In recent years, the leadership of Advanced Diagnostic Imaging (ADI) noticed that its market of Nashville, Tennessee, was experiencing an increasingly common trend. Chad Calendine, MD, president of ADI and CMO of Optimal Radiology Partners (ORP), says, “The national partnership we formed last year with ORP validated our observations that in many markets, health systems have begun—in earnest—to employ their referral base. As health systems employ those physicians, you can be in jeopardy of having your referral base hired away. It’s a well-known vulnerability for radiology practices and imaging-center owners, but options for addressing the problem can be limited.”

The ongoing success of the imaging-center industry has resulted in the proliferation of operating and management companies; this, in turn, has resulted in the increased acquisition of controlling interests in the imaging centers by the operators. By gaining a controlling interest, the operating company is able to bring substantial experience and negotiating clout to the venture, typically enhancing value. The success of these partnerships, combined with this increased demand, has resulted in the willingness of these operating and management companies not only to acquire controlling interests in imaging centers, but to do so at a premium.

Allison Breast Center in Richmond, Virginia, has always conducted business according to a patient-centered philosophy. Michael Bigg, MD, JD, who owns the women’s imaging center, says, “Our business model is providing a very personalized service to our patients.” Gillian Bigg, SRN, general manager of the center, says, “They receive their results from Michael Bigg before they leave. The physician goes over the results with the patient before the patient’s departure, resulting in there being no call-backs. They appreciate the same-day results, as well as not having to return for any additional imaging.”

In the years since the announcement of the federal meaningful-use program, the radiology community has been abuzz with discussion about how to meet several of the challenges that it has presented: interoperability with referring physicians; sharing not just of radiology reports, but of full imaging datasets as well; and recording of patient health information that had not previously been considered the domain of radiology. One goal of the program is less frequently discussed, however: deepening patient engagement and empowerment through encouraging the use of personal health records (PHRs).

When Medical Imaging LLC (Tupelo, Mississippi) needed to replace the MRI systems in two of its imaging centers, the practice faced an increasingly common challenge: Although both of the centers needed new equipment, the practice couldn’t afford to purchase two advanced imaging systems at the same time. “We need to conserve capital,” Lee Frans, executive director of the practice, explains. “As we wait to see how the health-care environment pans out over the next few years, we need to be cautious.”

On October 1, 36 states launched new health-insurance exchanges, beginning the influx of new patient volume for which the health-care community has been preparing itself since the passage of the Patient Protection and Affordable Care Act. For radiologists, who have been trying to redefine themselves in the eyes of patients for several years now, these new customers represent a once-in-a-lifetime opportunity, according to Harry Purcell, operations manager for Zotec Partners. “Radiologists have the chance to reinvent their image as more high-touch and integrated,” he says. “It will be key for forward-thinking groups to start making changes now.”

Mention the term “workflow” and a common response is a roll of the eyes. That’s because the medical imaging facilities that have not yet achieved optimal workflow are experiencing extreme frustration while the facilities that have constructed reliable, systematic workflow are always looking for more.

Over the past five years, leaders on both the clinical and business sides of radiology have learned the hard way that adaptability and flexibility are prized qualities required for survival.