CHICAGO — We've all heard of hospitals forming tighter bonds with physician groups or skilled nursing facilities to improve each patient's care coordination. But what about radiology practices? Can such specialists play just as key of a role in transforming health care as any other member of the team?

For leaders at 800-bed Aultman Hospital in Canton, Ohio, the answer was a resounding "yes." About three years ago, the nonprofit, which also owns a health plan and college, was facing many challenges similar to those of the rest of the field, among them intensifying competition, tightening financial pressures and care shifting to lower-cost settings. Too, Aultman was seeing unprecedented changes in imaging, with both declining use and reimbursement, CEO Christopher Remark told attendees at the Radiological Society of North America 2014 annual meeting Wednesday.

For decades, Aultman shared your typical vendor-customer relationship with its outside radiological practice — stuck in separate silos, uncommunicative and sorely lacking trust, communication or transparency. So, when its contract with Radiology Associates of Canton came up for renewal a few years ago, the two sides saw a chance to shake things up.
"When you summed it all up, it didn't look really good, from our standpoint, from an imaging standpoint," Remark said, later adding, "We really felt that we had an opportunity to do something different because it was right in the heat of [health care reform]."

The two sides retreated to their own corners and made a list of priorities, later convening to write their ideas on a whiteboard and develop a shared vision. What emerged was an agreement to co-manage the radiological service line, with shared governance and goals, tied to growing their outpatient market share, instituting patient-centered imaging services and preparing for new payment models coming down the pike. Plus, Aultman and Radiology Associates aligned around a set of incentives tied to quality, patient satisfaction and efficiency. Volume wasn't the focus, and the money side wasn't discussed until the back end of the process, Remark added.

The hospital and its partner hit most marks in 2013, the first year of the contract, even "blowing some out of the water," such as dropping the turnaround time for an MRI brain observation report from 24 hours down to two. Beyond the metrics, the agreement has helped the hospital to bolster employee and physician satisfaction while also growing market presence and strengthening patient care. They're pursuing further, more ambitious gains in the second year: improving core measure rates, increasing the appropriate removal of inferior vena cava filters, and standardizing protocols across all modalities, among other targets.

"This is the beauty of co-management because we were talking strategically, and as a hospital we were behind in these areas," Remark said. "It was neat to forge a relationship between the cardiologists and radiologists to really make this happen."

Radiology Associates of Canton, which works with two other hospitals, now is looking to expand the same model to other sites, said CEO Syed Furqan Zaidi, M.D. As was the case with Aultman Hospital, doing so is going to require ambitious leadership in any potential partner.

"This would not have happened without a visionary CEO of the hospital, like Chris Remark," he said. "His level of commitment to this process is what allowed this to happen."