As consolidation in the hospital market continues apace—driven by the increasing prevalence of integrated delivery networks (IDNs), accountable-care organizations, and other new payment/delivery models—many radiology groups find themselves at a crossroads. How can they gain the scale necessary to meet the mounting demands of today’s care continuum, given the continued downward pressure on reimbursement? RadAnalytics spoke with Bill Pickart, CEO of Integrated Medical Partners, about an emerging option that strikes a compromise between independence and scale, enabling groups to take a proactive approach to meeting hospitals’ evolving quality and service directives and needs.

Even in the wake of health care reform, radiology practices continue to struggle with managing payment from uninsured patients. The problem plagues hospital-based groups, in particular, according to Krista Pelensky, director of operations with Zotec-MMP. “Many hospital-based groups have seen an uptick in uninsured business and an increase in emergency-department services,” she says.

Few business processes for radiology practices are as fraught as negotiating managed-care contracts. Their duration and durability put a significant level of both current and future income on the line, but small and medium-sized practices, in particular, might feel that they have little leverage in the negotiating process. The keys to gaining the

Imaging Healthcare Specialists (“IHS”), a 30-radiologist practice based in San Diego, California, has a simple ethos driving its business decisions. “We view ourselves, first and foremost, as a medical practice,” Thomas Cleary, president and COO of Imaging Healthcare Specialists, explains. “Every day, every employee who works for us—from the person who schedules the patient, to the technologist who provides the exam, and from the radiologist delivering the report to the IT person—is making an impact on patients’ lives.”

The most common misconception regarding medical-practice reimbursement is that it’s about nothing more than money. In fact, reimbursement is about much more than the dollar numbers associated with CPT® codes in payors’ various fee schedules, and any discussion of it that doesn’t also touch on process, strategy, and service is incomplete.

Many radiology practices, by now, have been persuaded of the importance of deeper alignment and integration with their hospitals and health systems. Jana Landreth, director of practice management for Zotec-MMP, says, “If your hospital approaches you wanting this, you need to embrace it. Going into this with reluctance or hesitation will not move your relationship forward, and the odds are that you will wind up doing it eventually anyway. If you embrace it now, you will be able to set the goals with the hospital and make them realistic for what your practice can achieve.”

Inverness Medical Imaging (Inverness, Florida) had an especially strong motivation to apply for federal meaningful-use incentives: With a payor mix that was 60% Medicare, the radiology practice knew that the eventual penalties for not attesting to meaningful use would be too big a hit to sustain. John Erler, administrator, says, “The incentives are good, but if you aren’t meaningful-use compliant, the government will eventually reduce your reimbursement through Medicare. That’s a huge portion of our business, so it made sense for us to get onboard now and get as much of the incentive money as possible.”

The standard of value must be established in performing a valuation of any imaging business. The standard of value defines the hypothetical conditions under which a valuation will be performed. These hypothetical conditions affect many of the underlying assumptions that an appraiser or valuator would employ in establishing a value opinion.