PARTNERSHIPS ENGAGING IN EXCELLENCE AND INNOVATION IN RADIOLOGY 2018-2019 - 5333 MCAULEY DRIVE SUITE 6016 P.O BOX 992 ANN ARBOR, MI 48106 - HURON ...
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5333 McAuley Drive
Suite 6016
BUILDING
PARTNERSHIPS
P.O Box 992
Ann Arbor, MI 48106
Phone: 734-712-8350
Engaging in excellence and innovation in radiology
Fax: 734-712-8351
URL: huronvalleyradiology.com
2018-2019
BUILDING PARTNERSHIPS 2018- 2019
LETTER FROM
MEET OUR ALLIED HEALTH PROFESSIONALS
Huron Valley Radiology (HVR) humbly presents our 2018-2019 report “Building Partnerships.”
We appreciate the opportunity to be in partnership with our hospital clients and the many excellent
physicians we work with every day on behalf of our patients. HVR’s patient-centered service model
focuses on enhancing subspecialized diagnostic and interventional radiological care through strong
collaboration with provider facilities and referring physicians. As private practice physicians, we are
committed to continuously improving the quality of care, the patient experience of care, and patient BARRY CRAWFORD, PA-C JILL HANNAH, NP EVO LEVI, PA-C
access to care.
Vascular and Interventional Vascular and Interventional Vascular and Interventional
At the same time, we are mindful of the need to contribute to reducing overall health-care expenditures.
HVR has the experience, resources, and dedication to work with our partners to meet the needs of a
rapidly evolving health care environment. Alignment and integration are essential to driving sustainable
change and delivering optimal outcomes. We invest in mentoring and fostering health-care provider
alliances to facilitate highly functional and cohesive teams. Our practice takes great pride in supporting
and positively influencing the hospitals and communities that we serve. We believe that this is the basis
of our success since HVR was founded almost 60 years ago.
A cornerstone of radiology service provision of the future will be ever-increasing subspecialized care.
At HVR, we are committed to ensuring that these subspecialized radiological services are available
where and when they are needed, and indeed have been providing benchmark-setting around-the-clock
subspecialized coverage for many years. Looking ahead, we intend to continue building on that service
model, making further improvements to quality, safety, and patient satisfaction by providing dedicated
leadership committed to optimizing operations, building collaboration, and reducing risk.
PHILIP MACBRIDE, PA-C DAVID MARTIN, PA-C HEATHER SCHWALL, PA-C
During the past five years, we have significantly strengthened our ability to measure and improve
Vascular and Interventional Vascular and Interventional Vascular and Interventional
performance through quality-specific infrastructure. As members of the national consortium of leading
private radiology practices, Strategic Radiology (SR), and its Patient Safety Organization (SR-PSO),
we view quality and patient safety through a national as well as local lens. Our collaboration with other
leading community-based private practices—nationally through SR—is a proactive, competitive stance
against the trend in national consolidated physician practice funded by private equity and venture
capital. We believe that physician-owned, community-based practice is in the best interest of our
patients and partners.
HVR has well-established infrastructure and resources
across a wide array of domains including clinical, THE HVR BOARD OF DIRECTORS
operational, quality, IT, and business. It is our privilege Dr. Eric Ferguson, President
to apply this expertise to develop customized solutions
Dr. Rami Kaakaji, Vice-President
that fulfill our partners’ evolving needs and support their
long-term strategic development. We hope you will take Dr. Robert Taila, Secretary
the time to review our efforts, described in these pages. Dr. Kevin Hannawa, Treasurer
Dr. Ramin Behjatnia
Dr. Jill Knapp
Dr. Spencer Koch
2 39
BUILDING PARTNERSHIPS 2018- 2019
TABLE OF
MEET OUR PHYSICIANS
LETTER FROM THE BOARD 2
ABOUT OUR PRACTICE 4
Community-based, Global Experience 4
Subspecialized Care 5
Investing in Expertise 6
HRIDAY SHAH, MD JAMES SHIRLEY, M.D. ROBERT TAILA, M.D.
Vascular and Interventional Musculoskeletal Body Imaging A HISTORY OF INNOVATION 10
Ultrasound Breast Care Services
A Collaborative Solution for Pediatric Patients 10
Emergency Radiology Image-Guided Procedures
AIA: Divisional Radiology Model 11
Support for Hospital IT Initiatives 12
Research Collaboration 12
Closing Care Gaps 12
Outpatient and Emergency Department Imaging Joint Venture 13
ADVANCING QUALITY 14
Metrics and Results: Measuring Progress 16
The National Quality View—Strategic Radiology 17
Life-Long Learners 18
SEAN THEISEN, M.D. WILLIAM YOUNG, M.D. GERALD YUTZY, M.D. PATIENT EXPERIENCE 19
Musculoskeletal Imaging Neuroradiology Body Imaging
Stewardship: Image Gently and Image Wisely 20
Breast Care Services Breast Care Services
Patient-centered Communication 20
ALIGNMENT AROUND SHARED GOALS 22
State-wide and Regional Leadership 22
Hospital Life 23
Inter-departmental Activities 24
DRIVING PERFORMANCE THROUGH LEADERSHIP 25
HVR Structure and Leadership 26
Subspecialty Medical Directors 29
HVR Operations Executives 29
OUR IMAGING EXPERTS 33
38 3
BUILDING PARTNERSHIPS 2018- 2019
ABOUT
Huron Valley Radiology (HVR) is committed to delivering COMMUNITY-BASED, BROAD EXPERIENCE
the highest quality radiological services to patients,
HVR is a well-established, physician-owned group that has
referring physicians and health systems. Our Michigan-
provided our patients, leading hospitals and networks of
based subspecialty trained physicians have expertise in
care with a full range of diagnostic imaging and
all areas of diagnostic imaging and related therapies.
image-guided interventional procedures for close to JAMES LANDI, M.D. JACOB A. LIVERMORE, M.D. NADER MOHTADI, M.D.
