Achieve Elegant Radiology Through Aligning Hospital and Physician Goals Presented by: Dr. James Backstrom, Chief Medical Officer - Foundation Radiology Group Creating the ideal imaging model to achieve both clinical and financial results in a community hospital requires a shift in conventional thinking. This web presentation was on how changes in the radiology industry impact community hospitals and what strategic moves need to occur to create a level playing field with the larger more sophisticated major medical centers. The presentation reviews: - Strategic tactics to meet and exceed the necessary clinical quality requirements - How meeting subspecialty needs can differentiate your service - The importance of measuring “clinically relevant” turnaround times - How to satisfy your referral sources and patients by providing a superior service and clinical outreach About Dr. Backstrom: James W. Backstrom, MD, is the current Chief Medical Officer (CMO) for Foundation Radiology Group and is responsible for physician marketing, recruiting and program development. Dr. Backstrom holds a BS in Biology from Westminster College, and his MD from the University of Pittsburgh. He completed an Internal Medical Internship at Bethesda Naval Hospital and also spent time in the Quantico Naval Medical Clinic. He completed a Diagnostic Radiology Residency and six-month Fellowship in Neuroradiology at Duke University. For his pediatric training, Dr. Backstrom completed a Pediatric Radiology Fellowship at The Children’s Hospital of Buffalo, NY and also completed a six-month Pediatric Neuroradiology Fellowship at the Hospital for Sick Children, in Toronto, Ontario, Canada. Most recently Dr. Backstrom was named one of the top radiologists in his field by Pittsburgh Magazine in its annual “Top Doctors” issue. Only thirteen radiologists made the 2012 list out of the over 300 in the area. Dr. Backstrom was one of only three pediatric radiologists featured.

2. Delivering Elegant Radiology
Presented by: Dr. James Backstrom
Chief Medical Officer – Foundation Radiology Group

3. Foundation Radiology Group
Proven Model
▸ Amongst The Largest Full Service Radiology Groups in
the US
▸ Over 50 Board-certified Staff Radiologists, ALL
Subspecialties
▸ 100% US-Based
▸ All FINAL reads 24/7/365, including plain-film studies at
night
▸ Joint Commission Accredited Hospital Radiology Group
▸ Approaching 1 Million in Procedure Volume

4. Essence of Elegant Radiology
Pittsburgh at the Center of Innovation

5. Elegant Radiology
ELEGANT
▸ Historic Roles
▹ “Modality Monetization”
▹ “Results Recording for Referring”
▸ New “Elegant” Role
▹ Enterprise / Episode of Care Integration
▹ Proactive Care Consultant
▹ Strategic Agent/Impact
▹ New, Relevant Integration
▹ Care Coordination
▹ Subspecialization (From “Nice to Have” to “Necessity”)
▹ Critical Cost Path (ICU, Emergency Room)
▹ Strategic Alignment
▸ Elegant Radiology Phase

6. Differentiation
Strategic Alignment
Virtualization Leverage

7. Strategic Ideal
Planning
Outreach Group
Referral
Strategic Alignment
Leadership
Clinical
Systemic
Quality
Reports
Timely
Local Integrated Super/Hybrid “Systemic”
Group Group Group Group
Night Digitized Sub-specialty Web Workflow Advanced
Coverage Images Reads PACS A/V Tools Quality
Efficiency/Expertise Leverage

8. “Basement” Radiology on Skates
Patient Inadequate
Care
Foundation
Gs & Os
Operations
“From the
Traditional Basement to
Strategically Aligned Radiology Foundation
“Basement” the Board
Specialization 24/7 Radiology
Automation Virtualization Leadership Room”
Efficiency/Expertise Leverage

9. Elegant Radiology
ELEGANT
Patient
Care
Gs & Os
Operations
“From the
Strategically Aligned Basement to
Efficient/Expert Radiology Foundation the Board
Room”

10. ELEGANT
Solution Choices
“Own It” Elegant
Radiology Radiology
Strategic Alignment
“Basement” “Virtualized”
Radiology Radiology
Efficiency/Expertise Leverage

