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Closing the Books on 2021: What Happened, What Didn’t & What’s Next

By Matt Skoufalos

“Good riddance to 2021.”

That’s the topline reaction from Lydia Kleinschnitz, senior director of imaging services at UPMC Presbyterian Shadyside in Pittsburgh, Pennsylvania, when asked to sum up her experiences in the medical imaging space this year.

As difficult as 2020 was for health care workers and the facilities that employed them amid the novel coronavirus (COVID-19) pandemic, the year that followed was, in many respects, even harder, Kleinschnitz said. Not only was her department still tasked with handling significant volumes of COVID-19 patients who needed imaging studies performed – a workload that increased substantially with the wave of Delta variant cases that hit the United States over the summer – but also it lacked sufficient staff to handle the workload.

“We were hit with the same problems that everyone was experiencing, with staff finding other opportunities, from traveling to changing their courses of life; their occupations,” Kleinschnitz said.

“COVID made people really take a look inside and figure out what they wanted to do, or see how life could be when things are forced upon you,” she said. “They’re getting married, they’re moving away; I had techs that decided just to open up a coffee shop. We had folks who were living a couple states away from their family, and all this made them think, ‘We’ve got to be close to family now.’ We also lost a lot of folks just to retirement.”

Typical sources of new hires were also hamstrung by the pandemic: Kleinschnitz points out that the academic pipelines that traditionally support the workplace “were basically shut off.”

“The schools couldn’t get into clinicals, and there were people who maybe decided not to go into health care, and the classes weren’t as big,” she said. “You don’t have the number of people going into radiologic technology, so we’ve been working really hard to open up those pipelines, and be a support to our local schools so we can get people interested in making this a career. But that’s going to take some time.”

“Fatigue is huge,” she said, especially when everyone on staff is battling back feelings of being overworked in order to better support their peers. Kleinschnitz said her remaining team members pulled through as best they could under the circumstances, and UPMC found ways to incentivize and reward them; however, these challenges seemed to become compounded in an international labor market struggling against the same forces. In short, “2020 was COVID, 2021 now is staffing and COVID,” she said.

“I’m looking forward to 2022 having some solutions.”

Whereas elective procedures were curtailed for a few months in 2020, creating a backlog of patients who required diagnostic imaging, no such circumstance presented itself in 2021. Despite short-staffing concerns, Kleinschnitz said her department nonetheless managed to facilitate the needs of its patients who were receiving imaging studies. The one, major side-effect of thsee staffing concerns, however, is that addressing them occupied so much of her time that Kleinschnitz lost hours she typically would have dedicated to strategic and long-range planning. Shifting her focus entirely on the short-term to the neglect of long-term considerations put her into unfamiliar territory.

“This year has really forced me to spend so much time figuring out, ‘How am I going to make it through this month?’ Or, on a week-to-week basis, making sure you have plans in place to meet those needs,” Kleinschnitz said. “We’ve done it, but it has prevented me from being as strategic as I would usually be. I feel like in 2022 we’re going to be able to get back to that a little bit more.”

Nicole Dhanraj, systems director at Northern Arizona Healthcare in Flagstaff, Arizona, said her biggest takeaways from 2021 also involved navigating an ongoing staffing crisis. Whether organizations lost employees via the “Great Resignation” – the phenomenon of otherwise employed people quitting their jobs amid the COVID-19 pandemic – or ran the risk of overtaxing the staff they retained, they also faced the reverberations of those effects in terms of supply chain and logistical concerns, or simply in effectively communicating their management strategies during the crisis.

“Sometimes we struggle to learn what is the organization doing about the current crisis; what does it mean to being ahead of it,” Dhanraj said. “Some organizations were delayed in their response, and because it took too long, employees were left to their own assumptions, to talk amongst themselves.”

In an environment full of unknowns, what keeps the system running is clear, direct and precise internal communication, whether it’s managing the return of remote workers to their in-person assignments, keeping frontline workers current on regulatory concerns and policy changes (institutional initiatives or government mandates), or addressing open positions, and maintaining operations while short-staffed. Although, as Kleinschnitz described, strategic planning may have suffered amid the rush to address those labor concerns, Dhanraj said that’s ironically when it’s needed the most.

“I feel like we need to see strategic direction almost on a monthly basis,” she said. “The content has to be where are we going and how are we managing things at the same time; even just an update on where are we, dealing with hiring, dealing with the supply-chain crisis.”

For remote health care providers like Northern Arizona Healthcare, Dhanraj described the effects of other economic factors – remote location, wages, costs of living, housing availability and pricing – as playing havoc with the employment recruitment and retention processes as well.

“I have lost potential employees and travelers because they couldn’t find housing,” she said. “Now we have the location, the housing crisis, and additional factors that just amplify that crisis, and the impact is that we don’t have a pool of other applicants to pull from.”

