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Working behind the scenes in every Fusion RIS is a Practice Analysis application that quietly, automatically collects and stores daily practice data from the RIS database – a veritable goldmine of information waiting for Fusion RIS users to harness it to fine-tune their diagnostic imaging organization.
Manatee Diagnostic Center comprises three multi-modality locations and performs about 80,000 imaging procedures per year divided between MRI, CT, mammography, ultrasound, x-ray, nuclear medicine and bone densitometry studies. We have used the Practice Analysis application to gain an in depth understanding of critical operational aspects unique to our locations, such as room utilization, scheduling, staffing, demographics, referral patterns and numbers of procedure types. Combined and analyzed in appropriate ways, these data have helped us implement many different changes that have trimmed costs and boosted efficiency. Never has this been so important than now, in the post-Deficit Reduction Act (DRA) era, with deep cuts in Medicare reimbursement for several imaging modalities. Although multi-modality centers such as Manatee don’t face the extreme revenue reductions that certain single-modality facilities (e.g., MRI has an overall 16% Medicare reimbursement reduction), face, DRA reimbursement reductions still erode our bottom line. Like all imaging organizations, we must address this issue.
Post-DRA awakening
Before DRA, we didn’t give much thought to a formal, consistent program that utilized the Practice Analysis module, although the application was resident and functioning on our Fusion RIS when we went live in October 2003. The reason is obvious: when you’re fat and happy it’s hard to find a pulse, but when times become leaner you definitely feel it – and need to feel it – if you hope to effect positive changes in your business. With Fusion RIS Practice Analysis, Manatee’s pulse is right at my fingertips.
Among the first statistics we began to gather in 2004 were basic demographic data, such as age, gender and ZIP Codes of the patients visiting our locations, and the relative patient volumes per day of the week, in addition to the procedure breakdowns per modality. We also were able to glean referring physician data, such as referral volume and modality volume for each referring physician. These data, which Practice Analysis can present as spreadsheets, bar or pie charts, graphs or decomposition trees (see photos), can be leveraged in a number of ways. Using gender and ZIP Code data, for example, we contacted the local chamber of commerce, which sent us the numbers of adult males and females that lived in a given ZIP Code. We reconciled that data with our Practice Analysis information to determine the percentage of the eligible population per ZIP Code that is utilizing Manatee Diagnostic Center’s services and then adjusted our advertising strategy accordingly.
From a Practice Analysis evaluation over a period of time we also were able to determine what percentage of our referrals come from family practice physicians and what percentage are self-referrals, followed by obstetric ultrasound cases and lesser numbers of other imaging procedures. We further dissected those percentages to reveal that 32% of the family practice referred cases were for plain film x-rays and that 25% of the self-referrals were for screening mammography.
This in depth understanding of our volume breakdown also helped us refine our marketing strategy to more visibly promote our most prolific imaging service, screening mammography. Therefore, in advertising and promotional collateral, we typically highlight mammography and then list the other imaging services we offer at our three locations.
Schedule versus reality
In 2005, we began using the Merge Practice Analysis module to better understand the volume of completed studies per day per modality and how our schedule reflects reality. For example, we began to track scheduled exams versus no-shows and explored what the number of no-shows actually means. For instance, if I have 10 scheduled appointments on Monday and then on Tuesday I see that we completed six studies, that would seem to indicate a 4-no-show rate. Well, if the technologists tell me that three of the six patients who had scans were actually add-ons, then in reality, instead of four no-shows, we actually had seven no-shows. To get patient- specific, we can reference our Fusion RIS’s Crystal Reports to obtain the MRNs of the patients who arrived for their appointments that day and determine whether they were on the schedule to begin with or added on, and which patients were no-shows.
