Coordinated Community Care

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By Roland Rhynus, CRA, FAHRA

June 2011–Greetings! The past month has been ripe with AHRA Regional Meetings. I was lucky enough to attend two.

The AHRA Washington Group Second Quarter Meeting was held on the evening of Tuesday, May 31 at GroupHealth Headquarters in Seattle, WA. I kicked off the meeting discussing the benefits of AHRA membership benefits. Then things really got going with a panel discussion titled “The Impact of Accountable Care Organizations in Radiology.” Panelists include Dr. Norm Beauchamp, Chair, UW Department of Radiology; Dr. Brenda Bruns, Executive Medical Director, GroupHealth Plan; Joe Camaratta, Manager for ACO, GE Healthcare; and Wendy Wilkins-Russell, Executive Director, Washington Managed Imaging (WMI). Discussion points in this rousing conversation included integrated care and who we hold accountable for patient centered care. The vision of GroupHealth—the host of this event—is two fold: (1) to provide the best group practice in the country and (2) to have the best overall network for members. Its affordability goals include how to “bend the trend”: better quality equates to cost savings. Appropriate reductions in high end imaging via the ACR guidelines were also stressed. GroupHealth is working towards more owned integration to ensure best practice at affordable cost.

Roland Rhynus addresses attendees at the Seattle Area Meeting.

Dr. Norm Beauchamp provided great slides which were available to the group. Wendy Russell talked about the 12 independent radiology groups that she manages and the impact of ACOs will have on them. She explained that radiologists should seek out ACO planning and be involved in the process, but they also need to be diligent based on past history with capitation in the state. Russell then detailed how to find a good ACO partner and the legal, administrative, financial, and clinical structures associated with the process. Regarding the legal structure, anti-trust is potentially a big issue; should competitors come together, they will need to have careful safe harbors. This is where Stark laws, anti-kickback statutes, and physician incentive plan laws come into play. It is also extremely important to have exceptional IT structure for all phases from reporting to regulatory. Russell added that we must trust those who have “skin in the game” with you; in her experience, Washington State got burned by many consultants who were brought in for this process. Joe Camaratta added that ACOs ask providers to assume not only the clinical risk, but a community health outcome risk.

Other discussion points included the importance of having a culture of appropriateness in evidence based medicine (how we must be able to issue a strong “no” without offending referring physicians), instead of waiting for regulators to mandate this. We must really push on coordinated care, such as using cloud based PACS so images are always available. And trust must exist between typically non-trusting specialties/facilities/organizations. We must work to generate our own accepted evidence, employ more of a long term clinical approach—we can utilize industrial engineering, as in other industries, to help figure this out.

Much appreciation to meeting coordinator Mark Steffen and GroupHealth for their gracious sponsorship at their beautiful new downtown offices. I’m positive that Mark would be pleased to advise on how easy it is to put on a local area meeting, so please do connect with him and start the trend in your local area.

I was also able to attend the AHRA Southern California “Inland Empire” Area Meeting on the evening of Thursday, May 26 at my facility, Loma Linda University Medical Center – Murrieta Hospital in Murrieta, CA. Stay tuned to AHRA’s website for a synopsis of that meeting!

This spring has been full of wild weather, and our thoughts are still with AHRA member Nora Cannon, director of radiology at St. John’s Regional Medical Center in Joplin, MO. A tornado hit Joplin on the night of Sunday, May 22 and made direct contact with Nora’s hospital, which subsequently had to be abandoned. We got word that Nora is fine, but her facility has been devastated. When I spoke to Nora a few days back, her facility was just opening for outpatient services—what an amazing comeback in such a short time. It is amazing how quickly strong communities can work together to rebuild so quickly in even the direst of circumstances. Please keep Nora, as well as her coworkers, family, and community in your thoughts as they will need our support in the coming months.

Roland Rhynus, CRA, FAHRA is President of the 2010-2011 AHRA Board of Directors. He lives in Loma Linda, CA and can be reached at

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