60 years. We currently staff radiologists in-house at six Neuroradiology Musculoskeletal Imaging Nuclear Medicine
We are, however, much more than subspecialty image
Image-Guided Procedures General Radiology
hospitals in Southeast Michigan and provide selected
interpreters. We are an enthusiastic part of the health care
subspecialized service to several additional Michigan
teams in the communities we serve and committed to
hospitals, as well as numerous outpatient offices and
evolving health care to improve the patient experience,
centers that provide diagnostic imaging.
improve population health and lower the total cost of care.
Our level of engagement coupled with our operational,
HVR delivers radiological services across a wide range
analytical and administrative expertise allows us to redefine
of care settings, from the radiology departments at large,
what it means to be a full-service radiology provider.
medical school-affiliated teaching hospitals to rural
community hospitals, large and small private office
Whether a patient accesses HVR through the emergency
practices, outpatient imaging centers and remote emergency
department, a hospital’s inpatient unit or through an
departments and urgent care centers. Our diverse
outpatient imaging center, our objective is to advise, KRISTYN MURRY, M.D. JOSEPH PAINTER, M.D. JOEL ROBINSON, D.O.
experience provides us with a comprehensive
collaborate and participate with the care team to provide Musculoskeletal Radiology General Radiology Breast Care Services
understanding of the unique challenges facing hospitals and Ultrasound Breast Care Services General Radiology
the most efficient, high-quality, cost-effective care for each
office practices at every level and size, as well as
patient we serve. Additionally, by actively participating in
the expertise to effectively address those challenges.
committees and groups—not only clinically, but at all
An HVR radiologist is available 24/7/365 to consult or
levels of operation management within a health system—
answer questions from the ordering providers we serve.
we strive to contribute a perspective that further enhances
the conversations that improve patient care processes.
Our Mission: Improving the health and well-being of our patients by providing
JOSHUA RUBIN, M.D. MICHAEL SAROSI, M.D. JULIA SAVAGE, MD
collaborative, high quality, customer-centric radiology services.
Vascular and Interventional Vascular and Interventional Breast Care Services
4 37
BUILDING PARTNERSHIPS 2018- 2019
MEET OUR PHYSICIANS
SUBSPECIALIZED CARE
Our 42 subspecialty trained physicians offer a breadth and depth of expertise that enables health systems to meet the
radiological needs of clinicians and patients with medical imaging interpretations of the highest quality standards.
We constantly strive to maintain a standard of care and engagement that surpasses the expectations of those we serve.
KEVIN HANNAWA, M.D. DONNA HOFF, M.D. LYNN JOYNT, M.D.
Vascular and Interventional Breast Care Services Breast Care Services HVR provides a complete range of diagnostic interpretive services—including comprehensive women’s imaging,
Ultrasound Ultrasound
MRI, CT, PET/CT, ultrasound, and radiography—as well as interventional procedures to six hospitals and numerous
Image-Guided Procedures
outpatient imaging centers across Washtenaw, Wayne, Livingston, Oakland, Lenawee, Genesee, and Kent counties.
Just as general medicine and surgery have evolved into organ- and disease-based specialties, HVR has kept pace
with these changes through extensive subspecialization. HVR radiologists have completed post-residency,
fellowship-training and are experts in their fields. We staff these subspecialized radiologists throughout our hospital
systems and utilize PACS and advanced information technology to send the right case to the right specialist,
any time, day or night.
All of our radiologists are board certified/board eligible
(ABR, AOBR), and many have Certificates of
RAMI KAAKAJI, M.D. MICHAEL KASOTAKIS, M.D. JILL KNAPP, M.D. Added Qualification (CAQ) within their specialties.
HVR RADIOLOGY SUBSPECIALTIES
Neuroradiology Neuroradiology Breast Care Services
Ultrasound
Angiography
Body Imaging
Breast Imaging
Fluoroscopy
General Radiology
Interventional Radiology
Musculoskeletal Imaging
Neuroradiology Imaging
Nuclear Medicine
Pediatric Imaging
PET/CT
URSULA KNOEPP, M.D. SPENCER KOCH, M.D. SUNEEL KUMAR, M.D.
Ultrasound
Emergency Radiology Neuroradiology Body Imaging
Ultrasound
Image-Guided Procedures
36 5
BUILDING PARTNERSHIPS 2018- 2019
INVESTING IN EXPERTISE
Last year, HVR performed close to 750,000 medical imaging interpretations and procedures for 30 different locations
throughout Southeast Michigan. Our longest-standing partnership goes back 57 years, when HVR began, and many
more of our relationships have lasted for more than a decade. As we continue to form new partnerships, our goal
each year is to exceed the service and quality expectations of our patients and partners.
Table 1. Huron Valley Coverage Locations, Including Volumes, Length of Relationship
CAROLINE DALY, MD DANIEL DEVINCENT, MD CHRISTOPHER M. ESSHAKI, M.D.
