Operating a successful IR practice in today’s dynamic health care environment requires new strategies to bring value to a diverse set of stakeholders. Regulators, payers, health systems and patients, coming from different angles, have effectively reorganized the priorities of health care delivery. While maintaining a focus on high-quality patient care is still the top priority, greater emphasis is being given to more efficient access, enhancement of patient experience, and documented proof of high-quality outcomes—all at reduced cost.
One practice taking advantage of such innovations is Chicago-based Vascular and Interventional Radiology, or VIR Chicago, for short. As its name implies, the group’s eight physicians and four physician assistants are an independent group who practice vascular and interventional radiology exclusively and have successfully transitioned from a primarily inpatient service to an outpatient one.
According to Francis R. Facchini, MD, FSIR, the dual focus on developing both the clinical and business aspects of the practice has contributed to VIR’s success for nearly a decade. Recently, IR Quarterly spoke with physician practice co-leaders Dr. Facchini (whose area of interest is interventional oncology), Luke E. Sewall, MD (whose focus is on endovascular IR), and Beth Cummings, MBA, CMPE, CCRA, director of VIR, about how VIR Chicago has adapted to the changing health care landscape and what the future holds for the specialty.
What makes Vascular and Interventional Radiology (VIR) Chicago successful?
We are embracing the rapid changes occurring in the health care industry as it transitions from a business-tobusiness model to a consumer-oriented one. For example, we now provide 24/7 consultative services and have adopted a longitudinal care model, both of which have been instrumental in the development of a successful practice, in the hospital and out in the community. By being better able to engage with patients, families and the multidisciplinary care team throughout a course of care—ranging from weeks to years—we can open up a dialogue, build trust, enhance our reputation and boost our opportunities to collaborate with others seeking options for patients.
Adopting a longitudinal care model also has caused an increase in volume, prompting a need for increased scale and an investment in practice infrastructure. We have centralized our practice management functions, added physicians, physician assistants, and practice sites, improved our technology and Internet presence, and hired operational specialists to improve our reach in and service to the community.
We also made the decision to switch from a general IR practice to subspecialized IR practice, which has opened a lot of doors for us. As a result, we have become less of a commodity and are providing more diversified services. This has secured referrals from inside of our primary and secondary areas and made referrals from outside these areas more common.
How have these changes impacted patients?
These investments have helped improve both practice quality and the patient experience. The larger group of VIR Chicago physicians practicing full-time IR has fostered physician sub-specialization and clinical research participation, expanding treatment options, and enhancing our technical expertise and value as consulting physicians in the areas of cancer, spinal fractures, peripheral arterial disease, uterine fibroids, varicose veins, and portal hypertension. Engaging, educating, and advocating for patients has become a large part of what we do and is enriched by our passion for our sub-specialties.
Equally important, VIR Chicago’s enhanced infrastructure allows us to care for the sickest and costliest of patients, both in the hospital and in the community, providing opportunities for cost reduction and quality care close to home. VIR Chicago’s full-time presence in six hospitals and 24/7 call coverage facilitates timely inpatient treatment for liver and kidney obstruction, pulmonary embolism, DVT and vascular emergencies, helping community health systems manage care efficiently in-house with minimal transfers out. In addition, our three outpatient clinics are staffed with physicians and physician assistants to provide convenient, ongoing patient care and a cost-saving alternative to the emergency room.
Specialty outpatient medical care can be disjointed and confusing for consumers. By leveraging the centralized support services, our outpatient clinics can provide patients from a larger geographic area with a single point of contact for call-center enhanced nurse triage services, schedulers and insurance specialists to help coordinate care. Also, we are developing customized patient financial services to help meet patients’ needs for transparency in pricing and better-informed decision-making for their health care.
What innovations have you made to keep VIR on the leading edge?
Over the years, we have instituted a number of changes that have transformed the practice completely. We like to think of it as moving from “VIR 1.0” to “VIR 2.0”—going from a traditional IR practice model to one that is more interactive, collaborative and beneficial to patients and collaborating physicians. In VIR 2.0, our specialists are able to engage with patients along the continuum of care, consulting with them and other providers, collaborating about treatments, and providing follow-up care and communications. We know we are not alone in adopting this practice model, but it has been instrumental to our success. By being actively involved in patient care committees, on the floor in the hospitals and clinics, and participating in the decision-making process, we have become a more accessible, relationship-based practice. We are able to help people solve their clinical problems and are no longer just order-takers. More important, referring physicians have grown to trust our decision-making and our commitment to care beyond the procedure.
Changes we have made to accommodate this new model include moving a number of key employees from part time to full time, establishing uniform practice protocols, and upgrading our technical and business infrastructure in order to implement and support care across the continuum.
Also, the decision to switch from a general IR practice to subspecialized IR practice was a game-changer for us. We transitioned from being referred patients to being a referrer. Using a football analogy, it’s like switching from playing wide-receiver to starting quarterback. And by offering defined subspecialties, we are able to market to physicians and patients. Promoting along service lines—for instance, advertising our varicose vein, UFE or varicocele treatments in print and online—allows us to reach out to a specific and defined patient population in a way that’s understandable to all.
What has made the biggest difference?
Centralizing our business infrastructure has been critically important, providing economies of scale, greater efficiency, reducing variability in care and allowing us to cover more geography. With all of our supportive processes concentrated in one unit, we can think beyond the clinical practice model and design tools and business processes tailored to providing full-time IR care for the long haul. It allows us to scale up, develop and share best practices, and ultimately reach and treat more patients.
It is a combination of factors, really—the changes made to all of the people, processes, technology and training required to engage patients and referring physicians from consultation to treatment (procedural or not) to follow-up—that has allowed us to deliver value beyond the inpatient setting. It has been not what we do, as much as how we do it that has made the difference so far.
What does the future hold for VIR Chicago?
Interventional radiology, as a specialty highly regarded for its technical innovation, will need to continue to innovate in new ways. Future success will require effectiveness beyond the procedure table—at the board room table, at the dinner table and at the conference table—and with a healthy respect for the timetable of change within the industry and for care delivery. Advances in our practice will need to dovetail with changing payer and health system needs.
For us, the future of VIR Chicago—moving to VIR 3.0—requires continued excellence in consumer-focused, outpatient health care delivery, plus our internal push toward the mastery of the business of VIR Chicago. We must become masters of revenue cycle management, quality assessment, and reporting. To do this, we must generate and evaluate data and develop the systems and criteria in support of these efforts. This will allow us to identify and develop collaborative methods to reduce costs, improve outcomes, and deliver the value of VIR 3.0—clinically and financially—to a broader audience on a larger scale. When we get there, VIR 3.0 will be a solid business that is good for IR and great for patients.
