Revenue, Referrals, Ingenuity

While the U.S. and world economies have us distracted, concerned and pensive these days, the business priorities of healthcare imaging and IT leaders in 2008 are clear—patients, efficiency and building revenue are top of mind. The Top 5 business priorities this year are patient satisfaction, improving productivity and workflow, improving patient care, dealing with decreases in reimbursement and creating new revenue sources, according to the 661 respondents of this year’s Top Trends survey, our 5th annual dive into the market complexion. In addition to business priorities, this year we’re taking a closer look at healthcare facilities’ needs in IT infrastructure, clinical IT and clinical imaging systems. Topping the buying list for 2008 are data storage, radiology information systems, ultrasound units and speech recognition software. Facilities tell us the best strategy for increasing revenue is buying new technology to differentiate and attract new business, doing more marketing and adding new service lines. To meet our many requests for a peer-to-peer view on trends, we’ve also sliced the data based on facility types—such as community hospitals, academic medical centers, multi-hospital groups/IDNs and imaging centers. See how you compare—and how you can top the competition.

There is good news when it comes to healthcare facility revenue. Despite the uncertainty and flux of the U.S. economy, most healthcare facilities tell us their revenues are up from last year (46 percent) or flat (31 percent). Only 23 percent are reporting a dip in revenues. Typical revenue growth is ranging from 5 to 10 percent (44 percent), to less than 5 percent (29 percent). About 15 percent are seeing growth in the range of 10 to 15 percent. So why are revenues increasing? Facilities are buying new technology to attract new business, doing more marketing and adding new service lines.

For facilities seeing a revenue decline, the dips are small, for the most part. Decreases are most often in the 5 to 10 percent range (43 percent), followed by a decrease of less than 5 percent (21 percent), decrease of 10 to 15 percent (16 percent) and 15 to 20 percent (11 percent). To offset the declines, facilities tell us they are delaying technology purchases (13 percent), holding off filling vacant positions (12 percent), reducing staff (11 percent), trying to work more efficiently by investing in technology designed to increase productivity and efficiency (9 percent) and freezing investment and expansion (7 percent).

The fiercest competition is coming from freestanding imaging centers (46 percent), local general hospitals (35 percent), physician group practices (30 percent) and specialty hospitals (11 percent).

Budget watch: IT Infrastructure
 

IT budgets are solid, with 60 percent of healthcare facility executives and leaders showing increases in IT infrastructure spending in 2008. Most often, the increase is 5 to 10 percent (16 percent), 11 to 15 percent (12 percent) or 15 percent to 20 percent (8 percent). About 31 percent of the survey base is spending the same on IT as last year. Only 9 percent are experiencing any budget decrease, with 6 percent saying it is less than 15 percent.

Why are facilities increasing IT investment? A need to upgrade IT infrastructure tops the investment list, followed by increasing data storage, overall need for IT systems and technology, the additional of new clinical service lines and new facilities and the need to update and renovate existing facilities. Decreases in IT budgets are most often happening in facilities seeing overall budget decreases.


Budget watch: Clinical IT Systems
 

Healthcare facilities need new systems and upgrades to boost their clinical IT capabilities, with budgets on the rise, according to 54 percent of respondents. Typical budget increases are most often 5 to 10 percent (13 percent), less than 5 percent (10 percent), 10 to 15 percent (9 percent) and 15 to 20 percent (8 percent). About 41 percent of survey respondents have the same to spend as last year, again showing that IT is a much-needed investment among healthcare facilities. Only 3 percent of the survey base is seeing even a slight (<10 percent) decrease at all in their clinical IT systems budget.

Upgrading IT infrastructure, like IT spending, is the No. 1 reason to spend in 2008. A close second is the need to add or improve remote access to reports and images, followed by overall growth in systems and technology, improving their competitive advantage via IT efficiencies and the need to support a new clinical service line with IT. Decreases in IT budgets are only happening in facilities seeing overall budget decreases.

When it comes to replacing PACS, the odds are very much against going with the same vendor, no matter if you’re choosing a system for radiology, cardiology, orthopedics, nuclear medicine or ED. Only 1 to 4 percent are opting to stay with their current vendor if they are replacing PACS.

Speech recognition is the No. 1 investment this year for technologies that enhance imaging and image reading—followed by advanced visualization, CPOE, decision-support software and CAD. In advanced visualization, 3D software is the most popular technology, followed by CT, cardiac viewing and function, calcium scoring and image fusion. In CAD, mammography is still king with 25 percent of respondents investing. But breast MRI interest is building, with 21 percent of respondents saying they’ll invest in the technology this year, followed by lung CAD (10 percent), colon (8 percent), ultrasound (7 percent) and breast ultrasound (7 percent).
 

