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Co-management in Spokane: Inland and Providence Add Value with Market-wide Imaging Coordination

Many health systems are still doing outpatient work in the inpatient department, which is not the best place for that from both a cost standpoint and a patient experience standpoint.

Steve Duvoisin
CEO, Inland Imaging
March 28, 2018

Since 1930, Inland Imaging, Spokane, Wash., has provided radiology services for Providence Sacred Heart Medical Center & Children’s Hospital, a 719-bed quaternary care hospital, and Providence Holy Family Hospital, a 197-bed community hospital, owned by Providence Health & Services. The radiologists and hospitals deepened their relationship in 1998, when they entered into an exclusive outpatient imaging center joint venture (JV) contract that committed them to a 50-50 ownership of all of their outpatient imaging services in a prescribed geography.

During the past 20 years, the imaging center venture grew, extending outpatient services into eastern Washington and western Montana. The inclusion of Providence executives on the Finance and Operating Committees of the JV has given them an inside view of Inland’s clinical and business practices. Inland radiologists and executives have gained an appreciation of Providence’s approach to patient care.

“The 1998 imaging center joint venture is a foundational element to our relationship with our health system,” notes Steve Duvoisin, CEO, Inland Imaging, a founding member of the Strategic Radiology national coalition of private radiology practices. “It’s been very successful for both organizations and well-embraced by our hospital partners, payers, referring physicians, and patients.”

A few years ago, they moved even closer. 

Elaine Couture, well known to Inland executives through her service on the imaging center JV board, took the helm as chief executive of Providence’s Washington & Montana region. The two parties soon recognized that there was an opportunity to coordinate inpatient and outpatient imaging market-wide if Inland Imaging assumed management of inpatient radiology at the 719-bed hospital.

“Many health systems are still doing outpatient work in the inpatient department, which is not the best place for that from both a cost standpoint and a patient experience standpoint,” Duvoisin notes.

CLOSE RELATIONSHIP GETS CLOSER

Effective January 1, 2015, Inland Imaging Business Associates, LLC assumed responsibility for management of the inpatient imaging department at Sacred Heart Medical Center & Children’s Hospital, the 719-bed quaternary hospital. Inland’s COO, Kathleen Wilson, who oversees outpatient imaging, is now responsible for the inpatient imaging operations as well. Inland installed a manager who reports to Wilson. 

The overall strategic coordination of inpatient and outpatient imaging has yielded a number of benefits, including a more thoughtful deployment and use of technology system-wide, freeing up inpatient capacity by moving outpatient exams to their appropriate venue.

Not only has this mitigated the need to acquire new technology to meet growing inpatient demand, but it has directed work to its appropriate setting. “Payers love it because we are moving outpatient imaging to a more cost-effective place of service,” Duvoisin notes. 

The arrangement also gives Inland Imaging, Professional Services (the radiology group) the authority to work more closely with technologists on quality and productivity and provides a greater voice in inpatient technology purchases.

Typically, hospital imaging technology purchases are enacted through a supply chain person, often with limited understanding of the clinical needs. “All of a sudden, there’s a fully loaded MRI with all the bells and whistles installed, and the radiologists are saying, ‘We didn’t need all of this’,” Duvoisin explains.

All staffing is managed by Inland Imaging Clinical Associates, LLC which is wholly owned by Inland Imaging Business Associates, LLC, and this close working relationship has enabled Inland to apply cost accounting principles for a better understanding of radiology costs.

“Providence is working on a project looking at the cost of imaging modalities across the entire Providence system,” Duvoisin shares. “We’ve been doing cost accounting at Inland Imaging, LLC since 1989, and Providence’s cost accounting specific to radiology is starting to generate some interesting information. We are still working with Providence to make sure we are getting to apples to apples comparisons.”

OUTPATIENT SERVICE IN THE HOUSE

Historically, inpatient imaging departments have been challenged to compete with the level of service and patient experience typically found in an outpatient setting for reasons including patient acuity, but that is changing, Duvoisin says.

“Inpatient departments are coming around and functioning more like in-hospital imaging centers, and we hope that our co-management project can positively contribute to that trend,” he adds.

For example, many hospital patients who require medical imaging are admitted through the emergency department, so Inland Imaging Business Associates, LLC embedded a radiology intake person to streamline and facilitate ED patients getting into radiology.

Currently, Inland Imaging Business Associates, LLC is working with the hospital on a project to create a dedicated pediatric imaging area to service the Children’s Hospital, which is attached to the medical center. A dedicated team is exploring ways to multi-purpose technology so that it is both pediatric friendly and effective for adults.

To date, the arrangement has not yet resulted in lower operational costs, although significant increases in service have been accomplished with small increases in cost. “Costs are actually where they were, which is a good thing because they were projected to increase,” Duvosin says. “We definitely have seen an increase in service, and now we are working hard to bring the costs down.”

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