Saying, “I want it anyway,” the ICU physician insisted that his patient with breast cancer should get an MRI exam to look for lung metastases. My years of experience as a radiologist did not dissuade him; such a test would be a poor way to evaluate his patient’s lungs, even under ideal circumstances (which hers were not). She was on a ventilator, incoherent, and unable to hold her breath, rendering the study a useless waste of time and money. More important, her lungs, just days earlier, had been clear on a chest CT exam—the gold standard for detecting lung nodules. We already knew that she had no lung metastases.

Ask any health–IT executive for a synonym for change, and a probable response is merger/acquisition. The rapid pace of consolidation among physician practices, individual hospitals, hospital enterprises, and hospital-chain corporations has generated an unprecedented level of organizational, operational, and technological change.

It’s not a figment of your imagination: Radiology practices are getting larger via mergers/acquisitions. Hospitals are broadening their reach, using the same tactics, in their efforts to maintain regional influence.

From the man who imprinted the definition of value on health care’s collective forehead comes a prescription for the rescue of global health: Business guru Michael E. Porter (with Thomas H. Lee)¹ shares “The Strategy That Will Fix Health Care” in the October issue of Harvard Business Review. The article builds on everything that Porter has written on health care in the past to provide a solution with sheer simplicity at its center: Maximize value for patients by achieving the best outcomes at the lowest cost.

I read with interest the recent article by Cynthia Keen, “When a Hospital Replaces a Private Practice.”¹ The featured group is portrayed as an example of the type of practice that currently is being replaced by teleradiology companies. Poor customer service, substandard turnaround times, suboptimal call coverage, and lack of peer review are among the alleged failings.

June, a month long prized by brides, had a strong matrimonial pull on health-care providers, with a pair of announced mergers/acquisitions that created two massive health systems, one for profit and one nonprofit. Several other key mergers announced and expected to be completed this year highlight the diversity of the hospital players and their deals, but all share a common denominator: There is a pervasive ambition to grow.

Persistent decreases in outpatient imaging reimbursement and a dramatic decline in volume finally took their toll on the imaging-center market, with a resulting 3.65% decline in the total number of freestanding outpatient imaging centers. This is the first contraction since the dip that followed the stock-market crash in 2009.

In today’s health-care landscape, how can you expand your volume in the face of falling reimbursements, competition from larger health-care systems, and increasingly complex regulations? How do practiceas, imaging centers, and radiology departments increase revenue and margins—and address the challenges of patients’ tight budgets?