11. Essential Components - The Special Sauce
ELEGANT
▸ Comprehensive, “Elegant” Radiology Services
▸ Clinical Quality, Priority Reading Configuration
▸ Maximize Sub-specialization / Experience
▸ Seamless, Clinically Relevant Workflow/Metrics
▸ Low Distraction / Clinical Focus Environment
▸ High Value Physician Interchange Process
▸ Enabling, Accelerating Infrastructure
▸ Heavy Emphasis on High Quality Throughput

12. The Challenge  Complexity of Engineering Care
▸ Average hospital must coordinate care among 229
physicians across 117 practices for just the Medicare
beneficiary population
▸ The situation continues to become more complex due
to aging baby boomers and conditions resulting to a
generally overweight population.
▸ Individuals with 4+ chronic diseases at time of
admission are expected to be more than double in
2012 beyond what it was just ten years ago.
▸ Hospitals see declines in inpatient volumes offset by
growth in outpatient settings. This trend is
exacerbated by the favorable mix that tends to
accompany those served in an outpatient setting.

13. Imaging Impact
▸ Imaging procedures are increasing to support shifts
in industry
▹ Becoming more integrated throughout every episode
of care,
▹ Delivering more diagnostic capability
▹ Becoming more complex and multi-dimensional in
function
▸ Diagnostic imaging integral to the competitive and
financial dynamics faced by hospitals in critical
service lines
▹ Attracting and keeping the right patients
▹ Attracting and keeping the right physicians
▹ Contributes to the purchase of expensive assets

14. The Radiology Transition
▸ Radiology has gone through a clinical specialization
transition to keep up with demand.
▸ Sub-specialization – along with niche modality and
special procedure expertise – has gone from a luxury
available to some to a necessity for even the smallest of
community hospitals and imaging centers.
Pediatrics Specialized Ultrasound
▸ Many institutions and other physician specialties have Women's Imaging Nuclear Medicine
Coronary CT Abdominal Imaging
turned to employment as a partial answer Angiography Virtual Colonoscopy
Neuroradiology Vascular Imaging
▸ Most hospitals can’t afford to employ the level of sub- Musculoskeletal Gastrointestinal
specialty expertise Radiology Radiology
Thoracic Radiology Genitourinary
Emergency Radiology Radiology
▸ Community hospitals, even regional IDNs, shouldn’t Positron Emission
have to surrender patients, credibility and opportunity to Tomography (PET)
larger, distant institutions.
▸ Patients should be able to stay close to home where
they want and need to be

15. Subspecialty Radiology Study on Improving the Quality of Care
Department of Radiological Sciences, UCLA School of Medicine
▸ Subspecialty radiologists can provide consultations effectively to general radiologists as part of routine clinical operations
▸ 2,012 consecutive magnetic resonance (MR) imaging studies
▸ Initial interpretations provided by generalists then reviewed by specialists
RESULTS:
▸ Generalist and specialist radiologist interpretations differed in 427 (21.2%) cases
▸ Independent specialists reviewed disagreements and graded them as important, very important, or unimportant
▸ Differences were considered important or very important in 99% of the cases reviewed
CONCLUSION:
▸ Consultations by subspecialty radiologists improved the quality of the radiology reports studied
▸ In some cases eliminated unnecessary procedures or suggested more specific follow-up examinations.
▸ The consultation services can be provided cost-effectively from the payer's perspective and may save additional costs when
unnecessary procedures can be eliminated.

