The radiology industry has seen its shares of ups and downs during the past two decades. “In 1993, health care was in a period of chaos much like the one we are experiencing right now,” Mark Talley, COO of Medical Management Professionals (MMP), says. “The biggest fear was that everything would move to capitation. As time went by and things settled down, there was a period of rapid growth in radiology, primarily driven by advances in imaging technology.” G. Darrell Hulsey, president and CEO of MMP, concurs. He says, “Clinically, radiology has made significant advances in the past two decades, all contributing to better and more streamlined care.”

Contracts between hospitals and radiology groups are evolving to reflect the shifting requirements of health care—and both parties can expect to continue to see changes, according to Stephanie Krent, an analyst with The Advisory Board. “What we have learned, from speaking with many hospitals and radiology groups, is that contracts need to be individualized to fit the relationship and to reflect current priorities,” Krent says. “It has to be a fluid process, with the contract continually updated to reflect how needs are changing and risk is shifting.”

Patient satisfaction is often misunderstood by health-care providers, according to William R. Johnson, CRA, MBA, RT, system director of patient experience with Memorial Health System (Springfield, Illinois). In Los Angeles, California, on April 10, at the 2013 spring meeting of AHRA: The Association for Medical Imaging Management, he presented “Patient Satisfaction: What It Isn’t, What It Is, and How to Do It Better.” He says, “It’s all about the patients’ experience of how they were treated as human beings. It’s about their perceptions of the caring they received during their clinical journeys.”

When the hospital is the buying party in an imaging joint venture, there are four potential issues that could terminate the transaction, all of which stem from due diligence. These issues include one or both parties failing to understand the distinction between fair market value and strategic value, conflicts surrounding how professional payments are determined after the transaction, collection irregularities or other problems with revenue recognition, and management and governance issues for the newly joint-ventured or acquired imaging center. All four of these transaction deal-breakers, however, can be avoided through understanding, preparation, commitment to communication, and setting expectations.

“Why make your RIS into an electronic health record (EHR) just to satisfy meaningful use?” David Avrin, MD, PhD, asks. It is a question that Avrin, professor of radiology and biomedical imaging at the University of California–San Francisco, has been asking (in one form or another) since the government’s program to provide incentives for the use of health IT launched. “There are people who have taken feeds from various systems into their modular-certified RIS platforms,” he continues, “and they have HL7 feeds coming in from every direction. Even though a RIS vendor may have the best intentions in creating a modular system, you’re still responsible for the other components.”

Here’s a confession: Though a bit of a snob about most of what’s on television these days, I’m obsessed with AMC’s “Mad Men.” I’ve watched every episode more than once, analyzing each for hidden meanings and recurring themes; I even read recaps online in case there’s anything I missed. An oft-repeated truism on the show, trotted out when its ad executives are dealing with clients in difficult situations, is: If you don’t like what’s being said, change the conversation. I wonder, sometimes, what the creative geniuses of the fictional ad agencies of “Mad Men” would make of imaging’s biggest current problem.

Radiology groups’ conversations with their hospital partners are undergoing an evolution, in the experience of Edward Rittweger, MD, president of Navesink Radiology (Red Bank, New Jersey). “In the past, most of the hospital discussions involving imaging have been about decreasing turnaround times and increasing efficiency in response to decreased reimbursements,” he says. “As we move forward, however, it will be more important for the radiology group to assist the hospital in developing metrics to evaluate how imaging adheres to decision-support mechanisms and evidence-based care protocols.”

All over the country, radiology practices are merging, consolidating, and forming networks in order to grow in size and, in theory, negotiate from a more powerful position while making the most of economies of scale. Tom Vaughan, MD, president of Kent Diagnostic Radiology Associates (Dover, Delaware), points out that the emphasis on growth raises some challenging questions, from a practice-management perspective. He says, “As you grow from being a small practice to being a large one, management becomes much more challenging. In some ways, it can be a luxury to be small.”