By Adam Fairbourn, Vizient Director of Contract Services
Niki Owen, Vizient Director of Contract Services
As patients assume a greater slice of the financial cost of medical tests, it is understandable that many approach costly imaging diagnostics like MRIs with caution. This is especially true for healthcare consumers considering expensive elective procedures or carrying health plans with large deductibles.
Health systems that are already challenged by continued Medicare rate cuts for diagnostic imaging cannot afford a decline in diagnostic imaging volume during a slowing economy. Instead of reducing staffing levels if demand declines, the following two strategies can help forward-thinking health systems maintain or increase imaging volume:
- Aggressively pursue imaging volume associated with clinical research trials. In many cases, this can increase volume significantly.
- Seek to reduce leakage. Demand for imaging is increasing, but patients often receive their test outside the system of care. Firming up your referral base can reduce leakage, increase volume and improve patient satisfaction.
Clinical trials represent a proven imaging revenue stream
Some medical research programs and clinical trials require at least one imaging exam — if not several — for each patient enrolled in the program. This is especially true for cancer and neurology trials. These images accelerate the drug development process by providing noninvasive assessment of drug action and responses to treatments. In addition, relying on imaging for clinical trials offers several other advantages:
- Most regulatory agencies recognize imaging as surrogate biomarkers to monitor disease responses or progression.
- Unlike biopsies, clinical imaging is noninvasive and enables repeated evaluations.
- Generally, imaging can reduce clinical study costs and enable shorter drug development timelines.
Both inpatient and outpatient facilities can benefit from repeat clinical trial patient volume at a negotiated and fixed rate. Although payment structures can vary, in many cases the provider bills the entity sponsoring the study. Typically, that figure is billed at the allowable CMS rate. Sometimes providers can negotiate an additional percentage. Alternatively, some imaging studies performed as a part of a clinical trial may be reimbursable by CMS. For example, in 2020, Medicare approved reimbursement for PET scans for patients participating in the Imaging Dementia — Evidence for Amyloid Scanning (New IDEAS) study.
Clinical trial imaging contracts mean that providers don't have to worry about many of the traditional complexities of the billing process and chasing delinquent payments. When an academic medical center in the southwest pursued this strategy, clinical trial imaging eventually grew to represent up to 40% of its imaging revenue for certain modalities.
Strong industry growth is anticipated, with the global imaging contract research organization (CRO) services market expected to grow from $4.6 billion in 2022 to $8.8 billion in 2030. Savvy health systems that capture even a small percentage of growth from CRO facilities can significantly increase volumes and revenue.
Patient traffic can be substantial — in what was then the largest medical imaging study ever, 100,000 Britons were scanned starting in 2016 to determine the progression of major diseases. Often, providers can parlay that imaging traffic into additional volume by conducting other lab work that is required for the study.
In addition, health systems should closely monitor imaging needs associated with developing drugs, such as the recently approved monoclonal antibody treatments for Alzheimer's. In July, the FDA granted “traditional” approval for Leqembi, produced by Eisai Co. and Biogen. This treatment requires frequent brain scans, another opportunity for imaging centers.
Health systems should be aware that many clinical trial images require high levels of technology and the ability to read and transfer images to the group funding the study. They also can require a good amount of legwork to identify clinical trials and locate participants in your area. This often requires a full-time employee to lead the effort.
- Collaborate with pharmaceutical companies to determine how to become involved in current and upcoming trials.
- Communicate with your referral base to identify clinical trial investigators.
- Identify primary or secondary investigators to recruit clinical trial patients.
Increase volume by securing your referral base and reducing leakage
Increasing collaboration with your referral base can not only result in greater volume through clinical trial imaging but can ensure that your referral network is not sending patients elsewhere. It is essential to protect your patient base and become the imaging center of choice for providers in your area, especially during an economic downturn.
Becoming a provider of choice ensures a steady stream of referrals, especially when it comes to exams that must be repeated due to inconclusive results or because the referring physician didn't specify the right orders, such as an exam without contrast. By forming a collaborative relationship with physicians, radiologists can call the physician to ensure that the ordered test answers the desired clinical question. In the end, physicians will send more patients to imaging centers they trust.
This also builds patient satisfaction for your provider network. For example, a patient who needs a lumbar spine MRI repeated a second time because the first test was inconclusive or ordered incorrectly. This ends up costing the patient time and money, factors that may make them think twice about revisiting the original provider. It comes down to having the right exam for the right patient at the right time.
Collaborating with your referral base and reminding them of your imaging capabilities can prompt physicians to send more patients your way for scanning, especially when patient decisions might be based on insurance recommendations that don't consider local expertise in your area.
Consider that after an Evaluation and Management (E&M) visit with a primary care provider at an affiliated health system, Vizient data shows that roughly 50% of patients have an imaging encounter outside of the health system locations. The number of days in between an E&M visit and an imaging encounter does not have an impact on leakage to a location outside of the health system.
However, patients who visit an unaffiliated location for an imaging encounter only return to the affiliated health system for a specialist consult around 30% of the time. If a patient has the imaging encounter at the affiliated system, they subsequently visit an affiliated specialist 51% of the time.
- Form collaborative relationships with your referral base by offering a trustworthy consultative approach to answering clinical questions for the exam ordered.
- Ensure your referral receipt process is hassle free and is streamlined toward the right exam for the right patient at the right time.
- Work to reduce inter-provider communication barriers with referring providers for protocoling exams and delivering interpretation results and images. Often, this relates to old habits at the primary care office for preferred referral channels that need to be revisited.
- Market your facility's expertise and technology capabilities to providers in your referral base.
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About the authors
Adam Fairbourn leads Vizient’s diagnostic imaging category management team under the capital equipment solutions domain and facilitates Vizient’s Diagnostic Imaging Contracting Council. Prior to joining Vizient, he worked at UT Southwestern Medical Center as an imaging technologist. Fairbourn earned a Master of Business Administration degree from the University of Texas at Dallas and a Bachelor of Science degree in nuclear medicine technology from the University of Arkansas for Medical Sciences in Little Rock.
Niki Owen is director of contract services on Vizient’s capital equipment solutions team with responsibility for capital strategic sourcing and medical equipment planning procurement advisory solutions and Vizient’s quote review service. Prior to joining Vizient, Owen worked for Kelsey-Seybold Clinic in Houston for 19 years in a variety of management roles. Her expertise includes inventory management, healthcare technology management, procurement, logistics, equipment planning, construction