No-show solutions
No-shows can become a big problem if they occur frequently in your busiest service, again, for Manatee Diagnostic Center that is screening mammography. We exported Practice Analysis no-show data into a spreadsheet program, enabling us to monitor monthly no-show numbers much more efficiently. January of this year saw a whopping 208 no-shows across our locations, which compelled us to supplement our confirmation letter program 2.5 weeks ahead of scheduled mammograms with a confirmation phone call three days ahead of appointments. (Failed return phone calls or disconnected telephone lines get appointments cancelled; only person-to-person confirmations keep appointments scheduled. However, if the patient does ultimately make it for a scheduled mammogram that we cancelled, we make every effort to make the process seamless and complete the examination with as little delay as possible). The following month we experienced just 79 no-shows – but then the no-shows began to rise again, from 90 in March, 115 in April and 141 in May. There had been a breakdown in confirmation calling that was easy to see and correct, and which resulted by September in just 66 no-shows. Without the spreadsheet program and Practice Analysis, we wouldn’t know what was going on, whereas now we know on a daily basis.
Practice Analysis allows us to give feedback to supervisors regarding the impact that confirmation calls can have on the completed exam/no-show ratio. In addition to reducing no-shows, the confirmations free up appointment slots for women who call in inquiring about the availability of a follow-up diagnostic mammogram following suspicious findings on an earlier screening mammogram. For these understandably anxious patients, getting a definitive diagnosis as soon as possible is critical.
One final operational note about no-shows: For MRI and CT studies, we have used the Practice Analysis tool to track patients that have a history (at least one no-show) of skipping exams. This has given us the ability to efficiently schedule a patient who has not shown up for an exam in the past with a time that is efficient not only for the patient but for Manatee as well.
History made into a calculator
The no-show rate is a factor in Manatee Diagnostic Center’s overall capacity, which in turn impacts such things as staffing. We have used Practice Analysis initially to help us evaluate modality utilization, but by 2004 we had begun to refine that parameter to modalities within individual locations (i.e., capacity), which aided in fine-tuning of our staffing to better match capacity for a given day. The best example of this is, again, Manatee’s mammography service, which added the extra variable of four different CPT codes, those for screening, diagnosis, additional views and unilateral.
The data that Practice Analysis assembles on this multi-dimensional service enabled us to create a spreadsheet-based capacity calculator that unpacks and analyzes Manatee Diagnostic Center’s mammography. Consistently, over each of the last three years, we have found that 70% of Manatee’s mammograms are for screening and 30% are diagnostic (includes 20% diagnostic and 10% unilateral and additional views). Using the capacity calculator, we can predict that with four available rooms we will perform 60 examinations; around 42 will be screening mammograms, 12 will be diagnostic and six will combine additional views and unilateral studies. If we have 43 screening mammograms on the books at Riverside, for example, that means we have two openings, whereas if the West office has 11 openings it is significantly under-capacity and overstaffed with technologists. Consequently, we can alert the mammography administrator that the West office should either have a technologist go home or go to Riverside to help with its workload.
Regarding other modalities, Practice Analysis clearly showed us we need to add capacity for DEXA (bone densitometry) studies. We are performing DEXA three days at our Riverside location and two days at the West office, which brings us consistently up to 97% capacity. Accordingly, we will begin to add DEXA scanning time incrementally, beginning with a half-day, but eventually go to five days a week at Riverside. CT has been averaging right around the 57% capacity level, but in July and August, capacity jumped to the 74% to 96% range, indicating that marketing successfully leveraged Practice Analysis data to effect a rather rapid positive change.
Practice Analysis: the compass on our course to success
Because Practice Analysis can show us on a daily (if not hourly) basis what is happening operationally in our organization, it serves as a compass of sorts, keeping us on a true course and alerting us when we’re straying into hazardous waters. But the real beauty of this solution is that our Fusion RIS works behind the scenes gathering critical data sets – even if we choose not to use all of them. It also is extremely simple to use. Our IT staff does not need to get involved to extract the Practice Analysis information from the RIS or even spend countless hours creating scores of specialized reports if we didn’t have the Practice Analysis module to automatically generate them.
An application such as Practice Analysis is something that every CFO, executive director and marketing department should have.
Clear data formats enhance Practice Analysis
(generic examples)
(Above) This scatter plot indicates actual versus scheduled times by modality, enabling centers to address issues, such as chronic under- or over-scheduled examinations to improve room utilization.
(Above) Long-term tracking of modality study volumes can inform center expansion decisions.
(Above) Practice Analysis can provide decomposition tree data formatting, permitting – for example – demographic breakdowns by specialty area.
(Above) This view shows the number of exams and gross charges for a multi-site imaging center.
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