Quantum Leap: Radiology Groups Consolidate to Grow
Bruce LehrmanHealth care in the United States is evolving rapidly, and Bruce Lehrman, MD, president of Diagnostic Imaging Inc (DII), Philadelphia, Pennsylvania, believes that radiology is in the forefront of change in the industry. “I’ve never seen the landscape in health care changing more rapidly than it is now, and leading that change is radiology,” he says. DII is no stranger to evolution; in the past two decades, the practice grew from 10 radiologists to 60, and on September 7, 2011, it completed a merger with Virtual Radiologic (vRad), Minneapolis, Minnesota. “Our practice now reads for many different hospitals and health systems, and that means we’re using multiple PACS and RIS platforms,” Lehrman says. “vRad will provide us with a unified worklist to connect all of our sites, allowing us to provide a higher-quality product more efficiently.” Mergers in imaging are taking myriad forms; in March 2011, Southwest Diagnostic Imaging of Dallas, Texas, joined forces with three other local radiology groups to form Radiology Associates of North Texas. With 110 radiologists on staff, Radiology Associates of North Texas is now the largest radiology practice in the state—and one of the largest in the nation. Cynthia Sherry, MD, immediate past president of Southwest Diagnostic Imaging, says, “We were searching for ways to make our position more secure, to become more efficient and improve our productivity, and to be more value added for our hospitals and referring staff. We wanted a bigger presence in our market, more leverage, and more expertise.” Balancing the Load Providing efficient, subspecialized care is a primary motivator for practices consolidating with other groups on both local and national levels. “Subspecialty readings are now a necessity, even for smaller hospitals,” Lehrman says. “There’s no reason they shouldn’t have access to that, no matter where they’re located, but even a group our size couldn’t have every subspecialty.” As an example, Lehrman cites pediatric subspecialty imaging. “We don’t get a lot of pediatric work,” he says, “but when we do get a complex case, vRad has nine fellowship-trained pediatric radiologists to whom we’ll have access. This model is the wave of the future—there’s no other way to provide a quality product efficiently.” Sherry and her team were motivated by a similar concern. Among the four practices that joined to form Radiology Associates of North Texas, she says, “We had pockets of expertise in interventional and pediatric radiology, and now we’ll be able to extend that expertise across the system to provide better coverage to all of our facilities.” Like DII, all of the radiologists of Radiology Associates of North Texas will soon be working from a unified worklist, which Sherry expects to help them balance the consolidated load of cases from across the region. “We’re aiming to be able to staff more efficiently, so that every radiologist who is working that day will be fully occupied,” she says. “The people who are subspecialized can do what they’re best at faster, and with better results.” Positioning for Growth Another critical factor motivating DII’s decision to merge with vRad was the imperative to position the group for future growth, Lehrman says—and he predicts that other radiology groups will either engage in similar consolidation or face hospital employment. “You’ll see more and more groups joining up with national companies or becoming hospital employees,” he says. “It’s going to be almost impossible for small groups to stay independent.” Sherry echoes this sentiment. “At the time we started this project, employment of physicians wasn’t on the radar screen, but for my group, it’s not desirable for us to become employed,” she says. “I think radiology, as a medical specialty, is going to be better off if we stay independent and promote high-quality imaging and access for patients.” Providing that high quality will be critical to the survival of radiology groups, Lehrman says, but is impossible without a sophisticated IT infrastructure—which was another key benefit of DII’s merger with vRad. “The financial pressures hospitals are under now are extreme, and radiology groups need to provide an extremely high-quality product in the most efficient manner possible,” he says. “One of the ways you can do that is through the use of IT, and that’s where we saw a big advantage with vRad.” Sherry adds that without the strength in numbers provided by a larger group, growth is difficult for radiology practices. “It’s hard to grow,” she says. “It’s capital intensive, and you need to bring expertise on board that you can’t necessarily afford yet. In order to reach the next level, it seemed that we had to make more of a quantum leap—to join with a group that was bigger and already had that infrastructure in place.” After the merger, Lehrman is optimistic about DII’s future. “We’ve been a very aggressive group for the past 10 years, and I feel that with the IT backbone vRad can provide, we’ll be able to continue to grow,” Lehrman says. “We believe we’re in the forefront of something really exciting.”