Radiology CEO discusses bankruptcy and why he’s optimistic about his company’s second-chance future

Plantation, Florida-based radiology provider Akumin Inc. made headlines last year when it filed for Chapter 11 bankruptcy protection, seeking to cancel $470 million in debt. Radiology Business sat down with the organizations new CEO, Krishna Kumar, MBA, who took over the role in February, the same month the organization emerged from bankruptcy. 

Kumar spent 13 years with Philips before joining Akumin in June 2023 as chief operating officer. He later ascended to chief executive, replacing longtime president and CEO Riadh Zine, who stepped down from the role in February. At Philips, Kumar most recently served as senior VP and business leader in precision diagnostics. Before that, he was president and CEO overseeing Philips’ healthcare business in India. 

At the Radiological Society of North America’s annual meeting in Chicago, Kumar discussed Akumin’s new owner, lender Stonepeak, products it introduced at the conference, and why the company views radiology and radiation oncology as a “closed loop.” 

Radiology Business: What interested you in leaving the vendor side of radiology and joining an organization like Akumin? 

Krishna Kumar: There are three big shifts taking place in radiology. Radiology and oncology are coming together as a closed loop. If you look at most cancers today, they are moving toward targeted therapies, which require theranostics and diagnostics. Part of my role at Philips involved introducing the first FDA-approved digital pathology solution to the world. But Philips never had a focus on theranostics or on therapy. So, for me, the first key attraction is that Akumin is the only player in the world that is in both radiology and radiation oncology. We have a fleet of over 150 PET/CT scanners, which is one of the largest in the country, and we do the largest PET/CT volumes of any healthcare provider, including health systems as well as private freestanding providers. The field of theranostics is advancing very, very rapidly with several new tracers coming out almost every quarter. So, the opportunity to truly advance both diagnostics and therapy for cancer is very exciting. That’s Opportunity 1. 

The second is the whole space of radiology and radiation oncology is still in relative infancy. If you look at the total addressable market in radiology, it is more than $100 billion. That’s the sum total of all billings and global reimbursements for all providers, including health systems as well as freestanding centers. Radiation oncology is another $15 or $16 billion. HCA is the single largest provider of radiology services today in terms of total revenues, handling about 3.5% of the volume. The industry is so fragmented that it’s a super long tail. The top 20 players together account for less than 20% of the total radiology market. So, it’s a highly fragmented market, and we have massive headroom for growth. That’s the second big reason why. 

The third is we have a unique opportunity to truly transform radiology and migrate to what we call autonomous workflows. That will take quite a lot of trial and error to get there, but all three are powerful shifts that we have a unique opportunity to drive. 

What is an autonomous workflow?

Krishna Kumar: If you take the workflow of radiology, it starts with an order coming in from a physician, and then we schedule the appointment. We get prior authorization done for the patient. Then the patient comes in to get scanned, and the images are sent to the radiologist who does the reading and the reporting, and the report flows back to the referrer. That completes the loop. If you look at that workflow today, end to end, all of that is highly manual. There are many point solutions with AI available today on the market. If you walk around the show floor at RSNA, AI is the talk of the town, and it has been for the last five years. But almost every offering, without exception, is a point solution. Radiologists use clinical AI for a first read or to do quantifications, and then there’s operational AI, where I can automate a lot of that workflow in our clinics. 

The big opportunity is to ask why patients have a bad experience in some clinics but a great one in others. It’s because these processes are so dependent on humans. You still want to retain the human element for the patient experience to be great, but you want it supported by AI- and informatics-enabled workflows. That then reduces the variance in experience that each patient has at each clinic. The combination of the three—driving diagnostics to theranostics for cancer, scaling economies in a fragmented market, and autonomous workflows—is a very powerful, once-in-a-lifetime opportunity.

Why is it that more don’t deliver both diagnostic imaging and radiation therapy, as Akumin does?

Krishna Kumar: That is such a great question. If you look outside the walls of the U.S. at the diagnostics industry around the world—Germany, Brazil, etc.—most players handle both radiology and pathology under one roof. In the U.S., we have radiology pure plays whereas, elsewhere, most are recognizing the power of combining radiology and pathology for integrated diagnostics. But therapy has always been kind of held separate by most. We at Akumin see diagnostics and therapy becoming a closed loop, particularly with cancers. Intelligent diagnostics enable precision targeted therapy, and therapy requires monitoring for efficacy and safety. That brings us back to theranostics. So many see it as a pure play because there’s so much opportunity in radiology alone. But our goal is to stay focused and act as an integrated player from radiology to radiation therapy, within certain micro markets. 

How are things with the organization since you exited bankruptcy in February? 

Krishna Kumar: A lot has changed. We have a brand-new leadership team, for starters. February is when Stonepeak, which is a large infrastructure fund, became the 100% owner of Akumin. 

Are they considered private equity? 

