Centricity* RIS/PACS-IW Solution: A Platform for GrowthClarus Imaging Case Study February 2011

Centricity* RIS/PACS-IW Solution: A Platform for GrowthClarus Imaging Case Study

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Just two-and-a-half years after installing an integrated, web-based Centricity RIS/PACS-IW Solution, Clarus Imaging has seen a 25 percent increase in volume at its three imaging centers in and around Houston, Texas.

That is the largest of many positive effects from the new system, which is enabling Clarus to maximize its potential as an imaging business.

Scheduling is more precise. Billing accuracy has improved. Claims denials and average days in accounts receivable are down. Workflow is more efficient. The system provides a centralized image archive and a single web-based reading location for the firm’s radiologists, all of whom work off-site. It also has a positive impact on report turnaround to meet the needs of the referring physicians that support Clarus Imaging. Centralized office functions facilitate management of the three locations and provide a platform for easy expansion (scalability) in the future.

“The return on our investment has been strong,” observes Kevin Herrington, Senior Regional Vice President with Altus Health Management Services, parent company of Clarus Imaging. “Qualitatively, having an integrated RIS/PACS makes us competitive with the other imaging centers in our area.”

“Financially speaking, greater efficiency means we are seeing more patients per day and earning more revenue without adding staff or increasing business hours. We’re capturing charges effectively and sending out clean claims, and so we’re being reimbursed fully and in a timely fashion.”

Clarus Imaging experiences positive impact from Centricity RIS/PACS-IW Solution

• 25 percent increase in volume at its three imaging centers by improving scheduling to reduce idle time, add more time slots and see more patients per day

• Accounts receivable went from 60 to 90 days to less than 30 days• 21 percent increase in collections from 2008 to 2009• Strengthened competitive positioning by offering images and reports via Internet

to referring physicians• Scheduling is more precise, billing is more accurate, claims denials and average days

in accounts receivable are down• Native billing system in the RIS/PACS-IW Solution has DRA/OPPS Logic billing, which

submits the highest reimbursable study first in sequence on multiple studies, maximizing the reimbursement rates

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Gearing for growth

Clarus operates imaging centers in Houston and nearby Beaumont and Baytown, each specializing in advanced MRI, CT and PET/CT diagnostics. The centers share space with surgery and sleep centers owned by Altus Healthcare as part of its multidisciplinary physician network in the Houston area, and is an official show & reference site for Centricity RIS/PACS-IW Solution.

When founded in 2004, Clarus Imaging had no PACS and used a surgery center software package as their information system. As the practice expanded, the need for a dedicated RIS and PACS became clear. Among other limitations, the scheduling module did not fit the needs of an imaging practice, special information needed in scheduling patients had to be recorded on paper, images had to be pushed manually from device consoles to the radiologists’ computers, and the charge capture and billing process required error-prone manual, paper-based steps.

“The key driver in pursuing RIS/PACS was to get our images archived and easily available to physicians in the community to be on a strong competitive footing with hospitals and imaging centers that were rolling out PACS at the time,” says Herrington.

Smooth transition

After an extensive year-long evaluation process, Clarus Imaging chose the Centricity RIS/PACS-IW Solution from GE Healthcare. This integrated, web-based system is designed to help ambulatory imaging businesses including outpatient imaging centers, complete the patient care cycle smoothly and reliably, follow established best practices, and enhance workflow and revenue cycle efficiencies.

The selection process involved mainly Herrington, Altus COO Kraig Killough, Altus Vice President and Administrative Director Sourabh Sanduja, and the imaging technologists.

The system was implemented in two phases, the PACS in two months ending in March 2008, and the RIS in July of that year. GE representatives served on the implementation team. GE led phone conferences and web meetings to prepare the staff for the process, then provided staff training on the system and sent specialists to the Clarus sites for several days to assist with go-live.

Boosting volume

More efficiency in the scheduling process has a direct correlation to throughput, and that is where the new system had its greatest impact. Previously, scheduling was inflexible and error-prone. An exam slotted for less time than actually needed could put the staff behind schedule for the rest of the day. Too long an exam slot meant wasted time. Schedulers now can access the database of physician, patient and insurance demographics already pre-populated into the system. That helps with consistency and accuracy in scheduling, which in turn has a direct correlation to billing.

Exams are CPT-coded in the RIS down to the specific location and scanner where it will be performed. So long as the scheduler selects the correct CPT code for an exam, the correct exam time is automatically assigned – guesswork is eliminated.

“If we enter into the RIS that an exam takes 45 minutes, we know that’s how long it takes and that’s how it gets scheduled,” notes Rebecca Bridwell, MR/CT Technologist and RIS/PACS Administrator. “It enables us to put patients on literally back-to-back appointments.”

That means idle staff and scanner time is nearly eliminated, Herrington observes. “Ten minutes here and 15 minutes there adds up by the end of the day,” he says. “By reducing idle time, we’re able to add more exam slots and see more patients per day. We have seen a 25 percent increase in volume because we’re able to schedule more accurately.”

“ I know intuitively that this is increasing revenue cycle efficiencies because we are capturing more of the CPT codes to charge to the patient or insurance company.”

Kevin Herrington Senior Regional Vice President

Altus Health Management Services

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Scheduling agility

Cancellations can be a huge burden to outpatient imaging businesses. At Clarus, the system helps the staff act nimbly in dealing with cancellations. Schedulers have easy access to contact information and call the day before exams to remind patients of appointments. If a patient calls and wants to postpone, the scheduler can easily see other available time slots and simply drag-and-drop to make the change.

