When Peoria, Illinois-based OSF HealthCare transitioned from analog to digital imaging, one aspect of the radiology continuum proved challenging: quality assurance. “We had a fairly robust, paper-based QA process when we were film and paper,” recalls Tom Cox, director of radiology at OSF Saint Francis Medical Center (SFMC). “When we went to PACS and went paperless, however, we virtually stopped getting feedback from the radiologists on quality. We knew we needed something to replace the paper process.”

Radiologists and hospital administrators are finding common ground when it comes to one significant conundrum, according to Richard Duszak, MD, CEO of the ACR’s Harvey Neiman Health Policy Institute. “We are moving from a system where we got paid for doing procedures to one where we will get paid for taking care of patients,” Duszak said in a presentation at the 2013 conference of AHRA: The Association for Medical Imaging Management, held July 28-31 in Minneapolis, Minnesota. “The big word is value, and it’s going to be a real challenge for physicians and hospital administrators.”

Continuous improvement is an oft-repeated catchphrase, but achieving it while maintaining or even ramping up efficiency can be difficult. That was the dilemma faced by Tacoma, Washington-based MultiCare Health System (MHS) in 2009. “We wanted to be able to close the loop on our quality assurance, getting the results of review back to the individual radiologist for his or her input,” recalls Andrew Levine, MD, Chair of the Executive Committee at Medical Imaging Northwest, one of three radiology groups serving the health system. “We needed a system that was integrated into the PACS so the radiologists wouldn’t have to go find a piece of paper and fill it out, interrupting their workflow.”

As accountability in health care becomes an increasingly critical priority, many anticipate a future in which radiologists are employed by hospitals attempting to share risk and align incentives. Accountability can be achieved without employment, however, according to Carl Black, MD, of Utah Radiology Associates (URA), Orem/Provo, a 24-physician practice covering five hospital systems, including the oft-lauded Intermountain Healthcare (Orem). The practice’s relationship with Intermountain Healthcare was the subject of a presentation made by Black on July 28, 2013, in Minneapolis, Minnesota, at the annual meeting of the AHRA

Clinical analytics for radiology practices, in its current form, is defined by nothing so much as its limitations, according to Benjamin Strong, MD, CMO of Virtual Radiologic (vRad). “Practices don’t have the kinds of actionable insights they should, in terms of study characteristics, study mix, referring patterns, workflow, RVUs, and so on,” Strong says. “It’s something with which practices are struggling, if they’re even aware that they don’t have the analytics they need. We were managing blind during the good old days, and that continued for so long that many people don’t even miss analytics.”

On July 16, CMS announced the results1 of its accountable-care organization (ACO) program, the Pioneer ACO Model. The program was designed to test the impact of higher levels of shared savings and risk on ACO success, and it attracted 32 participants from around the country. After the first year of participation, seven Pioneer ACOs that did not produce shared savings announced their intention to transition to the lower-risk (and lower-reward) Medicare Shared Savings Program, while two dropped out of the ACO model entirely.

Few would disagree that it’s increasingly difficult to operate as a freestanding imaging-service provider. Reimbursement continues to face pressure, patients have become more savvy regarding their copayments, and increased competition from hospital operators has caused industry participants to become intensely focused on cost efficiencies. We have entered an environment where economies of scale and focused expertise will correlate with enhanced competitive advantages; consequently, we find evidence of increased partnerships and consolidations. One factor that stands to accelerate the partnership/consolidation trend is often left out of the conversation: The impact of the recession on capital investment in imaging equipment might soon create accelerated market activity, however.

Every business starts somewhere; even in the current period of radiology-practice consolidation, startups are popping up around the country. David Myrice, director of practice management for Medical Management Professionals (MMP), says, “Every so often, an opportunity still presents itself to form a new group.