Technical cost of radiologic examinations: analysis across imaging modalities.

PURPOSE: To determine the individual technical costs of general diagnostic radiographic, ultrasonographic (US), computed tomographic (CT), magnetic resonance (MR) imaging, and scintigraphic examinations and interventional radiology. MATERIALS AND METHODS: The Radiology Cost and Productivity Benchmarking Study method of the University HealthSystem Consortium, a cooperative group of academic medical centers, was modified and extended to the six imaging modalities in a tertiary care academic setting. Hospital billing and cost records were analyzed for fiscal year 1996. Costs were divided into labor and nonlabor categories and were allocated to individual imaging modalities on the basis of resources consumed. Physician cost and hospital overhead were not included. Unit costs were analyzed per technical relative value unit (RVU) and per examination. RESULTS: The costs per technical RVU for diagnostic radiography, US, CT, MR imaging, scintigraphy, and interventional radiology were $65. 06, $28.74, $20.95, $17.69, $42.19, and $89.03, respectively. The technical costs per examination for diagnostic radiography, US, CT, MR imaging, scintigraphy, and interventional radiology were $41.92, $50.28, $112.32, $266.96, $196.88, and $692.60, respectively. CONCLUSION: The method of unit cost analysis for individual imaging modalities was successfully tested in a tertiary care setting. The method should be adopted to allow cost comparison across many institutions, which will permit the promotion of best practices.

Can academic radiology departments become more efficient and cost less?

PURPOSE: To determine how successful two large academic radiology departments have been in responding to market-driven pressures to reduce costs and improve productivity by downsizing their technical and support staffs while maintaining or increasing volume. MATERIALS AND METHODS: A longitudinal study was performed in which benchmarking techniques were used to assess the changes in cost and productivity of the two departments for 5 years (fiscal years 1992-1996). Cost per relative value unit and relative value units per full-time equivalent employee were tracked. RESULTS: Substantial cost reduction and productivity enhancement were realized as linear improvements in two key metrics, namely, cost per relative value unit (decline of 19.0% [decline of $7.60 on a base year cost of $40.00] to 28.8% [$12.18 of $42.21]; P < or = .001) and relative value unit per full-time equivalent employee (increase of 46.0% [increase of 759.55 units over a base year productivity of 1,651.45 units] to 55.8% [968.28 of 1,733.97 units]; P < .001), during the 5 years of study. CONCLUSION: Academic radiology departments have proved that they can "do more with less" over a sustained period.

Expediting the turnaround of radiology reports in a teaching hospital setting.

OBJECTIVE: The purpose of this study was to determine whether total quality management (TQM) techniques that had proved successful in a pilot study in one departmental section of a teaching hospital could be generalized for use by the entire radiology department. MATERIALS AND METHODS: Each departmental section developed interventions to improve its report turnaround time. These interventions were tailored to practice style and habits of each section. Commonly used interventions included electronic signature from the radiologist's home, a report-signing buddy system, elimination of a trainee signature requirement, accelerated transcription, structured reports, faster film delivery to reading desks, and training about the importance of radiology reports for clinical decision making. Specialized programs included computerized form-driven reporting and reports generated directly by computer voice recognition of radiologists' dictation. Our radiology information system provided data on each step in the reporting process. RESULTS: The TQM approach produced significant improvements in departmental total report turnaround time (-55%; p = .001), transcription time (-80%; p = .003), and signature time (-68%; p = .0004). Each section achieved significant gains. The sonography section initiated a computerized, form-driven reporting system and outperformed the rest of the department. CONCLUSIONS: TQM techniques can be expanded and generalized for department-wide projects in teaching hospitals.

Achievement of substantial cost reduction through joint purchasing by the radiology departments of a large vertically integrated health care system.

RATIONALE AND OBJECTIVES: The authors sought to lower costs by coordinating the purchase of equipment, supplies, and services in the radiology departments of a vertically integrated health system formed by the merger of two of the largest academic medical centers in New England. METHODS: The radiology departments at Massachusetts General Hospital and Brigham & Women's Hospital formed a cost-reduction task force to explore opportunities to jointly decrease costs. Data from the operating budgets of both institutions were collected and analyzed to find specific items within the budgets that could yield substantial cost savings. RESULTS: The project's first phase yielded over $810,000 in reduced costs from a system-wide annual budget of only $7 million for film and contrast material. Ongoing additional projects suggest that longer term contracts that contain steeper discounts with a decreased number of vendors will result in further decreases in the cost of materials and supplies. CONCLUSION: Coordination of purchasing by the radiology members of an integrated delivery system can yield substantial savings.

Expediting the turnaround of radiology reports: use of total quality management to facilitate radiologists' report signing.

OBJECTIVE: The purpose of this study was to determine whether total quality management techniques could be used to speed radiologists' performance on the task of signing reports. SUBJECTS AND METHODS: Total quality management represents a group of tools that can be used to improve the functioning of complex processes in the workplace. The steps involved in our total quality management project were as follows: (1) commit to improving radiologists' performance, (2) commission an interdisciplinary study team, (3) propose hypotheses for the causes of signing delays, (4) identify the key issues constraining performance (Pareto analysis), (5) intervene to correct systematic problems in a test system, (6) evaluate the results of intervention on radiologists' report signing performance, and (7) hold the gains achieved by the intervention. An interdisciplinary study team identified five key obstacles to prompt signing of reports: (1) radiologists' absence from the department when reports were available for signing (e.g., nights and weekends), (2) dysfunctional hand-off between transcriptionist and radiologist, (3) requirement that a fellow or resident sign before a staff radiologist, (4) lack of a system for signing by proxy (if primary radiologist is away), (5) perceived lack of impact of signed report on clinical decision making. RESULTS: Interventions included (1) providing home computer terminals, (2) implementing a buddy system for proxy signing, (3) eliminating the requirement for a signature from a fellow or resident, (4) teaming groups of radiologists with specific transcriptionists, and (5) streamlining transcription service. When these enhancements were used in a test system, the mean time required to sign reports decreased 59% from 26.0 +/- 8.4 hr (mean +/- standard error) in the baseline period to 10.6 +/- 2.9 hr (in the enhanced period, p = .05). CONCLUSION: We conclude that total quality management methods can accelerate radiologists' signing of reports.

Marketing CT and MR imaging services in a large urban teaching hospital.

A three-phase marketing program was implemented to increase referrals for examination with computed tomographic (CT) or magnetic resonance (MR) imaging and improve services in an academic radiology department. In the research phase, a data base of 135 referring physicians was developed, and a questionnaire was mailed to 130 physicians. The market research identified three key issues: waiting time to get an appointment, scheduling procedures, and communication of findings. In the implementation phase, additional equipment was installed and a program of expanded appointments, service improvements, and public relations was introduced. In the evaluation phase, 1 year after the completion of phase 2, the effect of the marketing program was measured. The average number of physicians who made referrals per month increased from 609 to 653 (an increase of 7.2% over baseline); the average number of CT and MR examinations performed each month increased by 57.3% and 45.2%, respectively. Referrers' ratings of 10 imaging services improved significantly (P = .02). It is concluded that a well-designed marketing program can boost the productivity of a teaching hospital department.