As radiologists and other U.S. physicians look down the barrel of the latest 2.8% cut in physician reimbursement, the stakes for engaging in physician advocacy have never been greater.

Not only is pulsatile tinnitus a common, irritating (or worse) condition that three-fourths of adults will experience in their lifetimes, but it also is the canary in the coal mine for many potentially serious underlying conditions. 

Products of academia, most radiologists-in-training have many questions about how private practices operate and how to assess whether a group is a good fit. One evening in early September, interventional neuroradiologist Cuong Nguyen, MD, Mecklenburg Radiology Associates (MRA), Charlotte, NC, expertly moderated a panel discussion featuring five early-career, private-practice radiologists who aimed to help residents and fellows prepare for and land their private practice dream jobs.

Siobhan Alexander, MD, realized early on in her residency that she wanted to be a radiologist who was directly involved in patient care, and that interest ultimately led her to a breast imaging fellowship at the University of California, San Francisco.

When we caught up with Zachary Hartley-Blossom, MD, he was awaiting the birth of his first child. A cardiothoracic radiologist with Strategic Radiology member practice Advanced Radiology Services (ARS), in Grand Rapids,Michigan, he completed his fellowship at Massachusetts General Hospital a little more than a year ago and already was fully engaged in private practice life and work.

With the Covid shut-down and post-Covid imaging boom in the rear-view mirror, Darrin Spoden, DO, president, Regional Diagnostic Radiology, Sartell, Minn., is finally emerging from crisis mode with a much-altered practice model and thinking about the future.

Every year, Strategic Radiology (SR) hosts a Virtual First Year in Practice Happy Hour for residents and fellows held in the fall. An annual highlight, the virtual event features a panel of early-career radiologists from SR groups responding to questions submitted by the radiology resident and fellow community. Part I of the article focused on preparing for real-world radiology; Part II continues with insider tips on how to navigate the interview process, avoid rookie mistakes, achieve work-life balance, and assess practice culture.

Strategic Radiology has formed many committees in response to challenges and opportunities over the years, but no committee has been more active, more enduring, or better engaged than the CFO subcommittee. At 71 members, the SR CFO Subcommittee is one of the largest and busiest in the coalition. Considering the persistent, year-over-year downward pressure on radiology reimbursement, this should come as no surprise.

Compliance may not be the most compelling subject within radiology practices, but when you append cyber security to it, ears perk up. Health care has a target on its back right now, and compliance can help you keep cyber thieves out of your data, says Matt Brennan, CPC, RCC, Strategic Radiology director of compliance.

The health care regulatory and economic environment is so complex that independent physician practices are challenged to comply, compete, and function as cornerstones of both health care and the communities they serve. Strategic Radiology aims not just to help its 37 member groups remain competitive—it strives to influence how Washington perceives, values, and compensates private radiology practices in the U.S.

Occupying a ringside seat on the private practice radiology arena during a career that spans three decades, Greg Thomson, CPA, has seen the specialty evolve and adapt to a continually changing—and often challenging—health care environment. As Strategic Radiology’s new chief operating officer, he is far from done.

More than 400 diagnostic and interventional radiologists signed onto a virtual Town Hall organized by ACR and SIR to address a rising conflict that is currently roiling a specialty squeezed by a workforce shortage—DI and IR: Better Together…or Not?

This year, the SR-RSNA Research & Education (R&E) Foundation Resident Seed Grant will help finance the research of Wenhui Zhou, MD, PhD, a 4th year radiology resident at Stanford University Medical School with a strong interest in cancer imaging and interventions. Dr. Zhou’s grant is the fifth in a series of 20 grants to be funded through contributions by individual Strategic Radiology member practices to the RSNA R & E Foundation.

In January 2020, as cases of Covid-19 were proliferating across the globe, Eric Rubin, MD, began his first term as chair of the ACR Human Resources Commission. The commission has surveyed practice leaders annually since 2012, but that year the commission did something it had never done before—it paused.

It’s been a phenomenal year of growth for one of Strategic Radiology‘s newest members, Summit Radiology in Fort Wayne, Ind., which grew from 60 to 80 subspecialized radiologists and from 21 to 26 hospital contracts in the past 12 months. President Daniel Branam, MD, attributes the surge to three things: 15 years of investment in building IT infrastructure and personnel, vigorous experimentation in radiologist practice models, and a confluence of current radiology events.