16. Breast Imaging Study Comparing Subspecialist vs. Generalist
PURPOSE: Evaluate performance parameters for radiologists in a practice of breast imaging specialists and
general diagnostic radiologists who interpret a large series of consecutive screening and diagnostic
mammographic studies.
▸ Abnormal interpretation rate (ie. recall rate) for specialist radiologists was 4.9%, which is approximately 30% lower than
the rate of 7.1% for general radiologists
▸ Rate at which biopsy was performed was higher among the specialist radiologists. For screening mammography, the
biopsy rate was 1.5% for specialist radiologists, which is approximately 30% higher than the rate of 1.1% for general
radiologists
▸ Cancer detection rates were ~75% higher among specialist radiologists. For screening mammography, the cancer
detection rate was 6.0 cancer cases per 1,000 examinations for specialist radiologists vs. the rate of 3.4 cases per
1,000 examinations for general radiologists
▸ Rates of detecting less advanced cancers were ~75% higher among specialist radiologists. For screening
mammography, the stage 0–I cancer detection rate was 5.3 cancer cases per 1,000 examinations for specialist
radiologists vs. the rate of 3.0 cases per 1,000 examinations for general radiologists
▸ For both screening and diagnostic mammographic examinations, the subspecialists have somewhat higher abnormal
interpretation, biopsy performed, cancer detection, and stage 0–I cancer detection rates. Therefore, the subspecialty
radiologists make more positive interpretations, with increases in both true positive and false-positive cases.
CONCLUSION: Specialist radiologists detect more cancers and more early-stage cancers, recommend
more biopsies, and have lower recall rates than general radiologists
RSNA Study of over 47,798 screening and 13,286 diagnostic mammographic examinations.

17. Quality Assurance Study of Neuroradiology in a Hospital
Do we see material differences in Neuroradiology interpretations done by Sub-Specialists vs. Generalists?
▸ Analyzed 232 patients over 17-months
▸ Compared primary and secondary report findings, length of report and suggestions for additional investigations
▸ Reports of some patients differ substantially between generalists and sub-specialists.
▸ Optimal management of neurological patients may require timely access to appropriate sub-specialist.
Study by Altnagelvin Neurological Centre, Londonderry and Dept. of Epidemiology and Public Health, Queen’s University

18. Inadequate Answers for Traditional Models
▸ Decreasing availability and inadequate coverage
from traditional radiology groups
▸ Poor performance of typical virtual radiology, off-
shoring, and teleradiology “hybrid” companies.
▸ Traditional models serve up convoluted and
disconnected offerings, making matters more
complex, and exposing numerous potential points of
failure.
▸ Hospital require a far better answer to this
challenge that is local in nature, yet possesses
deep, innovative leverage to drastically reduce
costs.

19. Get Out of the Basement
▸ Move from traditional “basement” role into
the boardroom where knowledge base and
understanding can be utilized in real-time. Patient
Care
▸ Radiology groups must become
strategically aligned and far more
Gs & Os
interactive to support the following:
▹ Unique service line initiatives
▹ Large capital expenditures,
Operations
▹ Enterprise projects
▹ Competitive differentiation
▹ Overall performance improvement Strategically“Basement” Radiology
Aligned
Traditional
Foundation
Radiology
▸ Radiology groups will need a broad base Specialization 24/7 Automation Virtualization Leadership
of knowledge on which to draw in order to
properly fulfill this new role.

20. Automated High-Value Exchange
▸ Replace traditional “report and forget” mentalities
with a proactive, high-value interchange with
referring physicians
▸ Develop and implement automated software and
processes that help radiologists with the interaction
required for high quality results
▸ Support via new software and staffing
assistance/extenders for pre-
reads, prioritization, routing, and managing multiple
legal entities – similar to how PACS replaced film
hanging protocols and prior study availability.
▸ Discover critical clinical exchange time for
radiologists be more efficient to effective manage
and reduce unused capacity

21. New Methods, Configurations and Software
▸ New methods must be developed to provide the expertise necessary to quickly turn
around final results
▹ Identifying the best available radiologist with the right sub-specialization, modality or special
procedure know-how
▹ Providing centralized and virtualized expertise
▹ Availability of a team of radiologists spread across multiple sites for appropriate scale
▸ Radiology groups will have to become larger, smarter and far more automated.
▸ Clinical and workflow tools will have to be more advanced.
▸ Staffing cannot simply be placed off-site
▹ Employed blended configuration, automation, clinical tools and referring physician interaction
software
▹ Location of a radiologist becomes less relevant than the clinical expertise and availability
▸ Reporting and service levels for monitoring and measuring
▸ Quality systems will not be a separate function but will take on all the characteristics of a
service delivered like that seen in other industries.

22. For more information or to contact us call 205-807-2999.
Visit us www.foundationradiologygroup.com or follow us on Twitter @foundationrad