PRIMARY HOSPITALS
Breast Care Services Nuclear Medicine Vascular and Interventional
Hospital Location Health System Annual Volume Time Period Ultrasound Abdominal Imaging Neuroradiology
1. St. Joseph Mercy Hospital Ann Arbor, MI Trinity 268,186 57 years
2. St. Mary Mercy Hospital Livonia, MI Trinity 138,176 9 years
3. St. Joseph Mercy Hospital Howell, MI Trinity 48,103 23 years
4. St. Joseph Mercy Hospital Chelsea, MI Trinity 67,532 32 years
5. Bixby Medical Center Adrian, MI ProMedica 50,872 13 years
6. Herrick Medical Center Tecumseh, MI ProMedica 28,304 13 years
7. Forest Health Medical Center Ypsilanti, MI Barix Clinics 2,568 8 years
SECONDARY HOSPITALS
8. Mercy Health Saint Mary Grand Rapids, MI Trinity 62* 4 years
EDS/URGENT CARES/OFFICE PRACTICES
9. St. Joseph Mercy Health Center Brighton, MI Trinity 52,106 13 years
10. St. Joseph Mercy Health Center Canton, MI Trinity 32,690 30 years
11. Saline – Urgent Care & OP Services Saline, MI Trinity 4,158 23 years
12. Arbor Health Center Plymouth, MI Trinity 4,473 27 years
STEPHANIE FALBO, M.D. MICHAEL FATT, M.D. ERIC FERGUSON, M.D.
13. Michigan Heart Ann Arbor, MI Trinity 414 15 years Breast Care Services Body Imaging Body Imaging
14. Buckingham Family Medicine Redford, MI Trinity 330 1 year Ultrasound Musculoskeletal
15. Thorn Health Center Hudson, MI ProMedica 813 13 years
16. Health Specialists of Lenawee Tecumseh, MI ProMedica 1,772 13 years
17. Blissfield Health Center Blissfield, MI ProMedica 679 13 years
18. South Lyon Urgent Care South Lyon MI IHA 888 1 year
19. Schoolcraft Urgent Care Livonia, MI IHA 1,562 1 year
20. Urgent Care - Milan Milan, MI IHA 3,487 1 year
21. Imaging & Ultrasound–Domino Farms Ann Arbor, MI IHA 12,632 11 years
22. Imaging & Bone Density–Livingston Brighton, MI IHA 5,014 11 years
23. Imaging & Bone Density–Canton Canton, MI IHA 4,616 11 years
24. IHA West (Maple Urgent Care) Ann Arbor, MI IHA 7,171 35 years
25. Facial Pain and Sleep Center Troy, MI NA 267 5 years
26. Michigan Cardiology Flint, MI NA 357 4 years
27. Ultra X Plymouth, MI NA 1,262 2 years
28. WorkSphere Tecumseh, MI NA 567 1 year
29. Michigan Brain and Spine Institute Ypsilanti, MI NA 2,658 1 year
30. Levan Internists Livonia, MI NA 1,564 1 year DAVID FUGENSCHUH, M.D. DAVID GOLOVOY, M.D. KAREN HADDLESEY, M.D.
TOTAL 743,283 Breast Care Services Neuroradiology Breast Care Services
Body Imaging Nuclear Medicine
*Neuro Pediatric CTs and MRIs only
6 35
BUILDING PARTNERSHIPS 2018- 2019
MEET OUR PHYSICIANS
PAUL ARPASI, M.D. LAWRENCE BAHOURA, M.D. JOANNE BARBOUR WALKER, M.D.
Vascular and Interventional Neuroradiology Breast Care Services
Neuroradiology Ultrasound
MARK BAUMEIER, D.O. NAVIN BEDI, M.D. RAMIN BEHJATNIA, D.O.
General Radiology Vascular and Interventional General Radiology
Breast Care Services Neuroradiology Breast Care Services
Nuclear Medicine
VISHAL BHAGAT, M.D. ZEESHAAN BHATTI, MD JAMES CARL, M.D.
Vascular and Interventional Body Imaging Breast Care Services
Neuroradiology Musculoskeletal
Nuclear Medicine
34 7
BUILDING PARTNERSHIPS 2018- 2019
OUR
Radiological studies are most meaningful when an ordering physician can act upon their results in a timely manner.
A quick turnaround time on a radiological result directly contributes to faster, better care in addition to higher patient
and physician satisfaction.
We like to think that we are different. What distinguishes HVR physicians and staff from other radiology
services is engagement across our entire practice. We are committed to our patients and partners, meeting
Figure 1. Huron Valley Radiology’s ED report turnaround time, from procedure
the highest clinical quality standards of our specialty. We are highly subspecialized practice, committed to
completed to signed report, is significantly faster than the average as measured
recruiting subspecialty-trained physicians from some of the highest-rated medical programs in the country.
against national benchmarks.
Because we have developed strong hospital relationships over decades, we have achieved a rare alignment
45
of goals and mission. Our market penetration throughout Southeast Michigan has enabled us to not only
40 propagate best practices across the region, but achieve economies of scale that have translated into
investments in quality and service and contribute to radiology department efficiencies.
35
30
As a large radiology practice, we have achieved the scale necessary for a flexible staffing model capable
25
Minutes
of delivering 24/7 subspecialized radiological interpretations.
20
15
10
5 HVR PHYSICIAN ALMA MATERS
0 • Brown University
CT US XR MR ALL STUDIES
• Harvard University
• John’s Hopkins University
• Mallinckrodt Institute of Radiology
We have made strategic investments in market-leading technology, innovative imaging solutions, and extensive support
• Michigan State University
services to enable our health system, hospital, and outpatient partners to meet the needs of clinicians and patients with
• Northwestern University-Chicago
subspecialized interpretations. By facilitating delivery of the subspecialty expertise where and when it is needed these
• The Ohio State University
investments in software, technology, and support personnel enable 24/7/365 in-house and teleradiology interpretations
• The University of Michigan
with turnaround times that are faster than national benchmarks.