With dozens of artificial intelligence (AI) applications for radiology on the market, how does a private practice identify the best AI tools for its needs, cover licensing costs, implement the technology for maximum effectiveness, and measure the results to ensure that the tools are providing the anticipated return on investment?

Fresh from surfing in Costa Rico, a painful drubbing for the LSU Tigers, the first MRI lymphangiogram in the state of Georgia, and the birth of a son, a lively panel of early-career radiologists from Strategic Radiology (SR) member groups shared tips and pointers for residents and fellows during a fast-moving virtual happy hour exploring the First Year in Private Practice earlier this month. The panelists imparted practical and valuable information intended to help trainee radiologists navigate the transition to and through their first year in private practice.

Strategic Radiology (SR) launched SR Health on January 1, 2023, to provide coverage for the shareholders and employees of its 37 independent private practice member groups. In creating a partially self-funded insurance plan—totally owned by members—the coalition anticipates that members will achieve significant savings on premiums, greater control of coverage options, and visibility into plan data.

Radiology practices play a crucial role in health care, providing medical imaging services that aid in diagnosing and treating a wide range of medical conditions. When radiology departments experience staffing shortages, repercussions are felt throughout the enterprise with a significant impact on patient care and overall efficiency. Quality methods can help radiology practices improve efficiency during staffing shortages and ensure that patients receive timely and accurate diagnoses and treatment.

Southern Radiology Consultants (SRC)—a 25-radiologist practice based in Baton Rouge, LA—is a classic story of a well-run private practice that has succeeded by meeting every challenge and opportunity that crossed its path with excellent service and savvy business decisions. The group is one of Strategic Radiology’s newest members, electing to join in August 2022.

Residents and seasoned radiologists lucky enough to attend the 2022 meeting of the RSNA were treated to a cringe-inducing selection of MSK, abdominal, chest, and cervical spine trauma cases, all with the potential to show up in the queue for those taking night call, during a Tuesday afternoon session titled, “On-Call Primer for Residents: Don’t Miss Diagnoses.”

Min Lang, MD, MSc, was awarded the 2022 Strategic Radiology Arl Van Moore Jr. MD Research Resident Grant by the RSNA Research & Education Foundation (R&E) at the end of 2022. The grant provided Dr. Lang with $30,000 for one year to devote 50% of his time to a research project under the guidance of a scientific advisor. Dr. Lang, a radiology resident at Massachusetts General Hospital, will work to develop an ultrafast 3-minute MRI/MRA protocol for acute ischemic stroke evaluation using new rapid MR imaging techniques; a novel AI-assisted reconstruction technique that enhances image quality will occur in tandem. His goal is to improve timely diagnosis and treatment of acute ischemic stroke, and perhaps be implemented for other neuroimaging indications.

In a podcast interview with The Radiology Report host Daniel Arnold, Scott A. Bundy, MD, FACR, Chair and CEO of Strategic Radiology (SR), discussed a wide range of topics, including current challenges facing radiologists, Strategic Radiology, independence, and the virtues of having an ownership mentality.

Historically perceived as a relatively low risk and easy to secure line of coverage, recent developments in the global cyber threat environment have forced significant changes in the cyber liability insurance market, particularly in health care.

New Strategic Radiology (SR) member group Catawba Radiology Associates (CRA) was founded 72 years ago to serve the picturesque town of Hickory, North Carolina, pop. 43,532, back when the town was a thriving furniture-making hub at the foot of the Blue Ridge Mountains. In the intervening years, the manufacturing industries in Hickory diversified to include fiber optics and the practice grew steadily to 18 subspecialized radiologists, still occupying offices that date back nearly to its founding.

As quality focused health-care professionals, we share a commitment to making health-care safer and better for our patients. One of the common challenges to achieving this goal is the concern that patient safety information that you or your organization create as part of the care improvement process could also be used against you. 

