Riverside Radiology: The X-factor is technology

Laurie Allen
Drs. Douglas Reader, left, and Mark Alfonso, Riverside Radiology

With proprietary technology and an operational philosophy of “right image, right radiologist, right time,” Riverside Radiology and Interventional Associates has grown into one of the nation’s largest radiology practices.

The same radiologists who read exams for the Columbus Blue Jackets also serve military veterans in Cleveland and patients in Logan. “It’s the same quality of care, regardless of where you are—a 20-bed hospital or a tertiary-care center,” says Dr. Mark Alfonso, chief medical officer for LucidHealth, the physician-led company that provides infrastructure and management for Riverside Radiology and similar practices.

“We made a tremendous investment in proprietary technology and infrastructure to create 100 percent subspecialty coverage with higher quality and better outcomes,” Alfonso says.

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Extending subspecialty care beyond major medical centers keeps patients closer to home while saving time, money and unnecessary testing or procedures, says Riverside Radiology President Dr. Douglas Reader.

Riverside Radiology and Interventional Associates was formed in 1980 at its namesake OhioHealth Riverside Methodist Hospital. It now is the sixth-largest radiology practice in the U.S., serving 32 hospitals and 60 emergency and outpatient centers in Ohio, from Findlay to Marietta. About 110 radiologists provide round-the-clock subspecialty coverage in a dozen different areas, including vascular, interventional and emergency radiology; musculoskeletal imaging; neuroradiology and stroke. The physician-owned and -led practice is one of a handful in the country to be accredited by the Joint Commission.

Riverside Radiology’s proprietary technology gives physicians access to critical information about patient history that has traditionally been cumbersome to obtain. It also manages work flow in a way that brings decision-making data into view more seamlessly.

Clinical decision support algorithms help determine which radiologist is best qualified for a particular case, what type of exam will be most useful, and when imaging should occur, says Jason Guagenti, vice president and executive director. “The goal is right image, right radiologist, right time,” he says. Real-time peer review and analytics provide additional layers of quality assurance.

Software technology called RadAssist gives radiologists ready access to imaging studies done previously, regardless of location, which is significant when an estimated 30 percent of patients move between unrelated health care systems, Alfonso says.

“That’s a tremendous value,” Reader says. “We are practicing at a much higher level than 15 years ago.”

By carefully aligning patient, physician and test, Riverside Radiology practitioners can make quicker, more definitive diagnoses, which in turn inform the course of treatment. In the field of orthopedics, for example, that may mean choosing physical therapy over surgery, Reader says.

In the era of value-based medicine, third-party payers look for imaging and interpretation at lower cost, less unnecessary testing and intervention and demonstrated excellence, Guagenti says. Independent practices aren’t bound by the same cost structures as hospitals, which makes them less expensive to operate, Guagenti says.

Alfonso says each radiologist in the practice has a list of the cases he or she is best qualified to interpret. For example, a test ordered by an orthopedic specialist will be read by a musculoskeletal radiologist, who then generates a report in a way that is most meaningful to the referring physician.

“Physicians trust our reads,” Guagenti says. “If the physician doesn’t trust you, it results in re-imaging.” The filtering process also mitigates burnout, which is estimated at about 70 percent, he says.

Especially in smaller community health care settings, radiologists face being overtaxed with the volume and scope of images they are required to interpret, says Dr. Tom Harmon, vice president for medical affairs at OhioHealth Riverside. By funneling the work list, “It helps everybody focus on what they do well.”

Harmon says OhioHealth uses Riverside Radiology so it can reliably deploy radiologists to the growing number of communities it serves. “It helps us in a reputational sense, and it can bring people in” to the OhioHealth system. Riverside contracts with other independent physician practices for emergency, pathology and anesthesia services.

With a medical director at each site and radiologists who travel to the various network locations, patients can remain in their own communities for many exams, interventional procedures and hospital stays. More complicated cases that require specialized equipment or personnel are referred to larger centers such as Riverside.

Alfonso says physicians develop relationships with local hospitals and the communities they serve. In Marietta, Riverside Radiology’s team of seven radiology subspecialists live in the community. “Local presence is vital,” he says. “They are there to complement the needs of the local health system.”

Riverside Radiology’s growth plan continues to leverage artificial intelligence to prioritize work flow and fine-tune diagnosis and follow-up. On the horizon is use of an algorithm that detects if a patient coming to the hospital with a brain bleed needs to be moved to the top of the scheduling list for testing, Guagenti says. “It’s not taking over the radiologist’s job but enhancing it.” Other initiatives focus on lung nodule tracking and hard-to-detect cervical spine fractures.

The process of bringing in additional radiologists and hospitals is thoughtful and deliberate, Alfonso says. “We’re looking for groups that share the same vision we do: clinical integration, physician-centric, superior quality. Consolidation is happening everywhere, but in most cases, the groups are still functioning as isolated silos.”

The opportunity to read for both high-end athletes and residents of small rural areas appeals to radiology specialists likely to gel with the practice, Alfonso says. “It’s why so many groups have joined us, in addition to economies of scale and shared technologies.”

LucidHealth is owned by the physicians at Riverside Radiology and Interventional Associates, Radiology Associates of the Fox Valley in Wisconsin and Excellere, a private equity firm in Denver, Colorado. Governance is in the hands of physicians, with an executive council identifying best clinical practices and developing strategies to execute them.

LucidHealth CEO Marcia Flaherty says the concept of continuity is integral to success. “We don’t consider care complete once we are finished interpreting an image. We continue to follow up.” A protocol started in Wisconsin tracks patients who have been flagged for additional testing and reaches out to referring physicians if the patient hasn’t had the test.

“There are a lot of consolidations out there, but consolidation is not enough,” Flaherty says. “We did the harder thing. We look at everything.”

Laurie Allen is a freelance writer for Columbus CEO.

100 E. Campus View Blvd., Suite 100, Columbus 43235

Business: Physician-owned practice providing radiology services to 32 hospitals and 60 emergency and outpatient centers throughout Ohio.

Leadership/owners: Douglas Reader, MD, president; Peter Pema, MD, vice president; Douglas Heintzelman, MD, secretary, treasurer; and Jason Guagenti, vice president and executive director

Employees: 131

2018 revenue: Would not disclose

Patients served in 2018: 1.7 million

Riverside Radiology and Interventional Associates