology services, health systems can achieve measurable, sustainable improvements in their operational and financial performance. Transitioning from unorganized, individual contracts to more integrated services, systems can share best practices, enhance resource deployment, and more effectively recruit and retain providers. Restructuring contracts to create arrangements that better align with enterprise performance transforms a transaction-based relationship into a true partnership.

An integrated delivery system with over 20 hospitals and a large health plan identified imaging service optimization as a key strategy for improving quality and better managing costs. The system conducted more than 5,500 imaging exams per day, and roughly 50% of all patients were imaged. Leadership saw alignment with radiologists as essential to thriving in a value-based environment. 

The system’s imaging goals were to: 

• Tightly align all radiologists through performance-based contracts or employment, and remove conflicts of interest. 
• Establish consistent payment methodologies for employed and contracted radiologist partners. 
• Develop a unified governance structure.
• Develop physician leaders within the governance structure. 
• Create and deploy radiologist performance standards. 
• Work with radiologists to develop clinical best practices.

The organization had historically contracted with nine different radiology groups, representing over 100 radiologists, to provide diagnostic and interventional services across the system, and most of the groups preferred to remain independent.

The system’s long-term goals were to enhance the value of imaging services and achieve greater alignment with radiologists. Applying a common set of practices and philosophies to each radiology group ensured a consistent framework across all aligned groups. This included a consistent set of alignment objectives, common compensation principles and parameters, standard service requirements, and representation on a centralized management and governance body. Collaborative working sessions were held every other week to negotiate, design, and implement the new strategy. 

The process also incorporated a multiyear, phased approach for further integrating radiology providers, including an explicit goal of forming a new “supergroup” that would preserve existing group structures but also allow for a single contract.

The health system successfully employed or implemented a comprehensive professional services agreement with each of the nine groups. The health system now bills and collects for all professional radiology services globally and can more easily enter into value- or risk-based payer contracts. As a result, the system was able to create a common compensation system across both employed and contracted radiologists, eliminating perceived financial barriers and integrating the groups into a more cohesive service. A system-wide committee known as the Imaging Guidance Council was created and serves as a critical structure for integrating the various groups. The council also manages appropriate utilization, rationalizes services across the system, approves system-wide clinical protocols, creates level-loading parameters, and establishes annual goals (both clinical and administrative). 

The system is now capable of implementing value-added services such as decision support tools; radiation safety measures; and one-call scheduling, registration, and pre-authorization. In short, the strategy allowed imaging services to become a value generator, not just a volume generator.