Earlier this year, Radiology Associates of Albuquerque, PA (RAA), the largest independent private practice radiology group in New Mexico with 38 radiologists, became a member of Strategic Radiology. RAA brings its unique Southwestern experience to the collective’s group DNA. Theirs is a success story that has tracked closely with its health system partner, marked by growth and collaboration in the service of patients.

Strategic Radiology's 33 independent practices decamped to Charlotte for the spring Membership meeting, including 12.5 CME credits and talks that included AI in practice, transitioning to peer learning, and a witty and informed state of the union address. Here's a recap.

In urging our member practices to get started on the transition from peer review to peer learning during Strategic Radiology’s Quality Forum in May, Richard E. Sharpe Jr, MD, MBA, chair, breast imaging, Mayo Clinic Arizona, had a list of the limitations of the typical peer review process:

The first in a series of three presentations from Ferrum Health on the use of AI to impact population health, “AI in Oncology” provided Strategic Radiology members a provocative vision of a powerful new role for radiology in the health care enterprise from Elie Balesh, MD, private practice diagnostic and interventional radiologist and medical director of Ferrum Health.

Advanced Radiology Services, Grand Rapids, MI, merged with four other private practices, added a new health system and eight individual client hospitals, and partnered an IR residency in the past four years.

Practice ownership is a key point of differentiation between private practice and all other practice models in radiology. A panel of private practice radiologists, all members of Strategic Radiology, shared why they chose the practice model during a virtual happy hour for residents late last year and what they are doing to sustain that model.

Edward Kuoy, MD, second-year attending neuroradiologist in the UC Irvine Medical Center (UCIMC) radiology department, knows first-hand the challenges associated with transporting ICU and ED patients to the radiology department for an MRI study. He will use the 2021 SR-RSNA R&D Foundation Research Grant to research point-of-care MRI.

A group of seasoned imaging informatics veterans, fed up with years of relatively fruitless toil to achieve interinstitutional image exchange, called on health care providers to use their market power and contract only with image exchange vendors who commit to begin vendor-to-vendor image exchange by no later than 2024.

As the primary provider of radiology services in Northwest Georgia, Rome Radiology Group (RRG) was faced with an existential challenge familiar to many small- to medium-size radiology groups—invest in an enterprise PACS to improve the quality and efficiency of the care it provided to disparate health systems or watch quality and efficiency degrade.

When Barbara Deppman, RDMS, MSM, FACHE, assumed the role of Chief Operating Officer of Strategic Radiology (SR) on November 15, 2021, it represented the culmination of a successful career in health care administration that closely tracked radiology.

Physicians beleaguered by the latest pandemic surge, a run-up in inflation, and a potential double-digit pay-cut breathed easier when Congress passed the “Protecting Medicare and American Farmers from Sequester Cuts Act” last week. Numerous physician organizations—including the ACR and RBMA—joined in the big tent effort to stop the cuts, but for Strategic Radiology and newly engaged lobbying firm Thorn Run Partners, it was their first dance on Capitol Hill.

On September 9, 2021, a panel of early-career radiologists from four different Strategic Radiology member groups responded to questions from residents and fellows probing the topic, “First Year in Practice.” This article shares the responses of our panelists to the first question posed during a Resident & Fellow Virtual Happy Hour: What is the one thing you would you have done differently to make the first year better for yourself?

A projected upsurge in private equity investment in health care will result in accelerated consolidation, reduced competition, and increased patient risk, according to a 70-page paper published in May by the Nicholas C. Petris Center on Health Care Markets, UC Berkley Shool of Public Health, and the American Antitrust Institute (AAI), “Soaring Private Equity Investment in the Healthcare Sector: Consolidation Accelerated, Competition Undermined, and Patients at Risk.”

In an opinion piece that deliberates on changes in private practice over time as they relate to sustainability in the June issue of the Journal of the American College of Radiology, authors Frank Lexa, MD, MBA, and Lauren Golding, MD (who practices with Strategic Radiology member group Triad Radiology in Winston-Salem, NC), begin with size: in 1989, close to half of all radiology practices were composed of two to four radiologists and only 14% had 11 or more; in 2014, just 3.2% of practices had one or two members and 15.7% had more than 100 radiologists.

