Breast Imaging Paradox: It’s About the Annuity

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In 2002, Norwalk Radiology—like many radiology practices across the nation—reached a crossroads. Prepare to invest in expensive new digital mammography technology or stop doing mammograms. In fact, more mammography centers in the U.S. closed than opened between 2001 and 2004, but in Norwalk, Conn, practice president Allan Richman, MD, rightly recognized that women would drive service line growth, and it was a good idea to take care of them.

Given the proper attention, the mammogram is the engine that drives outpatient imaging, David R. Gruen, MD, radiologist, contended, during a presentation at the at the 2nd Annual GE Healthcare Outpatient Imaging Center Conference, July 27, Crystal City, Va. In an hour-long talk, Gruen, medical director for women’s imaging, described why Norwalk Radiology chose to grow its women’s imaging service, how it built that service, and its ancillary benefits.

“Mrs. Jones is a mammogram annuity,” Gruen explained, “and if you take good care of her she will be there every year, from age 40 until she’s 88 and retires to her nursing home and doesn’t get a mammogram anymore. At the $6 annual profit for Mrs Jones’ mammogram, you are going to make $240 over a lifetime. But that is not why we are doing this.”

In addition to performing her mammography, Gruen noted, the practice is positioned to be the first choice for all members of the family, adding up to a lifetime annuity of knee MRIs, carotid Doppler, coronary CTA, brain MRI, breast MRI, and so forth.

“Their families are your annuity,” Gruen said of the mammogram patient. “If you don’t take good care of your mammogram patients—and you can’t measure all of that spin off—you know you are going to lose it if she gets her mammogram at the competitor across the street or goes somewhere else. And that’s the way to think about women’s imaging: It is the engine for your practice’s growth.”

D2D48: Today is the Only Day that Matters

Norwalk Radiology veteran breast imager David Gruen, MD, fully understand that for women who discover a breast lump or receive news of a positive mammogram, “Today is the only day that matters.” Norwalk Radiology made a decision to commit to results in 48 hours for women with a positive mammogram, and designed its 2007 marketing campaign around that promise, known internally as D2D48. Much to the surprise of many of the practice’s radiologists, the campaign is having a noticeable effect on local referring patterns.

“We compete with other community hospitals in the surrounding towns, and the distances are not very great,” Gruen explained. “How do we really change referral patterns? Not an easy thing to do. We know referral patterns are made on the golf course.” According to Gruen, physicians in some of the surrounding towns who have heard about the D2D48 program through a lunch or physician marketing, are referring their patients who have had a positive screening mammogram elsewhere and are upset because they have to wait six days for their next mammogram and longer for their workup.

“Their doctor is saying, ‘You know what, Norwalk Radiology says they can see you the same day’,” Gruen said. “Hopefully, she’ll tell her friends, but now we have made Dr Brown a referrer. That’s the annuity. We may not get those patients who have been going elsewhere for years, but when a new patient shows up, and asks where should I go for my mammogram, she’ll say, ‘You know what, the service is better at Norwalk Radiology’. And that is how we differentiate.

Market Paradox
There is no time like the present to jump into women’s imaging, Gruen said. A July 2006 report from the General Accountability Office found a 6% reduction in facilities between 2001 and 2004; 4% fewer machines; 3% fewer technologists; and 5% fewer radiologists who are doing breast imaging. The same report found that 865 counties in the U.S. do not have any mammography machines at all, and in 117 counties, the number of machines decreased at least 25%.

“Here is the paradox, and this is why I still think there is great opportunity,” Gruen said. “The population is aging and the patient flow is going up. I am not an economist, but you have demand going up and supply going down. This is where there is a mis-match, this is where there is opportunity.”

Since adding digital mammography technology and retooling its processes in 2002, Norwalk Radiology has grown its mammography volume from about 8,000 in 2001 to an anticipated 15,000-plus mammograms this year. Additionally,