In addition, technologists can more easily move patients around in the schedule in response to cancellations or no-shows. “With the old system, we would have to go find the patient’s chart, or ask scheduling to do so, and that would take time,” says Bridwell. “So if you wanted to move the next patient up in the schedule, it wasn’t possible because finding the chart and contacting the patient ate up the extra time you had.”

Now, with contact information at hand, it’s easy to reach the next patient and ask him or her to come right in, or ask end-of-day patients to come in early, creating later openings that schedulers can fill. “It definitely helps our schedule management,” Bridwell says.

Smoother scheduling also means less time spent on the phone with referring physician offices who regularly schedule appointments. “The less hassle it is to schedule a patient, the more likely a physician office will continue to refer people to us,” says Herrington.

Other benefits of the Centricity RIS/PACS-IW Solution include:

Physicians better served. More available time slots means referring physicians can have their patients scheduled sooner. The system automatically faxes reports to referring physicians as soon as they are transcribed and signed off by the radiologist. This helps Clarus Imaging meet referring physician expectations for timely reporting. Physicians can log onto the integrated RIS/PACS and review their patient’s current and historical images, as well as reports – a point of differentiation for Clarus in its market.

More accurate billing. The previous system included CPT codes for a large number of procedures, inviting selection errors. “Typically no one would catch those errors, and we would end up billing out inaccurately,” says Herrington. “Now we build into our database the CPT codes for only procedures we actually perform.”

More charges captured. The billing system in the RIS/PACS-IW Solution has DRA/OPPS Logic billing, which submits the highest reimbursable study first in sequence on multiple studies, maximizing the reimbursement rates. The system electronically captures charges for all CPT codes required for a procedure, as well as additional billable items such as laboratory work and supplies. The technologist enters them to the system at the time of the exam instead of having to record them on paper for later manual entry in the back office. “I know intuitively that this is increasing revenue cycle efficiencies because we are capturing more of the CPT codes to charge to the patient or insurance company,” Herrington says.

Claims processed quickly. Accurate billing reduces claim denials, and accurate patient and insurance information, also captured in the system, has the same effect. “The computer system is a closed loop,” Herrington says. “Everything is electronic. All the information is as accurate as possible, and we don’t rely on one person on the back end, a day or two after an exam, to key in the information.” The system automatically sends completed claims to a clearinghouse where they are scrubbed before submittal to Medicare or private payers. Claims denied because of errors are easily corrected in the system and resubmitted.

“We’re being paid for procedures in the same month we bill them out.”

Kevin Herrington Senior Regional Vice President

Altus Health Management Services

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Revenue moved forward. “Days in accounts receivable have been significantly reduced, “ says Herrington. “We are billing out as soon as we have all the necessary claim information, and the insurance companies are paying us very quickly, because we’re sending clean bills, with no errors and no issues. We’re being paid for procedures in the same month we bill them out. Under the old system, we typically saw 60 to 90 days in accounts receivable. Now we’re pleasantly surprised at times to see less than 30 days.”

Patients served quickly. Patients in general get in and out quickly because scheduling is precise and because the system helps staff members track patients’ progress. “When patients arrive, the technologists know they are here and ready,” says Bridwell. “We’ve always been really conscious of patient wait time, and Centricity RIS/PACS-IW Solution has a tracking system built in. We know when we see certain symbols on screen that a patient has been waiting for an extended time and we need to see what is going on.”

Workflow streamlined. “Technologists like RIS and PACS integration,” says Bridwell. “If we need to look at a patient’s previous exam and sign on to the PACS, the RIS transfers the report over, so we don’t have to jump between systems to see a previous report. We can just stay in the PACS and manage the patient’s exam from there and pull up any previous reports we need. And because it’s web-based, I can manage studies from my home computer if I need to, instead of having to come in to take care of issues.”

Reports add value. The system can generate more than 100 standard reports to help the business and stay on track with short- and long-term goals. “The reports give us a really good understanding of our volumes for each procedure,” says Herrington. “I also like being able to run a report showing what we are being reimbursed for procedures on average, all the way down to the CPT code. If we find out, for example, that MRI of the brain is especially profitable, then we can step up our marketing to neurologists.” Reports also help managers track referral patterns, detect when referrals from a given physician or group are declining, and have a marketing representative make a call.

Looking to growHerrington sees Centricity RIS/PACS-IW Solution easily scaling up as Clarus Imaging adds more locations. “As we build more imaging centers, we’re going to use the same system and grow from it,” he says. “The centralized functions make it a natural basis for expansion.”

He advises organizations considering RIS/PACS to review and compare offerings carefully. “Be careful working with a vendor that hasn’t proven itself, even though the price may look appealing,” he says. “There could be hidden costs. And remember that buying and implementing a system is only part of the equation. Once you’re up and running, what kind of support will you have?”

“One of the strong points for the Centricity product is the ongoing support. Although GE is a large company, we have received personal service. It’s not a question of calling an 800 number and talking to someone in another country for technical support. We’re able to deal with people we’ve met before. We have their cell phone numbers, they’re available to us, and they have been highly responsive to our issues.”

Centricity RIS/PACS-IW Solution has provided Clarus Imaging a centralized business platform to improve performance in a wide range of critical areas, and to extend high-quality imaging services to more communities, more patients, and more referring physicians.

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