Strategic Radiology (SR)’s proprietary patient satisfaction survey tool, RadVox™, marks its fourth year of service to SR member groups this year by helping members survey new markets, including hospital-based imaging center patients and MRI research site subjects.

A team of radiologists from Wichita Radiological Group and Michigan State University College of Medicine laid out a thoughtful series of strengths, opportunities, and threats associated with private practice radiology in a paper published in the June issue of the Journal of the American College of Radiology. In doing so, they provided a compelling apologia for the private practice model itself.

While 2020 will be recalled as the year a rogue virus brought the world economy to its knees, the lung cancer screening community will remember it as a year of deliberation by the United States Preventive Services Task Force (USPSTF) on whether to expand low-dose CT (LDCT) lung cancer screening (LCS) to include adults aged 50—down from 55—to 80 years of age with at least 20—down from 30—pack-years as recommended by the Cancer Intervention and Surveillance Modeling Network (CISNET) Lung Cancer Working Group Technical Report.

During the past two years, six Strategic Radiology (SR) member groups explored methods of directly communicating incidental findings (IF) on studies acquired in the emergency department (ED) to patients and their primary care physicians. The project began when Strategic Radiology was named one of 12 recipients of a Coverys Community Healthcare Foundation (CCHF) grant at the end of 2018, with the objective of developing a low-cost program that could be rolled out across the United States.

The huge influx of federal stimulus funds into health care offered a rare window into the use by private equity of dividend recapitalization, a transaction in which private equity firms add debt to their portfolio companies’ balance sheets to finance fees and dividends for themselves without having to substantively improve operations.

A team from the Einstein Health System saw participation soar when it transitioned from a peer review to a peer improvement process implemented across a network that included an academic tertiary care center, two community hospitals, and multiple outpatient sites. That success in itself yielded some unintended consequences that were addressed in further iterations, according to a helpful article from Lee et al that appeared in the Journal of the American College of Radiology, “Transitioning to Peer Learning: Lessons Learned.”

Scott A. Bundy, MD, FACR, was selected as CEO of the Strategic Radiology (SR) coalition, succeeding longtime leader A. Van Moore Jr, MD, FACR. He also will serve as Chair of the SR Executive Committee (EC), responsible for crafting and implementing policy that is approved by the governing Board of Managers.

Strategic Radiology (SR) has finalized an agreement with Intelerad, Montreal Canada, to provide the components of a virtual reading platform—PACS, worklist, voice recognition—to members at volume discounts negotiated on behalf of the coalition’s independent practice member groups. The agreement unlocks potential savings for every member regardless of their size and technical configurations through leverage of SR’s collective scale.

Three radiologists and one emergency medicine physician shared tips, caveats, and lessons learned in the implementation of appropriate use criteria (AUC) during a timely session at the 2020 virtual meeting of the Radiological Society of North America, “Decision Support and the Implications for Federal Regulation (PAMA).”

When that question was posed several years ago, some of you may have been in the audience at the RSNA along with Neville Irani, MD, associate professor of radiology at Kansas University Medical Center, and a member of the ACR Informatics Commission. You may even have been one of the audience members who raised their hand.

If you are looking for evidence that the private practice model of radiology is sustainable long-term, look no further: five private practice radiologists made an open-and-shut case for practice ownership as they responded to questions submitted by early-career radiologists at Strategic Radiology's recent Virtual Happy Hour—Independence and the Radiologist: Why Own Your Practice.

While Strategic Radiology’s newest member group already has a half century under its belt, the 50-radiologist Triad Radiology Associates (TRA), Winston-Salem, NC, has a young leader, a youthful demographic, and a hallmark practice of making sure newcomers get a committee position. That was the beginning of the path Andrew Deibler, MD, took to become president and CEO of TRA at 42 years old on January 2019.

Judith An, MD, was awarded the Strategic Radiology–RSNA R&E Seed Grant to investigate the use of electronic alerts to improve compliance with imaging-based HCC surveillance in high-risk patients.

Back before the globe shut down on a balmy January weekend in La Jolla, Calif., radiology practice leaders gathered for the annual ACR–RBMA Practice Leaders Forum to explore subjects that ranged from physician burnout to adventures in clinical decision support implementation. One of the weekend treats was a session on Team Leadership featuring Frank Lexa, MD, MBA, FACR, professor, department of medical imaging, University of Arizona College of Medicine and CMO, The Radiology Leadership Institute.