• Wayne State University
• University of California Los Angeles
• University of California San Francisco
8 33
BUILDING PARTNERSHIPS
STRATEGIC RADIOLOGY
HVR is a member of Strategic Radiology, a nationwide coalition of
quality-focused independent, private radiology practices that provide
medical imaging services to more than 250 hospitals and 625 outpatient
sites in more than 40 states. Representing more than 1,100 radiologists,
Strategic Radiology’s goals of higher quality and greater cost efficiency
are achieved by providing a path to excellence and sustainability for the
private radiology practice through collaborative sharing of quality data,
benchmarks and best practices. We share SR’s mission to “improve lives
by creating superior value through collaboration and innovation.”
Achieving world-class quality through
clinical and operational collaboration
on a national scale.
During my days as a pulmonary and critical care clinician, you all were outstanding
colleagues to work with. It’s no secret that we in in the field of pulmonary only have
the potential to be at our best when we have superb radiology colleagues like you
helping us unravel the challenges of pulmonary disease.
– Paul Harkaway, MD, Chief Accountable Care Officer, SJMHS, Trinity Health
32 9
BUILDING PARTNERSHIPS 2018- 2019
A HISTORY OF
JULIA SKIPSKI-MAYER
Human Resources, Credentialing, Compliance and Security Officer
HVR offers solutions. Our goal is to meet and exceed the expectations of our health systems, outpatient practices, and the
Ms. Skipski-Mayer joined HVR in 1996 and is responsible for compliance, security, and human resources.
other facilities that we work with so that imaging services can be delivered effectively and efficiently with an emphasis
She has been a key practice employee during a period of significant growth—from 17 doctors providing
on service. Our track record has proven that when quality subspecialty interpretations are needed, we figure out a way to
imaging services to three hospitals to 41 doctors and six allied health professionals providing imaging
provide them. We use our clinical experience to advise ordering physicians on appropriate imaging modalities and utilization
services to seven hospitals and numerous urgent cares and physician offices. Ms Skipski-Mayer received
with respect to individual patient needs, indications, and radiation safety, making us an integral part of the patient care team.
her degree in teaching from Eastern Michigan University and transitioned into Human Resources later in
Taking a holistic approach, we create the solutions to support our hospitals and other partners with a three-part strategy:
her career. She became certified in Human Resources through the Human Resources Certification Institute
in 2007 and obtained additional certification through the Society for Human Resource Management
1. Integrate with those health systems, hospitals, physician providers, and communities that we serve.
in 2015.
2. Recruit dedicated leadership and a core team of passionate clinicians.
3. Maintain a quality and safety program that promotes the opportunity for continued best practice
and service excellence.
The following examples model our response to the needs of our partners. THERESA KING, CPC
Business Process Improvement Manager
A COLLABORATIVE SOLUTION FOR PEDIATRIC PATIENTS
Ms. King brings 30 years of operations management, corporate training, and process improvement to
HVR collaborated very closely with another private, independent radiology group, Kent Radiology, and Mercy Health HVR, including 17 years in radiology revenue cycle management. Prior to joining the HVR team in 2016,
St. Mary, a Trinity Health hospital in Grand Rapids, to establish a process for providing highly subspecialized pediatric she worked for a national revenue cycle management corporation, providing direction and leadership to
neurologic interpretations of pediatric MRI and CTs around the clock. a team that managed end-to-end billing process for more than 500 radiologists in four states. In addition
to revenue cycle oversight for HVR, Ms. King manages the quality program, ensuring participation and
accurate reporting of internal quality metrics and coordinating quality initiatives with hospital partners,
physician organizations, and payors. She serves on the Payor Relations Committee for the Radiology
HVR VALUES Business Management Association and as VP for the Michigan chapter. She obtained a BBA at Northwood
University in marketing and management.
Huron Valley Compassionate Unquestionable
High-quality partnership with corporate integrity
radiology. patients and and ethical
colleagues. standards.
10 31BUILDING PARTNERSHIPS 2018- 2019
HVR’s Operations Executives are:
JAMES R. KNAUF, RT (R), MA, CRA
Chief Operating Officer
AIA: A DIVISIONAL RADIOLOGY MODEL FOR TRINITY HEALTH
A 35-year veteran of health care, Mr. Knauf has served as practice administrator for HVR since February
2012. Prior to transitioning to private practice, much of his experience was earned in hospital radiology
In this era of hospital and health system consolidation, it is not uncommon for multiple independent radiology practices
operations, where he worked as a radiologic technologist, educator, quality manager, and director.
to provide services to a health system. HVR formed Advanced Imaging Affiliates, P.C. (AIA), which provides a divisional
From 1996 to 2006, his focus was health-care compliance, establishing a compliance program for
model for radiology groups providing services across Trinity Health to increase the quality, reduce cost, and promote a
Inova Health System and then serving as director of organizational integrity for Trinity Health.
standard level of service across the health system.
He holds an associate’s degree in radiology from Ferris State University, a BA in Health Systems
Administration from Western Michigan University, and an MA in Education and Human Development
The objective of AIA is to integrate interested private radiology groups
from George Washington University.
across Trinity Health into a divisional model that maintains operational
autonomy while leveraging scale and unified IT to provide a greater
degree of 24X7X365 subspecialized care than what any individual private
practice can provide. AIA has the potential to:
DENISE DUNAWAY
Director of Finance • Bring the best of private practice to a national scale.
• Provide patients, referring physicians, and local hospitals with the customized service, alignment,
Ms. Dunaway joined HVR as controller in 2005, bringing broad finance, service industry, and and embeddedness that private practice is uniquely positioned to deliver.
management experience. She has more than 30 years of financial and leadership experience. • Develop increasingly robust data analytics to quantify opportunities and drive best practices.
Prior to joining HVR, Denise was the controller for a large regional law firm, where she guided and • Lead Trinity Health to the best-in-class radiology services of tomorrow to support the Quadruple Aim of health care.
managed a staff of 200+ and provided financial management for 75 attorneys. She also held the controller
position for a national service provider, and as a member of senior
management, provided financial and accounting guidance through
two mergers and significant growth exceeding 100%.
