JACR: Rad practice assessment should evaluate nonclinical productivity

Nonclinical contributions to the radiology practice are measurable and can play a valuable role in the practice assessment process, according to an article in this month's Journal of the American College of Radiology.

“Administration and leadership, practice development and service, professionalism and clinical consulting, quality and safety, and … research and teaching are all mission-critical endeavors,” wrote Richard Duszak, MD, of University of Tennessee Health Science Center in Memphis and Lawrence R. Muroff, MD, of University of Florida College of Medicine in Gainesville.

Radiology practices with a narrow productivity focus on RVUs tend to undervalue nonclinical contributions. Duszak and Muroff offered several metrics to help practices capture data about nonclinical inputs and offered a rationale for including each.

Academic institutions can better measure the contributions of radiologists with heavy teaching or research roles by calculating publications, academic and community service, teaching and research to yield an ‘academic RVU,’ claimed the authors.

Surveys from the 2008 and 2009 Economics of Diagnostic Imaging: National Symposia revealed that more than half of practices offered no compensation to their presidents and other leaders, with one-quarter not providing dedicated administrative time, wrote Duszak and Muroff. Such a model ignores the critical role of effective governance in the ongoing health and growth of a practice. Sound leadership and administration, they noted, carry tangible economic benefits such as favorable and fair payor contracts and robust hospital contracts.

Similarly, radiology practices tend to neglect the role of practice development and service activities in their calculations of physician productivity. “Participation in local and national professional societies; on practice, hospital, and community committees; and in hospital and medical society conferences and lectures all promote and strengthen a practice,” the authors argued.

Professionalism--attentive and high-quality service-- is an unspoken requirement of radiologists; and physicians that overlook its value can impede the communication and collaboration necessary for patient care, wrote Duszak and Muroff, resulting in compromises in safety and quality. Periodic performance reviews can help factor in the value of professionalism.

Finally, Duszak and Muroff proposed using a dashboard to help individual radiologists set and meet quality and safety goals such as report signature time and communication of critical results.

The formula for the nonclinical RVU, stated Duszak, is: ncRVU = RVU_A + RVU_S + RVU_P + RVU_Q.

“RVU_A, RVU_S, RVU_P and RVU_Q represent the values of administration and leadership; practice, hospital and community service; professionalism; and quality and safety, respectively,” explained Duszak and Muroff. Committing to a rigorous nonclinical metric affirms a practices’ commitment to physician performance and assessment, continued Duszak, who added that objective performance measures may help identify opportunities for improvement at the physician level and inform short-term operational and long-term strategic goals.

Planning for productivity
Duszak and Muroff concluded with a series of questions for practices to ask before launching productivity metrics:

• Should we measure it?
• What should we measure?
• How should we measure it?
• How should we manage it?
• How should we modify it?

Duszak and Muroff urged sites to tread carefully and plan wisely as they devise and implement productivity metrics: “The success or failure of any physician productivity measurement and management system will hinge on the appropriateness of that system for a particular organization.”