Christopher J. Roth, MD, MMCI, was one of six courageous physician imaging informaticists who shared lessons learned during “Radiology Informatics Mistakes and War Stories from the Front Lines,” an RSNA 2019 session moderated by Peter Sachs, MD, a diagnostic and interventional radiologist at the University of Colorado Hospital, Denver, CO. Dr. Roth's tale featured the hubris of youth—apparently so common that it has been labeled the Icarus Syndrome.  

If you are wondering whether other radiology practices experienced the precipitous volume declines that yours did, an article in press at the Journal of the American College of Radiology suggests the affirmative for practices operating in both the academic and private practice settings.

For decades, Alicia Vasquez, CRA, FRBMA, has served as the administrative leader of The Hill Medical Corp., Pasadena, Calif., a founding member of Strategic Radiology. Her half of a Team Building session at the ACR–RBMA Practice Leaders Forum was a virtual master class for radiology practice leaders who serve in the administrator role, beginning with a clear-eyed assessment of the current health-care practice environment and ending with a mandate to become the change agent your practice needs.

One would think that leading an organization with 115 years of history carries extra weight, but Ray Beauchamp, MD, president of Radiology Associates of Richmond (RAR), dismisses that notion: “Everybody has the same pressures of adapting to the changing world and keeping your practice at the forefront and solvent.” 

James Whitfill, MD, is chief transformation officer at HonorHealth, Scottsdale, Ariz and past-president of SIIM. The former CIO of a large, private radiology practice in the Southwest confessed that his least proud moment in IT yielded a treasure trove of lessons during a unique and valuable 2019 RSNA session, “Radiology Informatics Mistakes and War Stories from the Front Lines,” moderated by Peter Sachs, MD, a diagnostic and interventional radiologist at the University of Colorado Hospital, Denver, CO.

Chesapeake Medical Imaging is a product of the 21st century, founded in 2001 by Mark Baganz, MD, a radiologist and refugee from academic medicine who craved a deeper connection with the patient. CMI joined Strategic Radiology earlier this year, also becoming its first Maryland-based practice.

Matthew McClain, MD, a radiologist with Rome Radiology in Northwest Georgia, did not envision becoming a local principle investigator in a national trial led by the Mayo Clinic to investigate the use of convalescent plasma therapy for Covid-19 patients when he noted the first outbreak in China in January.

Safwan Halabi, MD, radiologist and imaging informaticist at Stanford University, recently went through a PACS upgrade that brought the system down. Providentially, he made one fortuitous decision that limited downtime.

The Covid-19 pandemic appears to have decimated outpatient imaging volumes. With communities across the U.S. in various stages of re-opening for business, Strategic Radiology (SR) member practices with outpatient assets are beginning to carefully and mindfully take steps to resume non–Covid-related imaging of patients.

For Aileen Mickey, MD, FCCP, chief medical officer and pulmonologist, EvergreenHealth Medical Group, Kirkland, Wash., a key challenge in managing response to one of the initial outbreaks of the novel coronavirus in the U.S. was navigating constant change.

Judith K. Amorosa, MD, FACR, is clinical professor of radiology, Robert Wood Johnson Medical School, and a thoracic radiologist with University Radiology Group in New Brunswick, NJ, which is currently feeling a storm of community spread. In her portion of the Covera Health webinar, “Managing Covid-19 on the Front Lines,” she described the radiological features of coronavirus onset over time, providing context for advisories and consensus statements from ACR, Society of Thoracic Radiology, and RSNA, stating that chest CT is non-specific for screening or diagnosing Covid-19.

On the state of New Jersey’s map of coronavirus infections, University Radiology Group’s (URG) service area overlaps precisely the hardest hit counties. During his segment of the Covera Health webinar on March 26, “Managing Covid-19 on the Front Lines,”Sandip Basak, MD, president, University Radiology Group, offered a chilling account of a busy, thriving practice serving multiple hospitals and imaging centers devolving into a skeleton crew intent on protecting patients, employees, shareholders, and locations during the Covid-19 siege.

