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Comanagement: In Your Future?

By Jim Knaub

In this changing health care environment, many radiology groups worry about maintaining their autonomy and security. At the same time, hospital leaders want to provide quality imaging services and feel secure that their radiologists’ goals align with the hospital’s objectives. Finding a space that satisfies both can be a challenge.

For some groups, a formal comanagement agreement offers a good solution. Radiology groups can maintain their independence while hospitals can improve control over quality and management concerns. Syed F. Zaidi, MD, of Radiology Associates of Canton (Ohio), and Christopher E. Remark, MBA, CEO of Aultman Hospital in Canton, talked about the arrangement between their organizations at the Hospital Administrators Symposium at RSNA 2014 in Chicago.

Zaidi outlined the key concepts behind the comanagement agreement, which is essentially a professional services contract taken to the next level of detail between the hospital and the radiology group. The key points will vary among different arrangements, but Zaidi listed these key components of the Canton deal:

• Create a formal shared governance of imaging service line between the hospital and the radiology group.
• Establish a pay-for-performance component to the physician group.
• Install joint strategic planning between the organizations, including joint approval of capital equipment purchases and staffing FTE decisions in the imaging department.
• Define metrics to measure radiologist and department performance.
• Create fair market value payment for medical directorship and metrics.

Zaidi said the process was difficult, but ultimately put both organizations on the same page about what they were trying to accomplish. Together they developed metrics to measure areas where the parties wanted to quantify and/or improve performance. Initial metrics included emergency department report turnaround time (TAT), inpatient report TAT, observation report TAT for brain MRIs, mammography recall rate, and core measures for acquiring patient history and physical information and for providing patient medical records access to the radiologists. Zaidi said five of seven metric targets were met or exceeded in the first year.

In the second year, the groups sought to decrease inpatient report TAT (a goal not met in the first year), establish a cardiac CT angiography program, increase appropriate inferior vena cava filter removal, decrease inpatient biopsy TAT, improve core measure rates (they failed to meet the target for medical record availability in the first year), and standardize protocols for all modalities.

While the metrics were related to common objectives sought by quality imaging providers, spelling them out in the comanagement agreement and attaching a portion of compensation to them, helps achieve them. By jointly creating the targets, both sides are clear on what the other wants to achieve. Typically, the hospital strengthens its influence over quality and alignment with physicians, while taking advantage of radiologists’ practical skills in providing imaging services. It also avoids the common drop in productivity typically associated with employee physicians.

The radiologists maintain their highly valued independence. They continue professional billing for their services and control over their practice. Radiologists also maintain their sense of security in their improved relationship with the hospital.

Zaidi said the arrangement was built on the hypothesis that improved care coordination increases value and quality through better coordinated care, reduced variation in care, IT integration, cooperation, shared responsibility, shared goals, and shared consequences.

Zaidi stressed that it was not easy to develop the agreement, but the effort seems worthwhile to both groups. In addition to the defined metrics, Zaidi and Remark report stronger physician relationships, increased physician satisfaction and engagement, better employee satisfaction, increased market presence, and better patient care.

— Jim Knaub is editor of Radiology Today.