Nowadays, everything comes down to the bottom line. Managers are expected to do more with less, and making ends meet can be challenging. However, many techniques can be implemented to generate savings in a radiology department; some can be used hospital wide. Strategies that have proven successful include providing an incentive program for employees to suggest money-saving ideas, using cost-efficient equipment, using a hospital-wide computer system, and effectively employing staff. By implementing these strategies, directors of radiology will be in a better position to meet their budgetary goals-and even exceed them.

What's the Incentive?
One way to generate savings in a radiology department is to entice employees to provide money-saving suggestions. Jerry Fosselman, COO of the diagnostic division at Radiological Associates of Sacramento (RAS of Sacramento, Calif), says its Ideas at Work program allows employees to submit cost savings, revenue-generating ideas, or both to a committee that reviews the project's financial impact. If the idea is approved, the employee is awarded 10% of accumulated net savings or gains for 1 year from the date of implementation. The award is limited to $25,000.

Darren Daigle, RT(R), director of medical imaging of Charlotte Regional Medical Center (CRMC of Punta Gorda, Fla), says that although CRMC doesn't offer an incentive program, he believes components of a successful program should be to offer employee recognition, monetary rewards, and "pomp and circumstance"-similar to the military rewarding medals.

When employees feel they have a stake in the profits, they will make a conscious effort to save money, according to Deborah Manner, RVT, RDMS, RT(R), manager of the Northern Ohio Regional Imaging Center (Sandusky, Ohio). "Unfortunately, I think many employees believe that if it doesn't directly benefit them, they don't care," she says. Her facility's parent company, Northern Ohio Medical Specialists, offers a profit-sharing plan. A standard contribution is made to the employee's 401(k) plan; an additional contribution is based on annual earnings.

Any Ideas?
Employees experience operations firsthand and are, therefore, in an ideal position to determine methods to generate savings.

For example, RAS uses locum tenens for technologists who are hired on a daily basis to temporarily fill vacancies, explains Fosselman, who notes that the outpatient imaging practice has 18 diagnostic and nuclear medicine imaging locations. The facility paid an agency an all-inclusive rate of $75 per hour, which paid for the technologist, air travel, rental car, and apartment. An employee proposed paying the agency the technologist's rate only and to contract directly for the apartment and rental car. As a result, RAS reduced its imputed rate to $68 per hour, which amounts to annual savings of $14,560 per tech. After 8 months, the idea has saved RAS approximately $40,000.

Daigle says an employee suggested monitoring supply use to ensure that charges are posted on patient accounts. "There is a fine line between saving money and making more money," he says. "We concentrate on both. One can be successful without the other, but when both are in place, you have the highest chance of success."

Manner says an employee proposed scheduling "low time." Each employee could take off 2 hours per week (ie, 4 hours per pay period, without pay or as accrued time). Most employees took the time without pay and viewed it as extra time. "This was dependent on volume, but we could plan for it and adjust the schedule accordingly," Manner explains.

Cash-Conscious Commodities
Another way to reduce expenses is to use cost-efficient products. CRMC, which has 160 beds, is installing GE Healthcare's (Waukesha, Wis) Centricity PACS, a computer- and software-driven filmless system. Although the system cost approximately $1 million, Daigle says that, as with other PACS users in the industry, the facility saves money by not buying film and chemicals. He notes that PACS allows users to perform studies and send reports to physicians in minutes rather than hours, saving time and, therefore, money. Additionally, the system allows radiologists to view images from anywhere in the world via a computer with Internet access.

Peggy L. Anderson-Young, RT(R)(QM), is radiology manager of West Omaha Sports Medicine & Orthopedic Surgery PC (Omaha, Neb) and the ASRT Region 5 Management Chapter Delegate. Her facility also uses products to generate savings, specifically film sold under a generic label by a local distributor but produced by Eastman Kodak Co (Rochester, NY). As a result, film costs decreased 40%.

Corliss Panis, RT, director of radiology of Children's Mercy Hospital (Kansas City, Mo), says using the PACS system from Healthline (Davidson, NC) and DR saves money and time and is more efficient. "You save money by not having to print film; however, you spend the savings on hardware and software," she notes.

