Radiology Associates of Appleton, a 24-physician practice based in Appleton, Wis., joined the Strategic Radiology coalition of independent practices in November 2018, bringing with it the strong commitment to excellence and service to communities in Wisconsin’s Fox River Valley since 1968.

These values have driven many decisions over the years, including the introduction of radiation oncology services and the decision to subspecialize to the greatest degree possible for a practice of its size. Since Timothy Bernauer, MD, FACR, was elected president in 2016, the practice has embraced yet another core value—leadership development. 

“Embracing the core concept of excellence through shared leadership responsibilities has been critical to our continued success and improvement,” said Dr. Bernauer.  “This also provides opportunities to work on values that facilitate individual leadership growth.  Every member understands that they have unique skills and talents to contribute. We also have seen a synergy developing as group members care less about recognition and position, and more about the results of our combined efforts.”

According to Ryan Hoffman, practice manager, members of the practice have attended the ACR Radiology Leadership Institute conference—as well as other industry meetings—every year since Dr. Bernauer was elected president. “Leadership today is very different than it was in the past, when physicians elected to a leadership position ran with the aptitude that they had,” Hoffman notes. “The radiologists today who are interested in leadership are seeking the training that they need to be better leaders.” 

In addition to acquiring the necessary skills to lead effectively, leaders in radiology have a responsibility to groom a successor. “Leadership development can’t be concentrated just at the top,” Hoffman notes. “It needs to be pervasive throughout the practice and involve everyone in various efforts that they can take on and own within the group.”

Practicing Shared Leadership

Like many practices, RAA has transitioned from a democratic model of governance to a working board that makes all but the very biggest decisions for the practice.  More recently, the practice implemented a number of committees to drive activities such as operations and quality, with every partner assigned to a committee with a role to play.

“The development of the committees was a big initiative of Dr. Bernauer, and it has been a very successful approach in our group,” Hoffman reports. “This is really where independent practices need to be in this day and age, with everybody—not just the board and the president—involved in governance and knowing what is going on in the practice.”

“The committees have been instrumental in leveraging our group resources,” Dr. Bernauer added. “We are simply able to accomplish more in less time with board members leading committees and delegating tasks.  While turnaround time is typically considered in the setting of exam interpretation, being timely and competent in addressing administrative issues is also critical to providing the best possible service.”

In the past, the president and the board did most of the work and made most of the decisions that committees now make. Adding committees to the governance structure has exposed every member to how the practice functions as a business and its daily challenges, Hoffman notes. “Every partner now has an appreciation of the work the leaders in the group do, and the knowledge and background that will help them run the practice should they be called,” he said.

Roots and Relationships

Appleton is one of that rare breed of radiology practice that has maintained the specialty's historic connection between radiation oncology and radiology, to the benefit of its hospital partners, the cancer care teams, and their patients.

“As a multispecialty practice in a hospital system, we are involved in more departments with more interaction with upper management, and this gives us more exposure to the system,” Hoffman believes. “We also see the collegial side of things. The radiation oncologists and the radiologists work very well together when it comes to a patient’s cancer care. They know the capabilities of their partners and who to ask questions of regarding patient issues, so it is a benefit all around when it comes to a patient’s care.”

Because cancer care is an important service line to its health system, having radiation oncologists within its ranks has made RAA a more valuable partner. “On the business side of things, it certainly makes us more important to our health system because cancer care is a major focus.” 

While Hoffman can imagine scenarios in which tensions might arise between the specialties, none have emerged to date. Financial tensions are unlikely to arise, because the practice keeps revenue siloed on the respective sides of the practice.

“We are a pretty united group,” he observes. “It has been positive for us— we work together very well, there is a lot of mutual respect between the divisions of the company.”  

Market Dynamics

Of course, RAA faces the same challenges that confront other radiology practices across the nation—pressure on reimbursement from payors and market consolidation, both on the hospital and the radiology side. Aurora Health Care, headquartered in Milwaukee and serving eastern Wisconsin, recently completed a cross-border merger with Advocate Health Care, headquartered in Downers Grove, Ill.

“We’ve seen a lot of independent practice consolidation as well,” Hoffman says. “A competing group just went with a national consolidator model, so now we have that right in our backyard. Radiology is obviously a very hot market for consolidation right now. In our market, locally, I see a lot of anxiety about the best course of action for the future of individual practices. I don’t think there are any clear answers.”

“I see groups that want to maintain their independence and the good quality work they are doing,” Hoffman continues. “They don’t necessarily want that to be diluted in a larger practice. Then, there are some that see a benefit of the larger practice. From our perspective, Strategic Radiology is a good fit.”

RAA is particularly keen on participating in the Strategic Radiology Patient Safety Organization (PSO), the first and only radiology-specific PSO listed by the Agency for Healthcare Research and Quality.

“As a smaller radiology and radiation oncology practice, we don’t necessarily have access to the data and resources that SR would,” he acknowledges. “We are looking forward to working with other groups in developing best practices, processes, and systems that can help us with patient safety in the work environment, as well as seeing what others are doing.  For a practice of our size at this point in time, to gain some economies of scale, share best practices, and collaborate with other groups that are facing similar challenges, I think SR is a good fit for us.”