IR Service Line Business and Practice Building

Interventional Radiology Service Line
Business and Practice Building
Focus: Arterial Disease
Raj P. Shah MD, MBA
-Gain an understanding of the business environment in which
interventional radiologists practice.
-Learn about various market forces, and different entities that
contribute to delivery of interventional radiology services.
-Learn about the important aspects of a practice, and factors
one must consider when developing a strategic business plan.
-Develop a marketing strategy for your future practice.
-Learn about resources/initiatives to effectively manage
-Learn how to ‘create value’, and structure one’s practice to
compete and succeed in this dynamic environment.
Business Environment
- Increasing Competition/Diminishing Reimbursements 
Disruption of traditional referral practices, as physicians have
felt compelled to acquire minimally invasive skills/procedures
that they once referred  ‘Turf Wars’
- IR has felt this competition at multiple levels, due to the
coverage of procedures across many specialties
How to Prepare for the Future?
- Create/implement a strategic business plan that defines
your practice’s core purpose, outlines the principles that it
gives importance to, and focuses on specific
- Strategy integrates vision, policies, and action sequences
into an organized plan.
Components to Develop Strategy for a
Successful IR Service Line
- Goals – Mission and Vision
- Basic Market Analysis
- Service Lines Operations Analysis
- Marketing Overview
- Tools for Success
- Financial Overview
Organizational Structure
Mission Statement: Defines the overriding purpose of the
organization; it provides a framework for implementing specific
objectives. They are generally culture/business dependent.
Vision Statement: Outlines the core values of the organization;
it helps define the characteristics of the organization and its
people. It represents an image of what the organization wishes
to become, as they accomplish their mission.
Service Line Market Analysis
-Is there a need for this product/device or service?
-Who will be a customer? (Considering the wide variety of
customers is helpful, eg - patients, referring physicians,
hospital organizations, insurance companies)
-What value does the practice bring to its product/service?
-What competitive forces are in play?
The 5 C’s of Market Analysis
The 5 C’s of Market Analysis
.Referring Physicians
.Insurance Companies
eg- Arterial disease service line- carotid artery disease,
aortic dissection, peripheral artery disease,
aortic/peripheral aneurysms, renal artery disease,
mesenteric artery disease, vasculitis, medical management
of comorbidities.
The 5 C’s of Market Analysis
.Vascular surgeons, Interventional Cardiologists
Changing Context
.Turf wars
.Decreasing reimbursements
.Change in payment model, from fee-for-service to flat-fee (based
on admitting diagnoses/comorbidities)
The SWOT analysis aims to identify the key
internal and external factors seen as
important to achieving an objective
Customer Value Proposition
-The way we propose to help customers treat a condition,
including the benefits we claim they will receive and the costs we
ask them to pay.
-How we plan to address their ‘clinical need’, and do better than
our competitors (in terms of achieving goals of treatment, longterm clinical outcomes, providing reliable follow-up care, staying
up-to-date with the latest techniques and therapies) at a
comparable cost.
Positioning- Targeted Value Proposition
For (our target segment), our
(product/procedure/therapy/treatment) is (single most
differentiating element of value proposition) among all
(competing ways of solving targeted problem) because
(single most important “supporting evidence”)
Service Line Operations
-What is required to operate?
-Are there specific infrastructure or milestone requirements that
must exist to introduce the product/service?
-How will the quality be controlled and value assessed?
Value Analysis
-Do we provide value beyond ‘catheter skills’?
.Patient outcome?
.Patient satisfaction?
.Referral satisfaction?
.Institutional satisfaction?
A value analysis is important for all IR practitioners; in most
circumstances, results will directly relate to financial performance
of service line.
-Product – Procedures relevant to a particular service
What gives you a competitive advantage?
.Is it a shorter, less invasive procedure?
.Does it involve a shorter stay at the hospital?
.Is it less painful than other techniques to treat the
same condition?
.Is it your breadth of experience which such
.Does your technique result in better long-term clinical
.Is it your reputation for exceptional follow-up care?
-Promotion – (Acknowledgement: Dr. Mark Lessne of JHU)
. “Brand Yourself” – Distinguish your services in hospital
records; eg – title-specific notes/consults
. Follow-up with EVERYONE– Keep referring providers in the
loop; keep yourself “visible”.