Panis uses Siemens Medical Solutions' (Malvern, Pa) DR rooms, which don't require cassettes, and uses Fujifilm Medical Systems' (Stamford, Conn) CR. The department plans to update its existing PACS to a Fuji system.

"These are huge, up-front expenses to gain savings not only for the radiology department but also for the entire institution. Ultimately, it will improve patient care," Panis explains.

Performing an exam requires less time with DR, Panis adds. The patient is brought into the X-ray room and positioned for an image. An exposure is made, and the image is available for immediate viewing. With film processing and CR, technologists still use cassettes and process images. By having the image immediately available, the patient care process is expedited.

DR is also more efficient because films can't be lost. "We no longer worry about waiting for a lost film in surgery to return to the department to be read," Panis says. "We used to spend hours, days, and weeks trying to locate films." When a patient or physician needs a copy of a film, the department simply prints it out on film or burns it to a CD.

Northern Ohio Regional Imaging Center is a fully digital outpatient center. When patients are referred and need to take films with them, the cost to print studies quickly increases. The center purchased a Perfect Image Amigo II CD burner from Rimage Corp (Minneapolis) and now burns the majority of studies on a disc, Manner says, cutting costs from approximately $8.05 to $1.32 to print a study. An added bonus is that physicians can manipulate images.

Pete McCabe, general manager of performance solutions of GE Healthcare, says the average radiology department runs at 50% to 65% of its potential from a revenue standpoint. To achieve 100%, GE Healthcare provides extended training for its customers. "Most companies sell a product, provide training for 10 days, and then leave," he says. Most employees retain 30% of that information and forget many functions.

By offering the Tip Virtual Assistant, GE Healthcare can connect to a customer's equipment and virtually run it. The company also offers monthly training to ensure that employees are using equipment capabilities to their fullest. To increase efficiency, McCabe says a company must drive demand and increase throughput, clinical efficiency, and billing and processing.

Spending Makes Sense
Sometimes, spending a significant amount of cash up front pays off in the end. RAS has three full-field digital mammography (FFDM) units. The FFDM improves technologist productivity throughput by 15–18 exams per day, Fosselman says. Other benefits are increased reimbursement for FFDM.

Also, installing equipment (eg, dual-energy X-ray absorptiometry and MRI) in private offices generates income that would otherwise be sent to other facilities, notes Anderson-Young.

Manner says purchasing an expensive CD burner was cost efficient. "The cost analysis showed that with the number of studies we printed, we would break even in less than 9 months," she says, adding that it's a good public relations tool with patients and referring physicians. Ordering physicians then have the ability to look at the images on the CD and manipulate them in the same ways that radiologists can. Physicians can magnify or change the contrast or density to enhance an area of concern. This way, if the patient indicates an area of concern that the radiologist didn't comment on, it gives the ordering physician control to look at that specific area. For patients, having the ability to view images on their own computers is good public relations, as patients have the same capabilities to view images; most people like this option and find the images interesting.

Turning to Technology
Like cost-efficient equipment, computer systems also can reduce expenses. Fosselman says his facility's radiology information system (RIS) allows centralizing of scheduling and transcription staff, which provides a personnel cost savings. Another benefit of the RIS is the ability to schedule patients by exam room availability rather than by imaging site.

Both the hospital information system (HIS) and RIS improve efficiencies and, therefore, decrease expenditures, Panis says, enabling multiple care providers to review information anytime, anywhere.

One of the reasons a computer system cuts costs is because it saves time, Manner says. Hours for patient entry, order, and report searches accrue in the long run. A good computer program is invaluable to run reports for administration purposes. "Compiling reports manually is time-consuming and inconsistent," she says. "When you count hundreds of procedures and divide them into multiple categories, it's difficult to be exact no matter how careful you are."

David Smith, FACMPE, administrator at Radiology and Nuclear Medicine (Topeka, Kan), a radiology practice with two freestanding imaging centers, uses the computer system to electronically distribute most reports. This process has resulted in reduced printing and handling costs as well as improved report turnaround.

