American Medical Association cautions radiology groups considering corporate investments
The American Medical Association is cautioning physician practices in radiology and other specialties that may be considering accepting corporate investments.
Late last month, the AMA released new survey data showing that about 46.9% of radiologists work in a setting wholly owned by physicians, down 16.7 percentage points since 2012. Amid a “rise in corporate investment,” physicians and med students recently voted at the AMA Annual Meeting in Chicago to strengthen guidance for docs considering partnering with monied interests.
This new advice emphasizes that clinical and operational decisions must “remain in the ultimate control” of the radiologist or other clinician, the association said Monday.
“The AMA supports a physician’s right to choose their mode of practice and urges physicians to carefully consider the risks and benefits associated with corporate relationships,” Board Member Marilyn J. Heine, MD, an emergency medicine and hematology-oncology specialist, said in a statement June 9. “If a physician elects to enter into a corporate relationship, that choice should be made with important safeguards to ensure clinical autonomy and authority over patient care are retained by the physician.”
Outside investments from private equity or other such entities can offer benefits to radiology groups, freeing physicians from financial and operational responsibilities so they can focus on patient care. However, these arrangements also come with downsides, intruding on clinical decision-making and eroding radiologist autonomy, possibly impacting patient outcomes and care quality.
The AMA’s newly updated guidance outlines clinical and business decisions that should remain in the control of radiologists and other physicians, including:
- Determining which imaging or other diagnostic tests are appropriate.
- Weighing the need for a referral or consultation with another clinician.
- Deciding how many hours a radiologist should work or how many imaging exams he or she should process in a defined period.
- Selecting, hiring or firing radiologists and other medical staff based on clinical competency or proficiency.
- Setting the parameters under which a radiologist or imaging group shall enter contractual relationships with third-party entities.
- Making decisions around coding and billing procedures for patient care.
- Approving the selection of imaging equipment and other supplies.
The new AMA guidance also calls for agreements between radiologists and corporate entities to include “clear protection” and dispute resolution processes when rads advocate on patient care and quality issues.
“Many physicians are rightfully concerned about the loss of professional control that could arise from partnering with a corporate entity,” said Heine, who is based in southeast Pennsylvania and is an assistant professor at the Drexel University College of Medicine in Philadelphia. “At the same time, physicians may value corporate investment as an option to free private practices from the cumulative impact of burdensome regulations, rising financial strain, and relentless cuts in payment. The underlying challenges to physician practice viability and stability must be better addressed so independent physician practices can thrive without the need for corporate investment.”
About 12% of all radiologists in the U.S. work for private equity-backed entities, up sharply from estimates tallied 10 years ago, according to research published in March. Private equity-backed practices accounting for the largest proportion of employed radiologists nationally as of December 2023 were Radiology Partners (70%), LucidHealth (8%), and U.S. Radiology Specialists (7%). Other PE-backed players in imaging include SimonMed Imaging, Rezolut, Solis Mammography, Premier Radiology Services, Capitol Imaging, Rayus Radiology and MedQuest Associates, among others.