In addition to recruiting new hires to fill open positions, engaging with current staffers remains a critical priority, Dhanraj said. Employee satisfaction, incentivization and retention all have risen to become as important as bidding for the services of new workers.

“As we try to navigate through [The Great Resignation], how do we get our current staff to stay, and what other creative marketing strategies can we use to entice people to come and work for us permanently?” she said.

The operational limitations that have been foisted upon health care during the pandemic represent the value and necessity of operating within lean methodology, Dhanraj said, embracing automation technologies wherever possible, seeking to reduce the time physicians must spend on the phone, or eliminating any other inefficiencies throughout the institution.

“Either we really maximize what the vendors offer, or look at additional solutions to overcome these inefficiencies,” Dhanraj said. “From the PACS perspective, we are using traditional practices in the 21st century, but are not able to get everybody onboard to change their [individual] practices. Longer organizations take a while to implement changes, but we need to reduce waste and expenses, discover what automated tools there are, or what solutions we have from current vendors that we can employ.”

Lean methodology and crisis communication also support other critical demands of the imaging workspace, Dhanraj said; namely, ensuring patient safety and turnaround time and system quality of service. Eliminating system delays and inefficiencies is another way to address the hard practicalities of the current labor market, in which patients still must meet their health care needs. She foresees staffing and supply chain issues will persist for as long as six or nine months, and into 2022, translating into higher costs and routine logistical delays that smaller operations may not be able to manage as easily as their larger counterparts.

“Those supply challenges are scary to think about in the coming months,” Dhanraj said. “I’m concerned for those private practices.”

For Nathan Smith, founder and CEO of the Atlanta, Georgia-based radiology training and consultancy company Imaging Diversified, one of the biggest storylines for 2021 was how inpatient medical imaging utilization ramped up from 2020 lows to levels seen prior to the pandemic.

Outpatient practices, by Smith’s reckoning, still battle throughput and patient scheduling concerns that necessarily incorporate COVID-19 safety and screening precautions, and that’s before they faced Medicare Physician Fee Schedule (MPFS) reimbursement rate cuts to the professional component of radiology procedures from the federal Center for Medicare and Medicaid Services (CMS).

According to VMG Health, a health care strategy and valuation group based in Dallas, Texas, freestanding operators that rely on government payors stand to face “the most severe impact” of these cuts. In an April 2021 briefing on the impact and outlook of rate changes for diagnostic imaging services, the group identified “two potential options to combat reimbursement pressure: invest more heavily in advertisement and marketing, or renegotiate rates with commercial payors.” The brief also noted, however, that both tacks require either the flexibility to carry out such negotiations, or the supplemental income to elevate awareness of their brands. Those entities that operate multiple business locations may fare better by leveraging economies of scale or operational efficiencies across a number of sites.

The result of those pressures, the firm concludes, is presumed, continued market consolidation, including “joint venture models or outright buyouts by MPOs, health systems or management companies.”

“We’re looking at busier centers, busier places,” Smith said, “and we’re looking at reimbursement going down at the same time.”

Smith said radiology professionals are also looking toward different technological advances that might be built upon across the market in 2022, whether it’s the helium-free BlueSeal magnet from Philips or the low-helium Siemens Magnetom Free.Max, which both seek to obviate the complications of relying upon dwindling reserves of the nonrenewable gaseous element. Other advances are more market-driven, like the “all-in” perspective embraced by United Imaging of Houston, Texas, which turned heads at AHRA by announcing that its imaging scanners would be sold “fully configured, with all available software and functionality from the outset,” in a nod to “clinical flexibility and also investment transparency,” the company said in a press release, “because the health care provider does not have all of the hidden costs of future upgrades to add new services down the road.”

“What we’re seeing is everyone position themselves for the future,” Smith said. “I think with the newer scanners and newer technology coming out, it’s really making it easier to use. Two years from now, your average X-ray or MRI is going to be sub-20 minutes, and the image quality is going up with it.

“I think each vendor’s advances are pushing the other vendors to stay up,” he said. “One may create something really cool, technology-wise, and the other vendors come up with something to match that.”

While Smith agrees that the biggest throughline for medical imaging in 2021 remains staffing concerns, he also foresees a cooling-off in the market for travel positions in the coming months.

“There’s so many jobs that right now, I could leave my profession, go into traveling, and I’d be set,” he said. “I’d always have a job ready to go as soon as I’d finished. I think it’s a temporary bubble. I really feel like once everything levels itself out, those positions are going to get filled; there’ll be less jobs, and people will want to tie themselves to some sort of stability.”

Even if the job market corrects itself in the coming months, Smith also knows that new hires won’t necessarily command the same level of institutional knowledge that a veteran employee does. He’s an advocate of additional training for technologists, whenever possible, “to get the right type of imaging out to the right people, so they can be the most cost-efficient and get everything they need.”

“I want to be able to work more hand-in-hand with customers across North America to make sure that’s happening all the way around,” Smith said. “If that happens, we can get prepared for things like the lower reimbursement rate.”

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