Most Valuable Asset
Retaining employees reduces expenses in multiple ways. Each time a technologist is replaced, the new employee must be trained. Costs, from advertising to hours spent interviewing potential technologists, accumulate. In addition to funds spent searching for a replacement, the loss continues for the first weeks of employment. Each new person has a learning curve, Manner says. Until a technologist is established, he/she works at a slower pace.

Because Northern Ohio Regional Imaging Center is a small outpatient center with 15 employees, Manner takes a personal approach with staff and aims to be flexible with work hours. One staff member takes her lunch later to pick up children after school. Another staffer travels on weekends, so Manner allows the staffer to switch her day off to permit longer weekends.

The building has a private patio with a picnic table and grill. "We cook out at least once a week, and everyone brings in food," says Manner, who loves to cook. She frequently brings in treats for staff members, makes their favorite desserts for their birthdays, and lets them choose the lunch menu.

"All of these things combine to make a fun workplace," Manner says. "We have our share of stressful situations, but overall, when you know the person working next to you and you like them, you respect them more."

Like Manner, Smith says a team creates a fun work environment with lots of small celebrations that don't require much time or money. "We also try to meet employees' continuing education needs by providing as much on-site training as possible and facilitating off-site training as needed," she adds.

RAS performs annual regional salary surveys to determine if it offers competitive compensation. When RAS drops below the median compensation for the region, Fosselman says it implements a market adjustment.

The company's most limited employee resource is technologists, Fosselman says. When it loses technologists, it takes up to 6 months to fill positions. In most cases, they are replaced with locum tenens, the annual cost of which is $141,000, compared to $80,000 for an FTE. "So by retaining technologists, we save additional costs of temporary techs," he concludes. The other benefit of retaining employees is avoiding recruiting and training costs. RAS has determined that the cost for recruiting one technologist can run as high as $10,000 and that it costs $15,000 to train an MRI/CT tech.

To retain qualified personnel, Panis says Children's Mercy Hospital provides career ladders, cross training, continuing education, and committee involvement. Retaining employees saves money because employees aren't continuously in orientation, expensive temporary agency employees aren't needed, and existing employees don't have to be paid overtime to cover openings. "When you continually use existing staff to cover holes in the schedule because of turnover, you take the chance of losing staff. You'll never get ahead that way," she says.

Jennifer Volland, RN, BSN, MBE, Six Sigma Master Black Belt, of the Nebraska Medical Center (Omaha, Neb), says that her facility's interventional radiology department examined job responsibilities through a Six Sigma project-a methodology that provides businesses with the tools to improve the capability of their business processes. By changing the room coordination role from a nurse to a tech, the nurse scheduler was able to focus on scheduling and the technologist to focus on patient flow through rooms to efficiently use different equipment. The result was increased employee satisfaction, improved patient throughput, and less overtime hours.

Volland says Six Sigma at her center has focused not only on quality and patient safety, but also on how to make jobs better for staff. Empowering project teams to address issues in their areas through rigorous methodology of Six Sigma has given staff more participation in decision-making. With process improvements in the interventional radiology department, vacant positions were filled. This resulted in less employee turnover and more staff for accommodating patients.

The Crisscross Effect
Increase an employee's value with cross training, as employees can fill in for absentees, avoiding extra expenditures to obtain personnel to operate sophisticated equipment.

Anderson-Young says that her facility, an orthopedic surgery clinic, trains technologists in general office operations and basic nursing skills. Technologists can assist in other areas, thus avoiding canceled appointments and decreasing office hours when employees are absent.

Fosselman says all MRI/CT techs are cross trained because its imaging centers offer both modalities. This tactic provides flexibility in staffing centers as well as related cost savings.

Panis' 241-bed hospital also cross trains for constant CT coverage, decreasing the number of callbacks. Also, it's a requirement for a Level 1 trauma center, as determined by the state of Missouri.

At the Northern Ohio Regional Imaging Center, each technologist is cross trained in at least two areas and able to work the front desk when necessary, Manner notes. This provides backup in a tech's absence. Two full-time techs choose to work 32 hours; those hours can be increased when necessary with minimal overtime expense.

Smith says the majority of technologists at his facility are trained to work in multiple modalities, and the majority of clerical staff is trained to assist technologists with clinical functions.

Karen Appold is a contributing writer for Medical Imaging.