4 Things CFOs need to know about medical physicist services
Thomas J. Petrone, PhD, DABR, Chief Medical Physicist and CEO – Petrone Associates
Published in Becker’s Hospital Review - Monday, February 4th, 2019
CFOs deal with a lot of moving parts to keep their facilities financially viable. Any number of problems can arise on a daily basis, so minimizing the chance for something to go awry is a plus.
When CFOs are able to both minimize risk and exert sound fiscal responsibility, the benefits are even more attractive. Medical physics delivers the types of benefits that should be of interest to CFOs. After defining what a medical physicist does and differentiating between an in-house and a contract medical physics program, we will look closely at four of those benefits.
What is a medical physicist—and why should you care?
Medical physicists focus on one (or more) of the following roles: clinical service and consultation (including equipment evaluation, accreditation, and compliance); research and development; and teaching. It’s important to note that “service” in this case isn’t typically about the physical repair of a machine, but rather about monitoring equipment to make sure it’s operating within acceptable ranges. While each role can deliver meaningful benefits for many institutions, we’re going to highlight the clinical service and consultation role because of its clear ties to workflow, compliance, and safety – all of which link back to a facility’s financial health.
In-house vs. Contract
For a health system’s medical physics needs, the discussion about whether to go in-house or else to contract the service out would take diagrams and charts to explore fully. The key consideration, however, is weighing one thing—the skills your in-house medical physicists bring to the table plus the cost to train them on additional modalities or know-how—versus another—the cost of having a service contract. (It’s worth noting too that the necessary training, like an additional graduate degree, may not be possible to do in-house.) Other considerations include expenses attached to salary, such as healthcare coverage, paid vacation, sick time, and payroll tax, which don’t apply to contract medical physicists. In many cases, the best solution for a medium or larger facility will be a hybrid arrangement, with in-house medical physics being supplemented by contracted service.
Whether your medical physicist program is in-house, contracted to an outside organization, or a combination, here are four areas where they can impact your bottom line:
1. Efficiency and Billables
Medical physicists can have a direct financial impact on radiation oncology, diagnostic radiology, CT and MRI, ultrasound, and nuclear medicine by improving the efficiency of this equipment. One way they can improve efficiency is to help a facility decrease their equipment’s unscheduled downtime. By monitoring equipment regularly, the medical physicist is able to identify when it’s on a performance decline. With this type of early warning, the facility has the opportunity to alert patients well in advance of any appointments or procedures and to shift the relevant scheduling. This information can also help with staffing plans. For instance, if a specialist comes in only on certain days of the week, you may be able to shift his or her schedule.
Also keep in mind, radiation oncology may or may not be th-e revenue driver for your organization, but it certainly feeds into a lot of other billable procedures, not to mention being a pillar of your overall cancer program. That is to say that when your equipment goes down, the impact can be felt far beyond any immediate bottleneck.
2. Patient and Employee Safety
As a healthcare provider, patient safety should be a top-level concern. One aspect of patient safety is the proper dose for imaging procedures. When equipment performance degrades or is not calibrated properly, it can impact delivered dose by delivering either too much or not enough. Realistically, not enough dose for any one study will also result in too much total dose, because more imaging procedures will be required to provide the information that wasn’t captured in the earlier procedure(s).
Because a medical physicist monitors the performance range and can determine when a machine is moving toward the edge of the acceptable range, it can catch these problems before they ever get to the realm of patient safety. Operating out of the acceptable range can also impact the next topic, risk management.
3. Risk Management
It’s a huge problem for a health system when news about excessive radiation dosing or exposure hits the mainstream media. Those stories pop up with more frequency than they should, in part due to the issue itself but also because fear is a reliable way for news outlets to draw in readers. Beyond the immediate lawsuit issues and potential for fines, there’s also the public relations fallout for organizations to be considered, especially if they’re in a competitive market. If equipment isn’t carefully monitored and kept within the regulatory range, that is, the potential exists for a facility to face millions of dollars of financial damage as well as years of reputational damage.
A medical physicist or service company provides an early line of defense to help you manage your risk and keep you in compliance, our fourth benefit on the list.
4. Regulatory Compliance
Regulatory compliance is a complicated animal. New rules can be introduced which require additional cost and training for staff (but may not cost more to a service contract, depending on your terms of agreement). And if you’re not in compliance, you can expect fines. But those fines may just be the tip of the financial iceberg.
Because fines are so unsettling, they often lead to overreaction within an organization. This typically takes the form of thousands of dollars spent “lawyering up” (having legal review everything and create briefs, thus compounding the cost of the non-compliance). Some organizations overcompensate by hiring more people to work on compliance issues without really contemplating how much work they’ll have for those additional hires. Even leadership, those individuals at the top of the payroll, may end up dedicating substantial time to delving into the compliance issue instead of handling tasks commensurate with their pay scale.
The experience of a large medical facility in a location known for heavy regulation (and assertive enforcement) provides a salient example of this overreaction. After several weeks of taking measurements and scrutinizing records, including all of the facility’s medical physics evaluations, local radiation regulators sent this facility’s CEO a scathing letter full of pages of non-compliance issues. The facility’s administration mobilized immediately, setting up a series of compliance meetings that were later estimated to have cost more than $50,000 (a figure based on the salaries of the meeting participants). This compliance committee eventually recommended the addition of two more technical staff, each with a salary in excess of $150,000/year, plus benefits, to provide quality assurance redundancy of debatable necessity.
As this costly -response shows, it is a fiscal imperative to avoid regulatory non-compliance in the first place, especially as a typical reaction to a bad review is to incur expenses that go far beyond the scope of the initial problem.
CFOs shouldn’t have to be experts in medical physics, but they do need to know what they don’t know. With the backing of a full service company well-versed in compliance issues (or, less ideally, working with regulatory bodies to get into compliance and even potentially reduce fines), the leadership of a health care system can continue to focus on their areas of expertise while the experts in medical physics take that load off their shoulders.