Ms. Dunaway holds an associate degree in accounting
Huron Valley Radiology has been crucial to the successful development of a high-
from the University of Toledo, and a BS in quality lung cancer screening and incidental lung nodule program for St. Joseph
organizational management and accounting Mercy Health System by generously sharing their expertise and leadership.
from Madonna University (St. Mary’s College).
Their commitment to patient safety is remarkable, and they actively seek out
ways to make sure that radiology results are not lost to follow-up, but instead
available for use to provide timely patient care.
– Ruth Raleigh, BSN RN, Clinical Quality Specialist–Oncology
30 11BUILDING PARTNERSHIPS
SUBSPECIALTY
MEDICAL DIRECTORS
SUPPORT FOR HOSPITAL IT INITIATIVES
HVR’s Subspecialty Medical Directors are
A well-implemented electronic health record has great potential to improve patient care by providing physicians
subject matter experts within their subspecialty.
and allied health professionals access to patient information. HVR was eager to help Trinity Health succeed in its
In accepting these leadership roles, they assume
Epic implementation by participating in each of the following forums:
responsibility for working with the technical staff
to optimize imaging protocols to improve diagnosis
• Rapid Decision Groups for Breast Imaging, Clinical Scheduling, General Radiography and Interventional
and interventions, keep their radiologist peers current
• Clinical Content Groups for Breast Imaging, Radiography and Nuclear Medicine
on practices within their subspecialty, patient safety and
• Clinical Excellence Council for the Emergency Department
referring physician guidance. HVR’s Subspecialty
• Radiology Clinical Leadership Group
Medical Directors are:
HVR also was invited to advise Trinity Health with product selection and development of the Unified Clinical
• Jacob Livermore, MD, Musculoskeletal—University of Michigan, Ann Arbor, MI
Imaging Platform.
• Kristyn Murry, MD, Ultrasound, General Diagnostic, and Pediatrics—
University of Michigan, Ann Arbor, MI
• Josh Rubin, MD, Angiography and Cross-Section Interventional—University of Michigan, Ann Arbor, MI
RESEARCH COLLABORATION
• Suneel Kumar, MD, Body CT and MR—University of Michigan, Ann Arbor, MI
• Donna Hoff, MD, Mammography—University of Michigan, Ann Arbor, MI
Saint Joseph Mercy Health System’s Michigan Cancer Research Consortium Community Clinical Oncology
• Mike Kasotakis, MD, Neuroradiology and MRI Safety—Northwestern University, Chicago, IL
Program (MCRC-CCOP) has received an “Exceptional Rating” from the National Cancer Institute grant review
• Ramin Behjatnia, DO, Nuclear Medicine—Michigan State University/Henry Ford Horizon, Detroit MI
panel. Our radiologists collaborate with other physicians engaged in cancer care and research to support
oncologic research programs and to establish new protocols for cancer care through MCRC-CCOP.
HVR physicians also are active on tumor boards to optimize cancer care plans for individual patients.
HVR OPERATIONS EXECUTIVES
HVR’s Operations Executives are a team of individuals who manage the business office functions of
CLOSING CARE GAPS
the practice and interface with hospital executives and staff to close the gap between the technical and
professional operations of providing radiology services. Our team is committed to working on ensuring the
Our imaging technology offers powerful prognostic tools that sometimes uncover suspect results that may or
service, quality and business gaps are bridged so patients and business operations are managed seamlessly
may not prove to be disease on follow-up—called incidental findings. One of the most problematic incidental
with an emphasis on customer service.
findings are lung nodules, present in almost any normal adult, but possibly an early sign of lung cancer.
HVR developed a comprehensive incidental lung nodule follow-up program that is a model across
Trinity Health to detect lung cancers in early stages, using an evidence-based protocol that minimizes
false positive results.
12 29BUILDING PARTNERSHIPS 2018- 2019
ROBERT TAILA, MD
Secretary, Huron Valley Radiology and Advanced Imaging Affiliates
OUTPATIENT AND EMERGENCY DEPARTMENT IMAGING JV
Dr Taila has served on the Board of Directors for HVR since 2015, currently
HVR formed Avant Imaging JV, an imaging center
holding the secretary position. He also serves as the oncology liaison for the
co-owned by St. Joseph Mercy Hospital Ann Arbor
Mercy Cancer Network and the St. Mary Mercy Hospital liaison for
and HVR, that provides imaging services to both
cross-sectional and women’s imaging. Dr. Taila’s other administrative roles
outpatient and emergency department patients.
include member of the HVR Executive, Quality, Marketing, and Recruitment
It was established as a structure to implement
Committees. He joined HVR in 2009. Dr Talia received his medical degree
innovative imaging solutions for patients.
from Wayne State University School of Medicine, completed his radiology
Initiatives are often developed at Avant and if
residency at William Beaumont Hospital, and was fellowship-trained in body
successful, propagated to other Saint Joseph Mercy
imaging and intervention at the University of Southern California at Los Angeles.
Hospital System (SJMHS ) locations.
KEVIN HANNAWA, MD
Treasurer, Huron Valley Radiology and Advanced Imaging Affiliates
Dr Hannawa was elected to the HVR board in 2018 and also serves on the
Finance Committee. He first joined HVR in 2013 as a house physician,
providing overnight preliminary interpretations while he was still in
residency at the University of Michigan, where he was fellowship-trained in
interventional radiology. Dr. Hannawa became a full-time radiologist at
HVR in 2016 and is fellowship-trained in interventional radiology.
