Strategic Radiology’s newest affiliate member practice was founded in 1970 to serve the needs of North Memorial Medical Center in Robbinsdale, Minn. “Like most groups, it began with a couple of radiologists sitting in a dark room at a growing hospital,” shares Troy Roovers, the CEO of the 26-physician Minneapolis Radiology Associates (MRA).

In the mid-1990s, the group hired its first fellowship trained interventional radiologist, Scott Schultz, MD, directly out of training at UCSF. Four years later, Dr. Schultz was elected president. As MRA approaches its 50th anniversary, Dr. Schultz is still the president and the newly re-branded North Memorial Health remains a client and trusted partner, but quite a bit else has changed.

From the start, Dr. Schultz pushed the group to diversify beyond diagnostic radiology and to look for growth opportunities outside the hospital. Early on, the group considered merging with another local group, but instead elected to create an infrastructure for growth.  Roovers was hired as CEO in 2001 and has worked in tandem with Dr. Schultz to diversify the practice, both horizontally and vertically, through:

• outpatient imaging centers,
• ambulatory surgery centers,
• the addition of vascular surgeons to the practice,
• multiple hospital and health system relationships,
• a research and education 501(c) nonprofit, and
• a managed services organization for billing, IT, management, finance, HR, credentialing and strategic consulting.

In the process, the group has grown from half a dozen partners to include 22 radiologists and four vascular surgeons. Its decision to affiliate with the Strategic Radiology coalition can be characterized as both strategic and tactical.

From a strategic perspective, “We were attracted by the like-mindedness of the SR member groups, their fierce independence and desire to figure out a way to leverage resources to remain strong, viable, and growing in the future,” Roovers explains.  “From a tactical standpoint, one of our hospital systems desired interpretations by fellowship-trained pediatric radiologists. A group our size can’t afford to have a dedicated pediatric radiologist, so we were looking for a feasible way to provide that service to our hospital customer.  SR’s Subspecialty Reading Network was a perfect fit.”

Strategic partnerships

MRA serves the Northwest suburbs of the Twin Cities, supporting four health systems and covering six hospitals.  MRA also serves multiple outpatient sites. Having opened its first outpatient imaging center in 2001 as a joint venture with North Memorial Medical Center, MRA has experienced both fat and lean days in outpatient imaging. Partnering from the outset with hospitals and other physician specialties in these endeavors has proven to be prescient.

“We decided to create partnerships because whether it is the hospital or other physician groups, they ultimately control the patients,” Roovers explains. “Early on in the go-go days of outpatient imaging, it was easy to be profitable. The reason we have been able to maintain our centers is that we have strong joint ventures in place and are willing to take a half a loaf versus a full loaf.” 

The outpatient strategy has benefitted the group by generating both passive income as well as a steady stream of business for its management services organization, the entity that employs all non-physician personnel.

When the vascular surgeons first joined in 2005, MRA opened an ambulatory surgery center in partnership with a group of local nephrologists.   MRA subsequently diversified into other procedural centers, including vein centers and an office-based vascular lab.

Embracing the competition

When MRA surveyed the competitive landscape back in 2005, leadership recognized that its IR business was at risk of being encroached upon by vascular surgery and interventional cardiology. “We embarked on an initiative to see if we could align with them,” Roovers recalls. “In the case of vascular surgery, we realized it made sense to bring them right into the practice as equals. We started with one and this summer we will add our fourth full-time vascular surgeon.”

The move has allowed MRA to minimize turf wars, but most importantly, it has been able to position its vascular division—Minneapolis Vascular Physicians (MVP)—as a one-stop vascular shop. “We let referrers know they can call MVP, and we’ll take care of it,” Roovers says. “They don’t have to think about whether it is an interventional case or a surgical case. We have been able to retain more vascular work via MVP than if we had waged the turf battle.” 

The vascular surgeons also have contributed significantly to the success of the dialysis access center. “The relationship has not only fortified our interventional radiology subspecialty, it has allowed us to get into markets and to have relationships with health systems we would not otherwise have been able to penetrate.” 

Research and education

As proceduralists, Dr. Schultz and William McMillan, MD, the pioneer vascular surgeon who joined the practice in 2005, had relationships with industry and had supported a number of clinical trials through the years. Drs. McMillan and Schultz wondered if there was a way to formalize this and bring it under the umbrella of a non-profit foundation.

At the same time, MRA was considering starting its own conference in the vascular and endovascular care space around work that was clinically relevant to practicing physicians.

“What drove Dr. McMillan and Dr. Schultz was their interest in creating an educational forum where practicing physicians could learn about and discuss clinically relevant topics they were dealing with on an everyday basis,” Roovers explains.  

As a result, MRA founded the Minneapolis Radiology and Vascular Research Foundation, a 501(c)(3) nonprofit, which recently held its 11th annual CARVE conference (www.carve-cme.com) in Vail and has spawned a CARVE fellows program focused on physicians coming out of training. A few examples of clinically relevant topics include endovascular iliac branch repair, IVC filters: The Beginning of the End, and Stroke Intervention:  New Results and a New Era.

Cultural touchstones

Roovers portrays the MRA culture as one of classic innovation: forward-thinking and results-oriented, with a willingness to take risks and the recognition that failure is part of that gamble.

“We are small relative to other local groups, so we need to promote our uniqueness and constantly look for opportunities to diversify, even if it means failing,” Roovers says. “We have tried more ventures than I can count that didn’t work out. However we also have in our portfolio those that did. It is worth sinking 99 dry holes to get the one that pays off.”

MRA’s culture is driven by corporate values summed up in the six “C”s: Compassion (respecting unique needs of customers), courtesy (treating with kindness and respect), creativity (encouraging innovation), character (acting with honesty and integrity), conservation (judicious use of resources), and customer-centered service.

Although not an official corporate value, Roovers adds a seventh “C”: “Consistency” of vision, leadership, culture, and expectations. “You know what to expect from MRA whether you are a patient, hospital partner, employee, or referring physician,” he says. “It has paid off for us in retention of customers, recruitment of physicians, and staff tenure.”

In his two decades of leadership, Dr. Schultz has instilled a growth mentality that permeates the entire organization.  “We are not maintenance managers,” Roovers adds. “We push the envelope. That absolutely starts with the physician owners and executive leadership, but we have an amazing staff that lives and breathes these values daily.  Patients may be the reason we exist, but people are the reason we excel.”