Continuous improvement is an oft-repeated catchphrase, but achieving it while maintaining or even ramping up efficiency can be difficult. That was the dilemma faced by Tacoma, Washington-based MultiCare Health System (MHS) in 2009. “We wanted to be able to close the loop on our quality assurance, getting the results of review back to the individual radiologist for his or her input,” recalls Andrew Levine, MD, Chair of the Executive Committee at Medical Imaging Northwest, one of three radiology groups serving the health system. “We needed a system that was integrated into the PACS so the radiologists wouldn’t have to go find a piece of paper and fill it out, interrupting their workflow.”

As accountability in health care becomes an increasingly critical priority, many anticipate a future in which radiologists are employed by hospitals attempting to share risk and align incentives. Accountability can be achieved without employment, however, according to Carl Black, MD, of Utah Radiology Associates (URA), Orem/Provo, a 24-physician practice covering five hospital systems, including the oft-lauded Intermountain Healthcare (Orem). The practice’s relationship with Intermountain Healthcare was the subject of a presentation made by Black on July 28, 2013, in Minneapolis, Minnesota, at the annual meeting of the AHRA

Clinical analytics for radiology practices, in its current form, is defined by nothing so much as its limitations, according to Benjamin Strong, MD, CMO of Virtual Radiologic (vRad). “Practices don’t have the kinds of actionable insights they should, in terms of study characteristics, study mix, referring patterns, workflow, RVUs, and so on,” Strong says. “It’s something with which practices are struggling, if they’re even aware that they don’t have the analytics they need. We were managing blind during the good old days, and that continued for so long that many people don’t even miss analytics.”

On July 16, CMS announced the results1 of its accountable-care organization (ACO) program, the Pioneer ACO Model. The program was designed to test the impact of higher levels of shared savings and risk on ACO success, and it attracted 32 participants from around the country. After the first year of participation, seven Pioneer ACOs that did not produce shared savings announced their intention to transition to the lower-risk (and lower-reward) Medicare Shared Savings Program, while two dropped out of the ACO model entirely.

Few would disagree that it’s increasingly difficult to operate as a freestanding imaging-service provider. Reimbursement continues to face pressure, patients have become more savvy regarding their copayments, and increased competition from hospital operators has caused industry participants to become intensely focused on cost efficiencies. We have entered an environment where economies of scale and focused expertise will correlate with enhanced competitive advantages; consequently, we find evidence of increased partnerships and consolidations. One factor that stands to accelerate the partnership/consolidation trend is often left out of the conversation: The impact of the recession on capital investment in imaging equipment might soon create accelerated market activity, however.

Every business starts somewhere; even in the current period of radiology-practice consolidation, startups are popping up around the country. David Myrice, director of practice management for Medical Management Professionals (MMP), says, “Every so often, an opportunity still presents itself to form a new group.

When outpatient imaging center Ocean Radiology (New York, New York) opened its doors in South Brooklyn, seven years ago, the intention of Steven Polk, founder and owner, was to offer an unparalleled imaging service to the community. “We differentiated ourselves from the other imaging providers in the area by going with high-end equipment (which wasn’t common, around here) and with sophisticated studies that weren’t being done at the time,” Polk recalls. “The nearest hospital is an hour’s trip away, and having a study done there could take all day. We’re close to our patients’ homes, convenient, fast, and high quality.”

In the wake of the Cedars-Sinai CT overexposure scandal, California passed legislation in 2012 mandating the monitoring and reporting of CT-exam radiation dose; since then, dose-monitoring legislation has passed (or is being considered) in multiple states, and public awareness of radiation risk has been significantly heightened. Ian Judd, product manager for Sectra, says, “There’s been a lot of media attention in the United States, and in Europe as well. Due to instant access to information on the Internet, people are far more aware that radiation is a bad thing. What they haven’t been made aware of is that it’s a good thing, when used correctly.”