Creating a Community Radiology Division: An Academic Radiology Department’s 3-Year Experience

Abstract

PROBLEMThe US health care system is evolving rapidly with an emphasis on value-based care and management of populations. There is an increased expectation for improved patient outcome and service. As a response to these changes, academic health care systems are seeking care coordination and system integration. For radiology practices, this evolution has resulted in mergers and partnerships between traditional academic radiology departments and community practices [1][2][3][4].In 2014, a large academic radiology department in the Southeastern United States integrated an existing community practice into a new Division of Community Radiology. The division was created to meet both the inpatient and outpatient imaging needs of a large neighboring city. This brief communication describes our experience as one example of an academic radiology department's effort to develop an effective community radiology strategy.Our health system had previously purchased a community hospital in a large neighboring city. The acquisition was part of a health system strategic plan to expand services in the city's rapidly growing health care market [5]. Starting in the mid-2000s, the health system began to transition the 186-bed community hospital from community medicine to subspecialty medicine with a focus on oncology, neuroscience, and orthopedics.The community hospital was historically served by a six-member, hospital-based radiology practice. As the hospital moved to more subspecialized care over the ensuing years, however, the legacy group had difficulty providing sufficiently subspecialized imaging interpretations. For example, oncologists demanded disease-focused staging information. With the opening of a stroke center, neurosurgeons required increased neuroradiology expertise and availability. Breast surgeons insisted on fellowship-trained breast imagers for consultations.In interventional radiology, the existing radiology practice could not meet the hospital's need for coverage and expanded services. Because of the lack of 24-7 interventional coverage, the hospital was forced to limit interhospital transfers of patients with bowel hemorrhage. Urologists were reluctant to perform partial nephrectomies without interventional radiology backup. New oncologists demanded increasingly complex biopsies and new therapeutic interventions.There was also a health system need for an ambulatory radiology strategy and presence. To compete in the neighboring city's market, the health system's strategic plan called for a rapid outpatient expansion with dozens of new primary care and specialty providers located within multiple new distributed facilities. This provider growth would necessitate a concomitant substantial expansion of outpatient imaging services.Our academic radiology department has long been committed to its missions of teaching and research, but it has not historically been focused on clinical growth in the surrounding communities. The shifting health system goals and local inpatient clinical pressures made it clear that the acade...