All of the sudden, your employees are working from home—how do you manage them? The Harvard Business Review published a timely series of articles meant to help us all navigate the virtual workspace. Here are the highlights.

Ever since Covid-19 hit U.S. shores, a tsunami of content hits inboxes on a daily basis. We have collected a short list of links to mission-critical content gathered by Strategic Radiology members and staff, ranging from clinical consensus statements to Treasury Department resources for the Paycheck Protection Program. (Thank you, Team SR—keep those links, PDFs, and other resources coming!) One of our favorites is a link to a video from a pulmonologist at Weill Cornell Medical Center in New York City, offering reassurance, hope, and advice on how to protect and empower your family.

Results of a national survey of radiologists that aims to assess improvement opportunities for current peer review systems was published online in advance of the March issue of the American Journal of Roentgenology.  The article arrives at an opportune time for Strategic Radiology practices as the coalition embarks on a Peer Learning collaborative pilot program.

Delivering a talk on a successful initiative or research project at the annual RSNA is an act of generosity but getting up and sharing one’s failures takes courage. Six courageous—and generous—physician imaging informaticists shared lessons learned in a valuable and unique session that was by turns hilarious and painful, “Radiology Informatics Mistakes and War Stories from the Front Lines,” moderated by Peter Sachs, MD, a diagnostic radiologist and imaging informaticist at the University of Colorado Hospital, Aurora, CO. 

A University of Utah survey of 5,000 patients, 600 physicians, and 500 employers identified affordable out-of-pocket cost as what they value most when accessing health care. Yet knowing the cost of care in advance from any given provider requires a great deal of effort.

An article detailing Massachusetts General Radiology Department’s experience in marketing radiology services provides valuable insight into how an entrepreneurial, hospital-based private practice evolved its marketing strategy with a changing market. It is likely to make a marketer out of you, if you aren’t already.

Jeffrey Chang, MD, MBA—co-founder of Rad AI, a machine learning start-up based in Berkeley, CA, and a private practice radiologist—has an explanation for why there are dozens of FDA-cleared AI applications that most radiologists are not using: for the most part, they impede, rather than improve, workflow. Chang, who graduated from medical school at age 20, gave members of Strategic Radiology a 40-minute demonstration of Rad AI’s first product for the radiology marketplace, an application that automatically generates an Impression from a radiologist’s Findings and Indications.

Thirty-four Strategic Radiology revenue cycle employees gathered in Atlanta in early November for three days of education, collaboration, and revenue cycle optimization. Eighteen of SR’s 27 practices were represented, including many first-time attendees of SR events. It was an experiment that will likely become an annual ritual.

A report on the value, challenges, and prevalence of PSO participation among acute care hospitals issued by the Office of Inspector General in September reveals that virtually all hospitals that reported participating in a PSO value the relationship, with 63% saying that PSO participation has made a measurable difference in the quality of their care. 

As radiologists-in-training emerge from residency to interview for partnership-track positions with private practices, they are burdened with a relatively new concern: What are the chances that the practice they are interviewing with will sell their radiology group to a corporate entity? Unfortunately, this is a legitimate concern.

After completing his radiology residency and neuroradiology fellowship at Emory University, Ivan DeQuesada, MD, left Atlanta in 2016 and headed southwest to join one of the nation’s largest private radiology practices, Radiology Associates of North Texas, in Fort Worth, Texas. It was not a choice he made lightly.

By Arl Van Moore Jr, MD, FACR

I’m sometimes asked by academic radiologists, residents, and even private practice colleagues why I believe that a vibrant specialty needs a healthy, independent private practice model. I’ve had quite a while to think about this in various leadership roles, so in the interest of brevity, I’ll focus on three of the reasons that have the greatest implications for personal fulfillment.

The hotly anticipated white paper from the ACR Corporatization Task Force (CTF), recently published online by Journal of the American College of Radiology, reports on the current status of corporatization in radiology and its potential to impact patients, radiology, and radiologists.

In an all-too-familiar scenario, the patient entered the ED with pain and urinary problems, the emergency physician ordered a CT, and the radiologist issued a report identifying kidney stones, and, incidentally, a rounded area of high density in the bladder that warranted follow-up. 

