In a February 2013 article for JACR: The Journal of the American College of Radiology entitled “Culture Shift: An Imperative for Future Survival,” Lawrence R. Muroff, MD, CEO of Imaging Consultants Inc, outlined how radiology’s culture needs to evolve to meet the changing demands of US health care. “I think the overwhelming majority of radiology groups believe that what has worked for them in the past will continue to work—that if they just stay the course, they’ll be fine,” Muroff says. “Most groups don’t respond to change until something dramatic happens, at which point the pain of maintaining the status quo exceeds the pain of changing.”

Patient engagement in health care (or patient-centered communication, as it’s often called) has been compared to marriage, where the relationship between care seeker and caregiver is based on trust, respect, openness, and empowerment.

A decade after starting Diagnostic Professionals, Inc (DPI), Claude Hanuschak, its COO, still refuses to let federal payment policy thwart his success. When faced with a 35% reimbursement reduction due to implementation of the DRA, the 30-year radiology veteran and president/COO of the four-site Florida imaging-center chain responded with a resolve to become more efficient, largely through a reliance on appropriate technology.

If the triple aim—improved access to better-quality health care at a lower cost—is the goal of health-care reform, then patient-centered care is its soul. Throughout the Patient Protection and Affordable Care Act, the authors took precautions to protect patients from the abuses of 1990s-era managed care, when profits appeared to trump patient care.

Orthopedic practices are no strangers to pursuing optimum patient satisfaction with imaging as part of a growth strategy; in fact, their growth is often dependent on it. Dale Ingram, CEO of the Cardinal Orthopaedic Institute (COI), Columbus, Ohio, says, “Of our MRI patients, 98% came from within our practice—we get very few patients from outside referrals. Imaging plays a big role in whether patients are satisfied with our service. They don’t have to go somewhere else and re-register, and it also helps with their continuity of care—our radiologists are here in the building and can talk to our physicians at any time. Every aspect of the process is easier for patients.”

Whether given incentives by the continued cuts in reimbursement levels or by the desire to monetize an operating asset, radiologists in the market continue to sell their imaging centers to buyers of many kinds—for-profit imaging-center owner/operators, for-profit hospitals/health systems, and not-for-profit hospitals/health systems, among others. Although the sale of the imaging center transfers all (or a portion of) the ownership to the buyer, there are still opportunities for radiologists to remain involved in the business. Specifically, many radiologists continue to provide exam interpretations and/or specific management services.

As the momentum concerning accountable-care organizations (ACOs) continues to mount, forward-looking radiology groups already are anticipating participation in bundled-payment initiatives, according to Ed Gaines, JD, CCP, chief compliance officer for Medical Management Professionals (MMP). “There are large hospital systems, nationwide, that have been running bundled-payment models for years, and there are significant data out there about the improved outcomes and lower costs that can result from these models,” he says. “Radiology is not being confronted with the problem just yet, but there is growing recognition that the specialty needs to be prepared and educated on the subject.”

Boca Raton, Florida, became a competitive market for medical imaging when entrepreneurial nonphysicians began opening freestanding imaging centers in the late 1990s and early 2000s, Carl Rosenkrantz, MD, a radiologist with West Boca Medical Center (WBMC), recalls. “In South Florida, hospitals were reluctant, early on, to get into the outpatient imaging center business, and a tremendous number of nonphysicians got into the business just to make a profit,” he says. “A huge amount of marketing was done concerning them, and patients became accustomed to going to these freestanding centers that were not hospital affiliated.”