By: Paul Dubiel

Health care is going through an extremely tumultuous time. While there has never been a time when changes haven’t been present, it seems there were always periods where we could catch our breath, take stock of the changes and make the appropriate adjustments. This doesn’t seem to be the case this time around.

Changes in health care are coming faster and more furious than ever. Hospital staff can hardly take a breath when another random and seemingly impossible change has been dictated to us by some governing body or by our own administration. Not since the implementation of DRGs in the early ‘90s has so much stress been felt by every person in the industry. Change has affected more than just hospital workers — it’s felt by payers, providers, manufacturers, and most importantly, patients and their families. The fundamental question remains: how do we care for our patients amid these changes and how does the staff adapt to them and still provide the excellent patient care that brought us to this profession in the first place?



Imaging, like the rest of health care, has not escaped the need for change. Since I took my first X-ray back in 1984, change in imaging has dealt mostly with technological advances. When I started X-ray school, CT was just becoming a relevant tool for diagnosis, X-rays were still taken using film and needed to be processed with old style chemical processes, MRI (or, back then, NMR) was not even discussed. Special procedure images were done using cut film and a piece of equipment called a Schoenander. There were no PET scans, or multi slice CT or PACS or digital X-ray, but we survived and over time the equipment changed and developed and so did our ability to care for our patients.

Change for us meant advancement both in patient care and ability to diagnose and treat them, as well as our own advancement and professional growth by learning and mastering new, more complex technology. Change for us meant growth and potential and our challenge was to grasp the new technology and take our knowledge to help improve patient outcomes. The changes in our technology allowed both volumes and revenues to grow as new procedures not only helped diagnose diseases, but also were used as part of treatment and follow-up. Imaging was becoming a profit center for the hospital or outpatient center, and as profits continued to rise in health care in general, and specifically in imaging, the growth would become unsustainable and something needed to be done to control that growth. While profits soared, the number of uninsured or underinsured people needing health care increased, and while we did not withhold treatment from these patients the cost to the hospitals and the government put a huge burden on the system. It was unsustainable and cause for what we now see as the biggest changes in the history of the health care system.

As I look at imaging and the challenges brought on by the new world order of health care I see an increased demand for improving quality and patient satisfaction while continuing to reduce expenses to offset cuts in reimbursement. What keeps me up at night can be broken down into three categories: people, productivity and regulation. These are the major challenges facing imaging leaders as we move forward in the ever-changing world of health care.

People
Finding the right people, training them, helping them embrace the culture of the organization, having them buy into the system and see how their actions tie into its overall success, and retaining them are key to reaching the goals of the organization as a whole and the department specifically. People are your No. 1 asset that could easily turn into your No. 1 liability if you don’t take care of them and their needs (professionally and personally). Having the right blend of staff who understand the overall goals of the organization as well as having all the right technical skills to meet the needs of the patients and physicians is key to success.

Unfortunately, it is becoming harder to tie the productivity piece with the goals of good patient care and increased customer satisfaction. Staff is getting tired and burned out and our No. 1 job is working with them to have them better understand what the future holds and how they are a part of getting the organization there. Techs have choices these days and our hardest and most critical role is to keep good people engaged and on board with what we are trying to accomplish.

Productivity
With decreasing reimbursement and the need to streamline operations to ensure financial stability, productivity targets, and meeting those targets, have become a major focus for the majority of health care organizations. Although productivity targets are not a new concept and have been a focal point for a number of the for-profit organizations across the country, there is now a renewed focus on hitting and maintaining benchmarked productivity numbers to ensure that organizations remain fiscally sustainable. This new focus has taken its toll on both staff and management alike. With a new focus there comes new stress on meeting and beating those targets. Staff who are used to working their normal schedules are now having to reduce hours and flex off when volumes do not support them being there.

Staffing is based on volume and where in the past we had some flexibility with additional hours to compensate for vacation and for staff to participate in other activities, now with every hour measured it has become a numbers game that we are held accountable for. Not being at 100 percent productivity could delay or even prevent replacement staff from being hired, which drives up overtime, staff and patient frustration, and ultimately negatively impacts satisfaction scores for both staff and patients which will ultimately impact reimbursement and turnover. To survive in the new health care environment, we will need to find a balance between the productivity number and providing good patient care while preventing staff burnout.

Regulation
It seems every year there are new regulations thrown at imaging that are both time consuming and costly to implement. These regulations often come with what seems like unrealistic timelines with high price tags and stiff fines if they are not implemented by the due date. While every one of the regulations pertaining to imaging is in the best interest of patient care and radiation reduction, often the timelines and capital needed to achieve them are not part of the organization’s long-term plans. Regulations like XR-29 for CT scanners, dose tracking for CT dose, conversion to DR for all imaging procedures and the long-awaited

Clinical Decision Support initiative all have good intentions, but also steep price tags for implementation. How and, in certain cases, if organizations can meet the deadlines still remains to be seen. In certain instances, it may be cheaper to take the fines than implement the new regulations, which could result in PR nightmares. As the drive for both increased patient safety and decreasing reimbursement happen, we will see more of them. How we implement them will be key to our success.

Imaging leadership has much to consider. We face new and exciting challenges every day. Some easy, but most will be long term and hard to meet. But we are not alone. There is a wealth of information and help out there for each of us to pull from. Local groups as well as managers in other organizations can also be assets. AHRA is the dominant resource for imaging leadership. It has numerous resources that are geared to the imaging leader, and can be a wealth of information for you and your staff. Their conferences and resources cover a wide range of topics and issues related to imaging. If nothing else, it is a great place to discuss issues with peers and share experiences, solutions and sometimes just a good laugh.

Do we have challenges? You bet we do, but as with everything else, there are huge opportunities to be a central part of the changing health care environment and to be the center of patient care which, after all, is why we got into this business in the first place.


About the author: Paul Dubiel is the senior director of imaging at Seton Family of Hospitals, and editor-in-chief of Radiology Management magazine.