While McCormick Place hummed with science and commerce across town, an unusual gathering of top outpatient imaging center executives met for breakfast on the sixth floor of Chicago’s University Club on Tuesday, November 20. Adding to the unparalleled nature of the event were the invited guest speakers for the morning, two top executives from rival radiology benefits management (RBM) companies. Called by Joe McDonough, CEO of Soteria Imaging, and underwritten by another guest, Don Broomfield, president, Hitachi Medical Systems America, Twinsburg, Ohio, the meeting represented an historic gathering of top executives from some of the nation’s leading imaging center chains.
“With the DRA pinching everyone in our industry, it has forced a mentality of ‘coop-etition’ among those who historically have been competitors to find out together how we can meet the obstacles that have been put in front of us.” —Gary Albers, division president, Soteria Imaging, Louisville, Ky
“We see these people as being successful ultimately in spite of the Deficit Reduction Act and thought it was a good opportunity to get everyone together, understand some of the common challenges to all in the imaging space, and to try and figure out ways with which we can overcome them,” Albers explained.
Joining McDonough and Broomfield were Bob Jones, founder, Matt Smith, Albers, and David Eve, from Soteria; Jack M. Shields, JD, president, Shields Healthcare; Stephen J. Pomeranz, MD, CEO, and Mike O’Brien, Proscan Imaging, Cincinnati, Ohio; Scott Arant, CEO, American Health Imaging, Atlanta, Ga; Del Crebs CEO, and Paul Sherwood president, Envision Radiology, Colorado Springs, Colo; and representatives from the investment-banking firm of Jeffries Investment Banking and Allied Capital. David S. Harrington, CEO, American Imaging Management, and Gregg Allen, MD, chief medical officer, MedSolutions, were invited to speak.
“We wanted to get a general sense of where the RBM’s were going with their initiatives from this point moving forward, so that we can better anticipate what we need to do as outpatient imaging facilities to stay ahead of the curve,” Albers explained. “There are new grading systems for outpatient imaging, so it is important to understand the criteria in grading to position our facilities at the top of their grading curves.”
Harrington heads up American Imaging Management (AIM), which controls imaging for 20 million lives. AIM initiated a new trend among RBMs by introducing a scoring system to rate imaging providers within a network, Harrington said. The AIM process, called OptiNet, incorporates a number of factors, including physician and technologist training, facility accreditation status, system efficiency, performance, specifications, and quality to determine a final score. AIM provides referring physicians within a geographic area the scores for local imaging providers with the intent of steering referrals to cost effective, high quality providers.
Similar rating systems are beginning to be utilized within various region of Blue Cross Blue Shield, CIGNA, and other industry payers.
Underscoring another RBM industry trend of acquisitions by insurers and health plans, AIM was acquired by WellPoint, Indianapolis, IN, in 2007.
MedSolutions controls imaging for 25 million lives and saved the state of Texas $35 million in its Medicaid program in 2006, Allen told the group. The company has a 22% denial rate, Allen said, and suggested that there are synergies between outpatient imaging facilities and RBMs.
Both Harrington and Allen acknowledged the value of IDTFs to insurers, as a service oriented lower-price alternative to hospital-based imaging. Harrington urged the IDTF executives to take their story to the payers. “You have to tell your story to the payers, so there is some need to aggregate,” he said, recommending a message of service and value consistency.
Allen noted that medical beds are exceeding 50% of revenues in hospitals, so they are compelled to move into outpatient services.
Some interesting and compelling ideas emerged in a spirited exchange among all parties. Allen suggested that IDTFs would benefit by marketing to payers that offer high deductible plans. “Offer your services,” he said.
Allen also suggested that IDTFs approach big employers for employer-sited imaging. A recent report in the Philadelphia Inquire suggests that the United Auto Workers of America, which will be at risk for union member’s health benefits