The following important functions report up to the Board:
• Quality and Safety
• Compliance, Privacy, and Security
• Physician Engagement
• Manpower
• Recruitment
• Wellness
• Branding/Marketing
28 13BUILDING PARTNERSHIPS 2018- 2019
Four Board Members serve as officers:
ADVANCING ERIC FERGUSON, MD
President and CEO, Huron Valley Radiology and Advanced Imaging Affiliates
Dr. Ferguson has been with HVR since 2003 and has held the position of
HVR president since 2006 and president of Advanced Imaging Affiliates
High-quality radiology is a central value that our practice lives by, and we take our Quality and Safety Program
(AIA) since its inception in 2019. He is involved in both clinical practice and
seriously. HVR demonstrates its commitment to quality and safety through our outcomes as measured by
practice administration. Other administrative commitments include: member
performance metrics developed by our practice, our hospitals, and CMS. Under the leadership of
of SJM Board of Directors and Clinically Integrated Network (CIN) and chair,
Kristyn Murry, MD, our quality and safety plan is developed annually using a multi-pronged approach:
Finance Committee; board member, Avant Imaging; board member,
Strategic Radiology; member of HVR Investment Committee.
1) Metrics that traverse all locations.
He received his medical degree from University of Michigan Medical
2) Partnering with each of our health systems’ hospital-specific key metrics.
School and completed his radiology residency and cross-sectional imaging
3) Attention to CMS and other regulatory metrics.
fellowship at University of California at San Francisco. He is a
4) HVR-specific metrics.
fellowship-trained cross-sectional body imager, specializing in body imaging,
MSK imaging, and general radiology.
During the past five years, we have significantly strengthened our ability to measure and improve performance
through quality-specific infrastructure. The HVR Quality and Safety Program supports continuous evaluation of
best practices and provision of the feedback necessary to implement change, enhance performance, and
drive clinical excellence. As members of the national consortium of leading private radiology practices,
Strategic Radiology, and its Patient Safety Organization (SR-PSO), we view quality and patient safety
RAMI KAAKAJI, MD
through a national lens.
Vice-President, Huron Valley Radiology and Advanced Imaging Affiliates
HVR’s partnership philosophy pervades our service ethic and extends into our hospital quality improvement
Dr. Kaakaji joined HVR in 2009. He has been an HVR board member since
teams, where we work to contribute to the improvement of the care provided to the patients we all serve together.
2017 and was recently elected vice president. Dr. Kaakaji is also a member
of the Advanced Imaging Affiliates and the Strategic Radiology Board.
He serves as vice chairperson at St. Mary Mercy Hospital Livonia and also
serves as ED and neuroradiology liaison. He is the chair of the HVR
As HVR physicians, we consistently expand our focus on quality and accuracy.
Wellness Committee and a member of the Investment and Marketing
To that end, we work alongside our hospital partners to ensure a personal,
Committees. He received his medical degree from University of Arkansas
compassionate, and safe experience for every patient at every visit. College of Medicine and radiology residency and neuroradiology fellowship
This coordination of care results in readily available, reliable interpretations at Northwestern Memorial Hospital.
and has a remarkable impact on patient care and improved outcomes.
– Kristyn Murry, MD
14 27BUILDING PARTNERSHIPS 2018- 2019
HVR STRUCTURE AND LEADERSHIP
Figure 4. Clinical and Operational Structure HVR QUALITY AND SAFETY PROGRAM METRICS
Outpatient Turnaround Times
CT Head Stroke Protocol Turnaround Times
Patient
Culture of Safety Scores
Ordering Provider
Patient Satisfaction Scores
Hospital Needs IVC Filter Retrieval Rates
Percent of Screening Mammography Performed as Tomography
Cross
Section
Mammo
BodyMR MSK Angio
Office/ SJMH- SJMH-
Ann Arbor SJMH (Reduced Call-Back Rates)
graphy Practices Brighton/
Interventional & Livingston Chelsea
Avant
Appropriateness of Follow-up Recommendations on Thyroid Nodule Identification
CT Lung Nodule Follow-up
General Promedica
BodyCT Nuclear Ultrasound SMMH Bixby- ForestHealth
Diagnostic Medicine HVR President
& Board of
Livonia Herrick Central Venous Access History Review
Directors
Uterine Artery Embolization Documentation
Infection Following Tube Placement
ClinicalOperations
Nephrostomy Tube Dislodgement Replacement
Branding/ Manpower Quality IT
Physician
Recruitment
Adequate Image Guided Biopsy Sampling
Marketing Chief Engagement
Operating Port Placement Infection Rates
Officer
Business Days between Order and Scheduled Biopsy
Business Operations Minor Procedure Complication Rates
MRI Utilization for Pediatric Appendicitis
HR/Compliance/ Revenue Cycle
Finance HVR IT Clinic Services
Privacy Operations Peer Review Site of IV Access: Subclavian versus Jugular
CMS OUTPATIENT MEASURES
OP-23 Head CT Scan results for acute ischemic stroke or hemorrhagic stroke
HVR is a physician-owned practice, wholly owned by physician shareholders. With few exceptions, who received head CT scan interpretation within 45 minutes of arrival
all physicians are equal shareholders creating commitment and service orientation across the organization OP-8 MRI Lumbar Spine for Low Back Pain
that is shared by all. Seven shareholders make up the board, with elections taking place every two years. OP-9 Mammography Follow-up Rates
OP-10 Abdomen CT – Use of Contrast Material
OP-11 Thorax CT – Use of Contrast Material
OP-14 Simultaneous Use of Brain CT and Sinus CT
26 15BUILDING PARTNERSHIPS 2018- 2019
METRICS AND RESULTS: MEASURING PROGRESS DRIVING PERFORMANCE THROUGH
One outcome metric that HVR tracks is the diagnostic yield of biopsies, also an indicator of interventional accuracy.
