Communication crucial to resolving imaging fracas

Radiologists understood the implications of the cardiac-imaging technology, Ward learned. But as it turned out, at least one Bronson-associated cardiology group opted out of cardiac CT talks altogether. "They just weren't interested," Ward says.

Contractual traps stall progress

At Bronson, radiologists already maintained an exclusive contract that gave them rights to perform imaging procedures, Ward says.

So if Bronson planned to include cardiologists performing cardiac-imaging procedures using its new CT machine, it had to renegotiate radiologists' exclu-sive contracts and draw up new contracts with the cardiologists.

That took conversation-and lots of it, he says. "I have to say that communication was the key for us," Ward says.

Cardiologists and radiologists at Bronson discussed operating under a joint venture contract, with half the procedure going to the radiologists and half benefiting the cardiologists.

"This is an area that is rife with legal land mines," said Todd Sagin, MD, JD, vice president and national medical director of The Greeley Company, a division of HCPro, Inc., in Marblehead, MA, who spoke during HCPro's audioconference "The 64-Slice CT Scanner: The latest battleground in specialty turf disputes" (www.hcmarketplace.com/prod-4874.html).

Regardless of which approach your facility picks-joint-readings, overreads, or alternate billing arrangements-be sure to "establish a clear legal basis for it, because the false claims act, antitrust concerns, and Stark violations all have an impact on some of the schemes out there," Sagin said.

"We don't know how the government will view them in the future," he said.

Joint venture worries force further discussions

Although the joint venture option seemed to excite both sides at Bronson, "it just didn't work out legally for our particular situation," Ward says.

Through numerous discussions, Bronson officials finally helped facilitate an agreement in which radiologists retained their exclusive contract with the hospital but subcontracted additional interpretations to the cardiologist practice. The radiologists get paid, and they pay the cardiologists, Ward says.

"No matter what you chose to do, you need to keep an eye on the legal department and work closely with it, so if something changes [legally], you won't be on the hook [and in violation]," says Ward.

In the end, the hospital radiology administrator acts as a facilitator of the relationship. As such, he or she keeps the teamwork rolling while fostering dialogue and collaboration to establish a winning situation for all.

Henry Ford unearths a way to harmony

Some institutions find themselves in better collaborative positions than others. That's the case at the Henry Ford Hospital in Detroit, says Radiology Administrator Cheryl Martin.

Henry Ford's long academic history of working across departments and specialties helped reveal opportunities for continued relationships when it came to implementation of cardiac-imaging protocols, she says.

"Our physicians work as a group, so the determination of patient management is based on a team ap proach," Martin says.

A collaborative approach is ideal for several reasons, says Timothy Albert, MD, cardiologist at Central Coast Cardiology in Salinas, CA. "In general, most hospitals don't have a [cardiac-imaging] specialist. That represents an opportunity for both sides to bring something to the table," he says.

Henry Ford maintains a joint cost center where it pours all revenue from cardiac-imaging procedures into one account and divides it according to fair market value to both services, says Martin. "When performing joint readings, the cardiologists get the heart portion, and the radiologists get the rest," she says. Henry Ford files a single bill with a modifier -59 to signify a distinct procedural service, remaining careful not to bill twice for the same procedures.

That doesn't mean Martin established cardiac-imaging programs without turf war trouble. She simply managed them by communicating early and often, she says, to keep parties from fighting over procedures."I'm here to tell you that turf wars are real," says Martin. "Everyone has certain items they need to work out. Without open dialogue, how will you ever be able to surpass that conflict and work for the best interest of the patient?"

Credentialing charts pathway to peace

One primary discussion circled around maintaining an appropriate knowledge base to perform these complicated cardiac-imaging scans, says Martin. That meant establishing criteria for privileging and credentialing standards for performing cardiac-imaging scans.

She suggests that radiology administrators talk to vested parties and facilitate the following steps:

1. Establish a cardiac-imaging credentialing policy

2. Obtain recommendations from medical staff members and interested parties

3. Research association suggestions (e.g., American Col lege of Radiology, American Association of Cardiology, etc.)

4. Establish an agreement between the parties

5. Propose the agreement to the privileging committee

"It worked here because of communication," Martin says. "Keep going back to what's in the best interest of the patients."

Insider sources

Cheryl Martin, radiology administrator, Henry Ford Hospital, Detroit, MI.

Todd Sagin, MD, JD, vice president and national medical director, The Greeley Company, 200 Hoods Lane, Marblehead, MA, 01945, 781/639-1872; tsagin@greeley.com.

Brook Ward, executive director of clinical and ambulatory services, Bronson Healthcare Group, One Healthcare Plaza, Box C, Kalamazoo, MI 49007-5341, 269/341-8102; wardb@bronsonhg.org.

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