-Pre-procedure Plan (eg – medical management)
-Post-procedure Plan (eg – follow-up plan)
. Speak with Provider Organizations (eg – Connecticut Podiatric
Medical Association, Connecticut Academy of Family Physicians) –
Explain capabilities, services: What happens when you refer a
Provider identifies
patient who needs
vascular service
At my VIR clinic,
non-invasive testing
and procedures are
performed (if
Patient returns to
your care, with
for disease
A complete report
of findings and
performed is
. Write articles in referring providers’ non-peer
reviewed journals (educate providers and focus on
patient care)
. Patient Education –
-Speak at public institutions (places of worship, YMCA,
Rotary International, etc.) to educate potential
patients on common medical conditions.
-Screen patients at public places or events (malls,
parks, fairs, concerts, sports games)
-Provide information pamphlets, flyers, ‘email list’
-Follow-up with patients’ PCPs, and provide
explanation of services.
.Use Existing Hospital Resources
-give lectures (to other departments within the hospital),
through multidisciplinary conferences – case presentations,
medical management, follow-up care, relevant literature.
-write an article in the hospital newspaper/magazine to
distribute into the community (to providers + patients)
-Price – Competitive; negotiated to ensure that
procedure reimbursement exceeds variable cost and
contribute to overhead (concept of contribution
-Place – Diagnostic radiology office, referring
providers’ offices, public places,
television/radio/highway billboard advertisements,
SOCIAL MEDIA (Facebook Pages)
-Take ownership of your patients!
-Understand the value that you provide!
-Be able to articulate this to appropriate stakeholders, eg non-interventional colleagues, the hospital, an academic
institution, a private practice, the insurance companies, and
the patients themselves!
Building A Service Line – Tools for Success
-Mindset of continuous improvement
-Ownership of one’s role and focused effort on making the
role better.
-Kaizen ‘event’: A collection of resources (dedicated people,
money, and time resources) that are pulled with a targeted
problem project in mind.
Kaizen – The 5 Elements
1. Teamwork
2. Personal Discipline
3. Improved Morale
4. Quality Circles
5. Suggestions for Improvement
Building A Service Line – Tools for Success
- A management philosophy focused on improving process
speed and quality through reduction of process wastes.
- Reduce activities that drive up cycle times or cost; make
processes more efficient and more predictable.
Lean –
Basic Principles to Implement a Lean Process
RadioGraphics March-April 2012 Vol. 32 No. 2 573-587
-Particularly relevant to radiology departments, which
depend on a smooth flow of patients and uninterrupted
equipment function for efficient operation
-Vital to institute a gradual but continuous and
comprehensive “lean transformation” of work philosophy
and workplace culture
Six Sigma
-Key pieces of Six Sigma are consistent output, stability, and
-Six Sigma aims to reduce output variation through the use
of statistical analysis and root cause analysis.
Six Sigma
Example- Nebraska Medical Center IR Department’s use of Six
-Process inefficiencies were causing patient volumes to decline.
-Dissatisfied referring physicians were sending patients to other
-Patients who remained were experiencing delays in their
Six Sigma
-Collaborating with referring clinics, and strengthening relationships.
-Improving job satisfaction amongst employees, by establishing clear
expectations about each individual’s role. (eg – for the scheduler, this
involved clarifying what type of lab testing was required prior to each
procedure, obtaining timely clearance/approval from other providers,
and knowing the precise time that had to be scheduled)
-Improving communication between employees, to better understand
what each individual required to perform his/her job better.
Six Sigma
- The Nebraska Medical Center interventional radiology
department saw a 21% increase in patients from the previous
fiscal year; it reflected improvements in patient and
referring physician satisfaction as well as process
The Approach
1) When presented with an issue, transition to a Kaizen mindset
and ask “What is the problem we are looking to solve?”
2) Lean principles are the first set of tools applicable to any
scenario. Generally, we are addressing a problem in which there
is a complete lack of process standardization and optimization.
3) Six Sigma is a strong methodology after processes are
standardized and optimized. At that point, the process is looking
for improved process outputs and consistent performance.
-A decrease in fee for service payments
-An expansion of the ‘flat fee’ model (single payment based on
admitting and comorbid diagnoses)
The IR community should help the hospital by ensuring that
indications for procedures are evidence-based and appropriate.
Yousem, DM.,Beauchamp, NJ. Radiology Business Practice: How to
Succeed. Philadelphia: Saunders Elsevier; 2008.
Muroff, LR. Implementing an effective organization and
governance structure for a radiology practice. J Am Coll Radiol
Volland, J. Case Study: Now that’s Lean. Medical Imaging Magazing
Kruskal, JB. Quality Initiatives:Lean Approach to Improving
Performance and Efficiency in a Radiology Department. March
2012 Radiographics; 32; 573-587
Beheshti, MV. The interventional radiology business plan. J Vasc
Interv Radiol 2012;23;1181-1186

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