Triad Radiology Associates: A North Carolina Practice Looks Ahead with Optimism

As radiologists, we feel confident in our ability to make diagnoses, and some people feel a little threatened that AI could take that away. We look at it as a plus if it can help image patients faster and better and increase our efficiency.

Andrew Deibler, MD
President, Triad Radiology Associates
October 19, 2020

While Strategic Radiology’s newest member group already has a half century under its belt, the 50-radiologist Triad Radiology Associates (TRA), Winston-Salem, NC, has a young leader, a youthful demographic, and a hallmark practice of making sure newcomers get a committee position. That was the beginning of the path Andrew Deibler, MD, took to become president and CEO of TRA at 42 years old on January 2019.

A year and eight months later, TRA’s leader is six months into the pandemic and missing the good old days when he could get into a room with a person and hammer out a deal, or fix a problem, or forge a new relationship. “So much of leadership at the top is face-to-face interactions and that is what has suffered the most under Covid-19,” says Dr. Deibler.  “Other members of the executive team can fulfill their roles normally through email, phone calls, and other channels of communication, but what makes the president role unique is that face-to-face meetings really move the needle.”

Some challenges specific to managing a radiology practice during Covid-19 have been met and operationalized—compliance with hospital Covid-19 protocols and making sure patients, staff, and radiologists feel safe—and others will be leveraged for future growth. Like many private practices, TRA moved to a more distributed model during the pandemic, with more home workstations and less on-site coverage, adding flexibility to its manpower. This entailed complex, rules-based programming of the internal phone answering system to route phone calls to radiologists depending upon the day, the shift, and the subspecialty to ensure that the technologist or referring physician could connect with who they needed on the first try.

“We are having to operationalize strategies that teleradiology companies have had to deploy in the past,” says Dr Deibler. “The practice will leverage that and use it as a strength going forward.”

Generation X, Side of Millennial

Early in his career, Dr. Deibler was given opportunities to be on committees, and has served on the executive committee since 2013. His predecessor, Ted Kerner, MD, the practice’s first radiologist CEO, gave up his clinical practice to become a full-time administrator, paving the way for the practice’s robust billing and IT capabilities.

“He did a lot to build out our back-office in terms of having clinical operations, IT, and revenue cycle management altogether in the same building, and that made it easier for a radiologist to be the CEO,” Deibler notes. “When he retired, I took on his role and benefited from what he built, as well as my previous admin experience.”

TRA’s most common demographic is the 40 to 49 age group, followed by the 30- to 39-year-old millennial-generation demographic. “We do skew younger,” he says. “We do value the younger radiologist. At the same time, we are fortunate to have retained a number of late-career radiologists who are guiding the group in the right direction prior to their retirement in terms of committee involvement and recruiting, to keep the group going in the right directions. We have good balance between younger, more active radiologists and those that are very experienced and lending their wisdom, for which I am grateful.”

Between the support from practice elders and a groundswell of youthful practitioners, Dr. Deibler sports an optimistic view of radiology and the radiologist’s role in medicine. “There are challenges, but I am optimistic because radiology plays such a critical role in medicine and is so ingrained in the care continuum ,” he says. “Despite perceived threats from artificial intelligence and reimbursement, I think there will always be a need for radiology and radiologists, and in fact it continues to grow. Our group and a lot of similar groups are continuing to add radiologists despite Covid, and I think it will continue to be that way.”

Patient-centered Radiology

A caveat to that optimistic view is that it is based on radiologists staying relevant in an age of medical record visibility in which patients have ready access to their reports. “Radiologists have to be a visible, tangible part of patient care,” he emphasizes, “we can play a role in guiding these patients who have access to their reports prior to a visit with their clinicians. Radiologists can help clarify what is in the report and in some cases allay unnecessary fears and guide patients to the right specialists. We have to figure out how to do that in a time-sensitive fashion without getting reimbursed for that—at least now.”

For TRA, information technology is likely to play a role in such a solution. The practice has an IT managed services organization based on internally developed software and infrastructure that is the foundation of its business intelligence and quality programs. “We lean heavily on our business intelligence and quality programs, which are home-grown,” he says. “We are fortunate to have a lot experience and talent in our IT division, and we have invested in software engineers and HL-7 interface engineers that have created some sophisticated tools for us to examine data related to our day-to-day practice.”

One such tool is a radiologist dashboard, an at-a-glance one-stop-shop for radiologists designed to automate administrative activities they are required to participate in, such as billing addendums, practice quality activities, and radiology–pathology correlations. Dr. Deibler is emailed a nightshift dashboard every morning that drills down into metrics from the previous evening, and all radiologists have access to worklist gauges that are real-time reflections of subspecialty worklists across the practice, viewable anywhere from anyone’s smartphone. “If they are going to come in and work extra, they know where we need help,” he notes.

The investment in IT has enabled the practice to track and reporting on a wide variety of quality metrics for its primary health system partner, Novant Health, as well as Northern Regional Hospital. TRA provides full-service, subspecialized interpretations for both.

More Reasons for Optimism

An MSK and abdominal imaging subspecialist, Dr. Deibler expects to see some of radiology’s greatest advances near-term in interventional oncology. “I see many young, well-trained, interventional candidates that have interest in interventional oncology and finding new ways to treat cancer patients,” he says. “Certainly, in our practice, oncology is a big emphasis—we have good expertise in that area, and we are continuing to grow that. I am excited about that.”

He also has high hopes for artificial intelligence to bear low-hanging fruit in aiding diagnoses and speeding up scanning protocols for MRI and CT. “There are some time-consuming steps that can be eliminated through artificial intelligence and scanning software-reconstruction algorithms,” he says, predicting that a cross-sectional MRI that takes 45 minutes today will be acquired in 15 to 20 minutes in just a few years or even sooner.

“As radiologists, we feel confident in our ability to make diagnoses, and some people feel a little threatened that AI could take that away,” he observes. “We look at it as a plus if it can help image patients faster and better and increase our efficiency.”

As CEO of Strategic Radiology’s newest member group, Dr. Deibler is enthusiastic about membership in a coalition that supports independent private practices that are community based and focused on quality. “Being tied into that really allows you to work on the local initiatives that make your practice great, but also allows you to participate in something larger—it’s a good feeling to be a part of that,” he concludes.

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