Orthopedic practices are no strangers to pursuing optimum patient satisfaction with imaging as part of a growth strategy; in fact, their growth is often dependent on it. Dale Ingram, CEO of the Cardinal Orthopaedic Institute (COI), Columbus, Ohio, says, “Of our MRI patients, 98% came from within our practice—we get very few patients from outside referrals. Imaging plays a big role in whether patients are satisfied with our service. They don’t have to go somewhere else and re-register, and it also helps with their continuity of care—our radiologists are here in the building and can talk to our physicians at any time. Every aspect of the process is easier for patients.”

Whether given incentives by the continued cuts in reimbursement levels or by the desire to monetize an operating asset, radiologists in the market continue to sell their imaging centers to buyers of many kinds—for-profit imaging-center owner/operators, for-profit hospitals/health systems, and not-for-profit hospitals/health systems, among others. Although the sale of the imaging center transfers all (or a portion of) the ownership to the buyer, there are still opportunities for radiologists to remain involved in the business. Specifically, many radiologists continue to provide exam interpretations and/or specific management services.

As the momentum concerning accountable-care organizations (ACOs) continues to mount, forward-looking radiology groups already are anticipating participation in bundled-payment initiatives, according to Ed Gaines, JD, CCP, chief compliance officer for Medical Management Professionals (MMP). “There are large hospital systems, nationwide, that have been running bundled-payment models for years, and there are significant data out there about the improved outcomes and lower costs that can result from these models,” he says. “Radiology is not being confronted with the problem just yet, but there is growing recognition that the specialty needs to be prepared and educated on the subject.”

Boca Raton, Florida, became a competitive market for medical imaging when entrepreneurial nonphysicians began opening freestanding imaging centers in the late 1990s and early 2000s, Carl Rosenkrantz, MD, a radiologist with West Boca Medical Center (WBMC), recalls. “In South Florida, hospitals were reluctant, early on, to get into the outpatient imaging center business, and a tremendous number of nonphysicians got into the business just to make a profit,” he says. “A huge amount of marketing was done concerning them, and patients became accustomed to going to these freestanding centers that were not hospital affiliated.”

When Hurricane Sandy and its aftermath devastated New York, New York, in October 2012, perhaps no one was more vulnerable than the patients needing care in area hospitals. Eli Tarlow, CIO of the city’s Bellevue Hospital Center (BHC), recalls, “It was the best of times and worst of times—a natural event that no one could have prevented. You really see the best of your staff in moments of crisis, and that held true during Hurricane Sandy. Staff members at all levels volunteered to do anything necessary, from bringing needed supplies up and down many flights of stairs to helping with preparing or delivering food for patients. Nothing came between the employees and the work that needed to be done to maintain patient care.”

It seems that I was not the only one alarmed by “Bitter Pill,”¹ about which I wrote in my commentary last month. In a meeting the week after the article hit newsstands, the discussion of the American Enterprise Institute (AEI) about hospital consolidation took a turn for the accusatory, with the pro–free-market organization concluding that the hospital market is broken.

The ACR will “aggressively fight any approach” that does not incorporate decision support and appropriateness criteria, vows ACR official in her reaction to the budget.

When CMS expanded the MPPR methodology to include the professional component of imaging, the argument was that it was a fair and valid to discount subsequent reads after the first read by 25 percent because there are efficiencies in reading multiple scans. A new JACR study finds this is not so.