Budget watch: Imaging Systems
 

More than half of respondents (52 percent) have increased spending on imaging equipment. Budgets remain unchanged for 39 percent of facilities, while 8 percent are decreasing, (albeit slightly, 5 percent is less than 10 percent). Overall growth in systems and technology is the top reason for more and continued investment, followed by adding new facilities and new clinical service lines as well as updating and renovating existing facilities. When imaging purchases are on the decline, either overall budget decreases (4 percent) or deteriorating financial conditions (3 percent) are to blame.

Ultrasound is the No. 1 imaging technology in which facilities are investing in 2008. Applications are very evenly matched, with 15 percent of respondents each choosing portable, ob/gyn, echocardiography, 4D and 3D applications. Surgery represents about 6 percent of the new installs or replacements.

CT is No. 2, with 32 percent of respondents opting for 64-slice systems. About 8 percent are choosing 128-slice systems, 7 percent are opting for 320-slice and 7 percent still see 16-slice as the best option. The radiology department sees the majority of CT installs (43 percent), followed by the emergency department (12 percent) and cardiology (10 percent). Surgery sees about 2 percent of CT installs, with other areas making up the 2 percent balance.

Digital mammography, last year’s top technology buy, is No. 3 this year, followed by MRI. When adding or replacing MRI, 1.5T technology is king with a quarter of installs—but 3T is the choice of 19 percent of respondents. MR-based breast imaging is really gaining steam, too. It is the top clinical area facilities are focusing on with MRI (33 percent) this year. Neurology (21 percent) is next, followed by cardiac (20 percent), orthopedics (16 percent) and musculoskeletal (16 percent).

Bread-and-butter imaging with CR is No. 5. Multi-plate CR options are most popular, being the choice for 21 percent of respondents, followed by mammography (11 percent), single plate (10 percent) and long bone (6 percent). DR is close behind at No. 6. Buying a new DR system is the choice about three quarters of the time vs. retrofitting systems which is the option for a quarter of the market.

PET/CT is rising in popularity at No. 7 on the clinical imaging systems need-to-buy list—last year it didn’t make the Top 10. When buying PET/CT, 64-slice is the choice 46 percent of the time, followed by 16-slice (29 percent) and 32-slice (10 percent). Oncology is still PET/CT’s top application (25 percent), followed by cardiology (9 percent), neurology (6 percent) and infection imaging (4 percent).


New service lines
 

When it comes to increasing clinical service lines, cardiology comes out tops—with 22 percent of facilities saying they will add cardiology to their offerings. Women’s health is running a close second, with 21 percent of respondents telling us they plan to add this to their portfolio. A new outpatient center is the focus for about 13 percent of facilities. The placings were identical in 2007’s survey.


How to build business
 

To drive business, the focus is always on referring physicians. More than half (53 percent) of survey respondents see adding or providing remote access to clinical images and information as the No. 1 reason to gain physician mindshare and referrals. (Note: respondents could choose multiple answers.) That goes hand in hand with just about half (49 percent) who rank improving report/image turn-around time as the next most important way to earn referrals. Adding or providing access to the EMR is a priority for 31 percent of respondents. To make contact with physicians and their key office staff, about 38 percent of imaging facilities and departments are sending out marketing reps to discuss with doctors and educate them on services offered. Other means to increasing business include providing new services and subspecialty services (33 percent), forming partnerships with physician groups (33 percent), holding educational meetings and seminars (27 percent), creating alliances with local hospitals (24 percent) and adding remote, mobile and outreach clinical services (20 percent). About 20 percent of facilities send their physicians to interface peer to peer with physicians, surgeons and specialists.

Customer and patient web sites, respondents tell us, are the best way to market imaging services (36 percent), followed by newspaper or magazine ads to consumers (30 percent), radio and TV ads. Almost a quarter do direct mail campaigns to consumers and referring physicians (23 percent each) to generate business. A quarter have physicians helping to market to physicians.
 

Hiring: Staff You Need
 

When it comes to hiring FTEs over the next year, 41 percent of respondents project an increase in staffing, while 50 percent project no change. Only 9 percent expect a decrease in FTEs. Few facilities look to change their current levels of temporary (64 percent) and outsourced staff (67 percent). Increases in temporary staff positions are expected by 16 percent of respondents vs. 12 percent for outsourced professionals. Look for a 22 percent decrease in outsourced staff, while temp staff will decrease in about 20 percent of facilities. 

So where will we see hiring? Physicians top the need list, followed by nurses, IT professionals, technologists, clerical support, physicians assistants, marketing, administrative staff and physicists.


Extending Operating Hours
 

To boost revenue, about 29 percent of respondents tell us they are extending imaging hours during the week, while 23 percent are offering extended weekend hours. About 7 percent are extending operating hours by using remote reading and outsourced clinical services. About 60 percent don’t see a need to extend operating hours.