Krishna Kumar: You could call them private equity, but what’s different about Stonepeak is they essentially started about 13 years ago as a dedicated infrastructure fund with logistics a big focus for them. About two and a half years ago, they realized that they also needed to look at social infrastructure, which is health and education. They assessed a number of different players in the industry and chose Akumin as their first healthcare investment. Stonepeak has a longer-term investment horizon compared to traditional private equity, which typically holds assets for three to five years. For Stonepeak, eight to 12 years has been their typical investment horizon. Our relationship has gone really well with them because, once they own an asset in this space, they stay with it for a long time. 

The other key thing that’s changed is we now have a brand-new, world-class leadership team. Each of our leaders is very accomplished in their respective areas of expertise and come with very high integrity. We’ve been steadily rebuilding and preparing Akumin for scale over the last year. That’s the reason you haven’t heard from us for the last nine months: We’ve been busy building the foundations for scale and delivering on the promise of those three key opportunities we talked about. 

Did you have to shed any unprofitable divisions or was there some paring down during the bankruptcy process?

Krishna Kumar: Yes, Akumin went through the Chapter 11 process, but unlike traditional bankruptcies, there is not a single creditor or debt provider taking a haircut here. The reason Stonepeak routed this through Chapter 11 is because it allows us to have a clean start with no liabilities that carry over from the past. That’s important when you are rebuilding a company for the future. We are in a rebuild-and-grow mode rather than a pare-down mode.

Do you think Akumin learned anything from the bankruptcy process? 

Krishna Kumar: The foundation must be rebuilt with a patient-first mindset. That is the most important transformation for any company—returning to the roots of healthcare. Other than that, the bankruptcy issue arose because of debt overhanging the company, but liabilities have been pared down now. 

Your acquisition of Alliance Healthcare Services was the biggest driver of that debt, correct? 

Krishna Kumar: Yes, the acquisition was for about $820 million. 

Do you think there is any regret in the company about taking on that deal? 

Krishna Kumar: I actually think it gives us a big platform from which to scale. The reason we are able to launch Akumin Axis is because we have the Alliance platform and because Alliance was in mobile imaging and Akumin was in fixed-site imaging. When you’re able to bring those two strengths together, you create a hybrid category in the middle, which is what Akumin Axis offers now.

That was my next question. Could you talk a little about how you came up with the idea for these new ‘relocatable and expandable’ imaging centers? 

Krishna Kumar: We serve more than 1,000 health systems in 47 states. As I traveled across the country in my first three months as CEO, I was constantly hearing the same No. 1 challenge: Radiology and oncology are too expensive. They have high capital costs. When you add to that construction time and frequent delays, that just compounds the capital requirements. Add in staffing shortages—which have been huge in this industry, with demand continuing to outpace supply—and it has really proven a big challenge for most health systems to create access to care.

This became a recurring theme when I met health system leaders. While Akumin is by far the leader in the U.S. when it comes to mobile imaging, the distinction comes with a few limitations, such as you cannot de-bottleneck that capacity. Most mobile imaging units only have one PET/CT scanner and no flexibility to add additional uptake rooms. Most health systems were telling us: Give us access to a hot lab, three uptake rooms and a PET/CT, because everyone has seen theranostic volumes grow quite dramatically. That’s when we put together a small, passionate team that was excited about the opportunity, and we gave them a tough timeline to launch this at RSNA. 

Did you run into any regulatory issues when creating this offering? 

Krishna Kumar: Akumin Axis comes with all of the necessary shielding. We do this bread-and-butter stuff for all our mobile units across the country. These are hurricane proof and designed to be seismic proof as well, and they meet all the necessary requirements for PET/CT or other modalities. We are an exclusive patent holder, too. What we introduced at [the American Society for Radiation Oncology meeting] this year is the Akumin Axis unit with a linear accelerator for radiation therapy. The rest of the concepts are roughly the same as what we do in a traditional mobile imaging unit, but this meets all the regulatory and quality requirements that you’d expect. 

Can you also talk a little about the center of excellence you are building in your home city of Plantation, Florida? 

Krishna Kumar: Plantation is by far one of our busiest sites in the country. We’ve built Plantation to become a theranostic center of excellence for us, where we are launching the most state-of-the art digital PET/CT and theranostics unit, along with the most advanced 3T MRI in the country. That allows us to advance care for our high-volume site.

Another big thing we are doing with our Plantation site is putting up a 15-seat radiology command center to introduce subspecialty technologists to support all of our sites across the country. We have a fleet of more than 450 MRI scanners today, and every technologist now has access to a team of super-subspecialized techs for the first time in our industry. For example, if you need to do a cardiac MRI at one of our sites in Massachusetts, and the tech there is not well-versed with cardiac MR—the volumes are very low in cardiac MRI—the inexperienced tech can reach out to a peer expert in Florida. The expert tech can provide quality oversight from our center of excellence to every tech anywhere in the country.

What other things are you keeping an eye on at RSNA? 

Krishna Kumar: AI is of particular interest for us, as it is for everyone else. Our interest is in both clinical and operational AI to be able to deliver on our vision of making autonomous workflows a reality. Super exciting. That’s one thing. Apart from the opportunity to meet with most customers here for our own operations, being able to meet with most of the AI companies in this space and really understand what’s going on is of huge value.