We also closely follow our complication rates and measure them against national benchmarks. Measuring the
diagnostic quality (or yield) and complication rate of biopsy results performed by our interventional radiologists,
Exceptional performance cannot be accomplished without effective leadership. HVR invests in leadership
body imagers, and women’s imaging experts provides confidence that we are well within national norms on
selection, development, and support systems to develop our partner radiologists who have an interest in
quality and safety with respect to biopsies. Measuring results also provides an opportunity for continuous
becoming a leader. HVR’s leadership track begins with the SJMH Western Region System Chair and Site
performance improvement.
Medical Directors. The leaders in these positions work with hospital radiology department leadership to:
• Ensure the safest and highest quality radiology service to our patients.
Table 2. Biopsy Tissue Yield and Complication Rate, 2018
• Collaborate with radiology technical staff and hospital administration on policy and protocol development.
• Engage with finance and IT on selecting state-of-the-art equipment and systems while stewarding the
Biopsy Type HVR % Yield of Diagnosis National % Yield of Diagnosis available resources.
• Integrating with medical staff on radiology appropriateness and utilization initiatives in addition to
Lung 90% 77-96% participating in medical staff meetings and committees.
All Other 93% 70-90% • Engage with inpatient nursing, emergency, and other department teams to promote continuity of care
across the care continuum.
Complication Report - Lung Biopsies
Developing leaders within the organization requires an investment in education and training.
HVR Pneumothorax Rate National HVR w/ Treatment Rate National Many of our physicians participate in leadership training courses and curricula through:
9.1% 12-45%* 2.7% 2-15%
• The American College of Radiology Leadership Institute
*ACR-SIR-SPR Practice Parameter: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/PNB.pdf
• American Association for Physician Leadership
• Trinity Health Leadership Forums
Incidental lung nodules that are found in imaging studies performed for another purpose can get lost in the
• Dyad Partner Training
shuffle. While most of these findings are not life threatening, some are revealed to be cancer, so they warrant
judicious monitoring. HVR, in partnership with SJMHS, developed a comprehensive process that incorporates
capturing identified lung nodules into a database. A nurse navigator, working in a lung nodule clinic under the
supervision of a thoracic surgeon, facilitates a work-up with the patients and their primary care physicians to
determine the appropriate care and follow-up for each individual patient.
Each patient is maintained within the database until they receive their definitive treatment or until their prescribed
imaging follow-up course is completed. HVR along with SJMHS is committed to ensuring follow-up of all incidental
lung nodules that are identified in order to greatly improve patient outcomes through early detection of lung cancer.
16 25BUILDING PARTNERSHIPS 2018- 2019
Figure 2. The Lung Nodule Tracking Database has enabled HVR and
INTER-DEPARTMENTAL ACTIVITIES
Saint Joseph Mercy Hospital to significantly increase the number of
high-risk patients under surveillance for early detection of lung cancer.
HVR physicians are eager to collaborate with their colleagues in other departments and specialties to improve
care through participation in the following Interdepartmental Operational Meetings and Clinical Multispecialty
Conferences and Committees: 6,000
5,500
• ED/Radiology • GI Oncology Multispecialty Board
5,000
Number of Lung Cancers
• Hospitalist/Radiology • GU Oncology Multispecialty Board
• Cardiac Imaging Committee • Melanoma Multispecialty Conference 4,500
• Breast Cancer Advisory Committee • Gynecologic Oncology Multispecialty Board 4,000
• Cancer Care Committee • Pulmonary Nodule Clinic
3,500 ~327 lung cancers have been idenƟĮed
• Quality and Patient Safety Committee • Breast Cancer Multispecialty Tumor Board through the lung nodule program; a 1.8%
• Trauma Committee • Neurospine & Neuroscience Clinics 3,000 cancer diagnosis rate
• General Oncology Tumor Board • Neuro ENT Oncology Clinic 2,500
2,000
HVR physicians also support the medical community through regular donations to the following hospitals and 2016 2017 2018 2019 (annualized)
medical organizations:
• St Joseph Mercy Hospital Ann Arbor • ProMedica Herrick Hospital
• St Joseph Mercy Hospital Livingston • Catherine’s House THE NATIONAL QUALITY VIEW—STRATEGIC RADIOLOGY
• St Joseph Mercy Hospital Chelsea • HOPE Foundation
• St Mary Hospital Livonia • American Red Cross HVR participates at a national level in the Strategic Radiology – Patient Safety Organization (SR-PSO).
• American Cancer Society • American College of Radiology The SR- PSO is the first PSO to be established by radiologists, officially listed by the Agency for
• American Heart Association • Radiological Society of North America (RSNA) Healthcare Research and Quality (AHRQ) on behalf of the Secretary of the U.S. Department of Health
• ProMedica Bixby Hospital Research & Education (R&E) Foundation and Human Services in June 2013. It is the only radiology-specific PSO listed by the AHRQ.
HVR is committed to providing charitable care to the underserved patient population. Our charitable care HVR’s sole purpose of being a member of the PSO is to improve the care we deliver to patients by
policies are aligned with our faith-based hospital partners. conducting quality and safety analyses. Aggregating data across the multiple
radiology group PSO members allows for faster identification of issues and
allows for improved early warning and communication in regards to risk
reduction and quality improvement. The key reason behind the formation
Kudos, thanks to (Dr.) Joe Painter for guiding me today with the bilateral of SR’s PSO is the need to create a safe environment for transparent
UE abscesses. They provided the landmarks needed to locate the cavities. sharing and learning in order to achieve that shared goal.
