How CRL meets evolving customer needs
CRL’s President, Christopher Tillotson, MD, reflects on the reasons for the Practice’s longterm success. Article also featured in this month’s edition of Metro Doctors.
MINNEAPOLIS, June 30, 2015 – Consulting Radiologists, Ltd. (CRL) is an independent radiology group based out of Minneapolis. At the time of its inception in 1971, CRL was a practice centered at Abbott-Northwestern Hospital with a radiology staff in the single digits. When I came to CRL in 1989, I was the 18th radiologist. By then CRL had expanded to Buffalo Hospital and Ridgeview Hospital in Waconia. Today CRL has 70 radiologists, 27 on-site locations and a robust teleradiology business. Our network provides on-site services from Duluth in the north, New Ulm in the south, Woodbury in the east, to Watertown (South Dakota) in the west. CRL does not operate under a professional services agreement (PSA) with any of its clients. We have simple contracts with renewal periods of one to three years and in some cases, no contract at all.
After 44 years of existence, why does CRL continue to remain a vibrant and independent practice? Before delving into some specifics about our practice, let me first say that all the strategy and tactics imaginable cannot offset poor quality and lack of service reliability. To that end, CRL is a physician-led practice with myself as President and with a Chairman of the Board and Board of Directors who are all physicians. In the past, CRL had utilized a non-physician CEO, but the group decided to change to the current format in 2009. The members of CRL knew that only through physician leadership could we fully realize our potential and be in a position to best respond to the rapidly changing healthcare environment in the upper Midwest. CRL also has a variety of physician-led and staffed committees in technology, quality, finance and medical staff affairs. The involvement of so many physicians in the leadership of our practice puts us in the best possible position to understand our market and clients in order to tailor our business and development plans. Also, the high degree of physician involvement promotes cohesion and more fully leverages our intrinsic talents.
In addition to our physician leadership model, I would like to discuss three additional characteristics of our practice, which have allowed us to remain thriving and independent: size, diversification and cooperation.
SIZE
Of course CRL did not set out to be a large group first and find our business opportunities second. We have grown intentionally and incrementally over time as new opportunities became available. The value of size, and by this I mean a group of 30-40 physicians or more, is threefold.
First, a larger size allows short-term flexibility in taking on new opportunities without having to specifically hire for them. The new work is distributed across a large group and incrementally there is not a marked change in any one person’s workday. This is greatly aided by our PACS system, which allows work to be evenly distributed regardless of the site of origin or the location of the radiologist. This permits CRL to act on promising opportunities in the near term without having to specifically hire, a process that typically takes 6-9 months to complete.
Second, a larger size allows CRL to reasonably afford a robust infrastructure in our business office. At the executive level we have a CFO, COO, CIO and Chief of Strategy and Development. There is an additional staff of over 75 employees in place for IT, billing, marketing and site & workflow management. In the same way that we distribute new work over many radiologists, there are similar economies of scale in distributing the administrative duties as well. As such, it takes little incremental effort to accommodate the next new opportunity.
Lastly, a larger size allows a high degree of subspecialization among the radiologists, which is necessary in a sophisticated medical community such as the Twin Cities. This has become even more essential given the current PACS environment, which allows images to be easily available regardless of location. Subspecialization is also an asset for marketing to new clients, especially in out-state areas that may have been underserved in the past. CRL has fellowship-trained subspecialists in breast, body interventional, neurointerventional, musculoskeletal, diagnostic neuroradiology and nuclear medicine. We also employ a large number of general radiologists as well. This diversity and size also permits possibilities for flexible work and vacation assignments. All in all, this improves CRL’s ability to recruit and retain the best physicians.
DIVERSIFICATION
A second critical feature of our success is the diversification of our book of business. As mentioned above, CRL currently provides services at many locations. These locations are broadly diverse and include our flagship quaternary hospital, Abbott-Northwestern, as well as multiple regional hospitals in Duluth, Hutchinson, Cambridge, Shakopee, Buffalo and Waconia. CRL also provides services at many smaller hospitals in places such as New Ulm, Faribault, Northfield, Mora and Glencoe to name a few. CRL also has several wholly owned or joint-ventured imaging centers throughout the Twin Cities area. Lastly, CRL has over 20 teleradiology contracts throughout the local 5 state area providing daytime and afterhours coverage for hospitals and other radiology groups. This variety of locations, sizes, providers, modalities and payer-mixes protects CRL from being overly vulnerable to a particular source or untoward event such as the acquisition of a hospital by an entity, which mandates an employment model for physicians.
Diversification also exists within our internal capabilities as a result of our overall size. In addition to the usual radiology services, CRL expands its revenue stream by providing additional services to clients in areas such as billing, PACS, transcription and outside quality assurance reviews. Just as with our radiologists and management team, the next new client can be added to the pre-existing workload with very little incremental cost.
COOPERATION
The last area I want to touch on is our effort to cooperate with several other local radiology groups, which are independent as well. This initially started around the fact that CRL, as well as Suburban Radiologic Consultants (North) and St. Paul Radiology, have all had significant commitments over many years to Allina to provide radiology services. Over time we have come to realize that it is in the best interest of ourselves and Allina that Allina’s radiology services be as uniform and integrated as possible across their entire network. In response to that need, about 12 months ago, the leadership of the three groups began meeting regularly to develop a sense of trust and common cause.
Recently, these radiology groups and Allina have come together to form two new committees, one strategic and one operational in nature. These committees identify and operationalize, respectively, the changes necessary to achieve Allina’s goals. Throughout this process the lines of communication and interaction between the groups have greatly improved. This by itself is of great worth as all three groups value their independent status. By removing opportunities for misunderstanding and working together instead of against one another, we pave the way for continued satisfying, autonomous practices.
In summary, as in any business, deliverable quality and reliability always comes first. We at CRL feel that through physician leadership we can best achieve this goal. By virtue of its size and diversification, CRL has managed to remain an independent, dynamic and progressive practice without outside assistance or PSAs. Through a willingness to engage and cooperate with other local radiology groups we further our ability to make progress and peacefully coexist.
Dr. Christopher Tillotson joined Consulting Radiologists, Ltd. in 1989 and currently serves as the President of the company. Tillotson, MD is also a Musculoskeletal Radiologist for the practice.