– Fred Hankin, MD
24 17BUILDING PARTNERSHIPS
LIFE-LONG LEARNERS
All HVR physicians and allied health professionals (AHP) adhere to state and radiology-specific guidelines
for continuing medical education (CME) credits. HVR expects its physicians and AHPs to pursue CME credits
HOSPITAL LIFE
above and beyond minimum requirements. This is encouraged in various ways, including:
HVR radiologists are
• Maintaining memberships in various radiology societies, including the American College of Radiology
enthusiastic participants in
(ACR) and American Roentgen Ray Society (ARRS).
hospital life, volunteering to serve
• Funding the individual Maintenance of Certification.
on the following hospital committees:
• Providing an annual allowance for each professional that empowers them to obtain their CME credits
in a way that is best suited to their learning and life-style.
• Medical Executive Committees
• Housing an in-office library of courses for specific training.
• System Physician Leadership Council
• Department Chairs Committee
• Ann Arbor Quality and Patient Safety Committee
• Clinical Medical Records Committee
• Credentials Committee
• Operative/Invasive Quality Improvement Committee
• By-laws Committee
• Mortality Review Committee
Passing along huge kudos to Drs. Rubin and Sarosi. I have received multiple • Internal Medicine Section Heads Meeting
messages about how awesome you two were in Angio over the course of the day • Radiation Safety Committee
• Physician Partnership Committee
and during a very complex case. I don’t think you two get enough praise for all the
• Patient Safety Rounding
work you do for our department—thank you! I appreciate you! • Vascular Steering Committee
• CME Committee
– Meghan Glabach, Director Radiology West Market
• Cardiovascular Service Line Steering Committee
Dr. Murry is a strong leader with her XR and US sections. She never
hesitates to push technologists to their fullest potential. I appreciate
that she is approachable and always makes time for technical staff.
– Amy Humbarger, Radiology Manager
18 23BUILDING PARTNERSHIPS 2018- 2019
ALIGNMENT AROUND
IMPROVING
Our partnerships with our health systems, hospitals, and other clients are based on a deep level of clinical
engagement with our patients, the success of our partners, our medical specialty, and our colleagues
How our patients experience the care we provide is important to HVR. We work closely with our hospital
in medicine. David Fugenschuh, MD, a senior member of HVR, is the current Vice-Chief of Staff for
partners to measure and assess patient satisfaction at all of the imaging locations we serve.
St. Joseph Mercy Hospital – Ann Arbor. His two-year appointment as Chief of Staff begins in January 2020.
The high level of our patient-satisfaction scores demonstrate across-the-board excellence in patient wait
times, responsiveness to patient needs, and willingness to recommend our services to others. We are proud
STATE-WIDE AND REGIONAL LEADERSHIP of the collaborative efforts we have made with our hospital partners in ensuring that we provide great
service to our patients.
HVR is active at the national, state, local, and health system levels through participation in health system
committees, hospital boards, and leadership roles. Our radiologists have held the following leadership
Figure 3. High patient satisfaction scores earned in the Saint Joseph Mercy
positions within the state of Michigan:
Hospital Radiology Department, July through December 2018, reflect close
collaboration between HVR and SJMH.
• Michigan Radiological Society President • SJMHP CIN Board
• Michigan Radiological Society Board Member • SJMHP CIN Finance Committee Chair
At-Large • Huron Valley Physician Association (HVPA)
100
• Strategic Radiology Board of Managers Executive Committee/Board Member 100% 100% 99% 99%
90
• SJMHP Local Hospital Board • McAuley Health Partners ACO Board Member
80
PercenV5CVKUƂGF
• SJMHP Local Hospital Finance Committee Chair and Finance Committee Chair 70
60
HVR radiologists are involved in many patient care initiatives, engaging with our health care colleagues by 50
participating in the following health system and regional committees: 40
30
• Unified Clinical Organization • Trinity Radiology Clinical Leadership Group 20
10
• Mercy Cancer Network Co-Chair
0
• Lung Advisory Board • Trinity Epic Groups Helpfulness Cleanliness Overall Satisfaction Would Recommend
• Regional Radiology Leadership Committee • Unified Clinical Imaging Platform
• Radiology Service Line Advisory Committee Advisory Group
Additionally, we have created new ways to improve the patient experience.
22 19BUILDING PARTNERSHIPS 2018- 2019
STEWARDSHIP: IMAGE GENTLY AND IMAGE WISELY
HVR is committed to the health and safety of all the patients we serve by producing top quality images using
the lowest radiation dose possible in accordance with the Image Wisely® and Image Gently® campaigns.
These programs were developed by the radiology community with the objective of lowering the amount of
radiation used in medically necessary imaging studies and eliminating unnecessary procedures through resources
and information available to radiologists, medical physicists, other imaging practitioners and patients.
Image Gently was created for the pediatric patient population, our most vulnerable patients. Image Wisely
is a radiation safety program created for adults.
Working together with 28 Strategic Radiology member radiology groups, HVR is helping to fill a need
within the radiology field to educate health care consumers and providers about the scope of services
PATIENT-CENTERED COMMUNICATION
radiologists provide to their communities and their contributions to patient care. Through these and other
efforts, we hope to create a platform to engage other radiology industry organizations in advocacy for the
HVR developed a unique tool to help patients
profession and the future success of local, community-based independent radiology groups.
understand the language used in radiology reports
called RadiologyExplained.com, a website that
translates the terminology used in the
radiology report into everyday language.
Radiologists use “medical speak” in radiology
reports because most medical imaging studies have
been ordered by other physicians to obtain clinical
information needed to complete the diagnostic
assessment of a patient’s condition. With the
availability of patient portals, many patients
today can directly access their reports.
Because medical report language can be quite difficult to interpret or understand for many people, HVR created
the website to help the patient understand the imaging report, empower them to take a greater role in their
health care, and increase their engagement with their health care providers.
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