A recent communication issued by CMS in July provided some all-important billing guidance for radiology practices and others that intend to use the Appropriate Use Criteria (AUC) program test year for exactly that—to test the mechanics of implementing AUC in 2020, before penalties begin in 2021.

While most would agree that radiology practices are undergoing consolidation, many questions remain regarding its extent and its effects, resulting in hype, hyperbole, and not a small amount of uneasiness throughout the specialty. In an attempt to bring some order to the subject, Randal Roat, FRBMA, Strategic Radiology COO, reviewed the landscape, tallied up the available numbers, and attempted to assess whether consolidation had delivered on its objectives in “Radiology and Independence in a Consolidating World,” a talk presented at the RBMA Paradigm meeting on April 15 in Colorado Springs.

Radiology practices across the country can no longer bet that CMS will delay the mandate to consult appropriate use criteria (AUC) scheduled to commence in 2020—but that did not stop the American Medical Association (AMA) from passing a resolution at its annual meeting in Chicago requesting yet another delay in implementation. According to Strategic Radiology chair and CEO Arl Van Moore Jr, MD, FACR, the resolution is likely a shout into the wind, as turning back the clock yet again would require new legislation to reconcile the differences in PAMA (enacted 2014) and MACRA (enacted 2015). Dr Moore is chair of the ACR delegation to the AMA.

North Carolina’s oldest radiology practice dates back to the First World War and in one respect, says Mecklenburg Radiology Associates (MRA) president James C. Johnson, MD, the practice remains single-minded in a business strategy that has served it well. “From its early beginnings, the practice has employed an approach of being aligned with our health system partners,” Johnson says. “We think it is important to be as engaged as possible with our health system partners.”

If you heard corks popping, that was the Strategic Radiology (SR) revenue cycle and data analytics team cheering completion of Phase 2 of the reconfigured revenue cycle database. The team celebrated the transition from charge data to transactional data with a webinar to show members around the enhanced reporting capabilities of SR’s new RadIQ™ business intelligence (BI) tools.

The latest segment in the Radiology Leadership Institute (RLI) podcast series will be a treat for Strategic Radiology members as the interview subject is our CEO and Chair, Arl Van Moore Jr, MD, FACR. In this episode—the eighth in a compelling series of interviews with prominent leaders in radiology by RLI board member Geoffrey Rubin, MD, FACR—Moore shares a bit about his early years, leadership path, current tenure with SR, and passion for independent radiology. Below are highlights of the 1.5-hour interview.

Few practices these days can claim a pedigree that reaches back to the Great Generation, but Strategic Radiology’s newest practice, 44-member Asheville Radiology Associates, is one of them. Located in North Carolina’s western Blue Ridge Mountains in Asheville, county seat of Buncombe County, the practice was founded by three radiologists in 1944.

Taking the podium mid-stream during a series of talks on AI at the annual meeting of the California Radiological Society in February, Greg Mogel, MD, was mock-apologetic about interjecting a dose of cold reality into radiology’s topic du jour. Yet the timeliness of his talk on implementing order-entry radiology clinical decision support could not have been better. With CDS on the docket for a test year in 2020, the day of reckoning is near, barring any further delays. Furthermore—as you will read—he sees a very real and pressing role for AI in future iterations of CDS.

Ever wonder how many radiology practices there are, what their size is, and how much consolidation has occurred in recent years? All of those questions are addressed in a fruitful effort by Rosenkrantz et al published online in the Journal of the American College of Radiology.

TMIST—the first randomized controlled trial (RCT) to identify patients for whom breast tomosynthesis bests digital mammography (DM) in reducing the development of advanced breast cancer—is now underway and accruing patients.

In a historic first for the coalition, Strategic Radiology was awarded a $282,000 grant from the Coverys Community Healthcare Foundation (CCHF) to research methods to ensure that patients are aware of incidental findings identified in imaging exams acquired in the ED, a setting fraught with communication challenges.

As president of a 55-radiologist practice that covers 24 hospitals and operates two busy outpatient imaging centers, W. Kent Hansen, MD, has a full plate that just got fuller—he answered the call affirmatively to serve as newly elected member-at-large on Strategic Radiology’s Executive Committee (EC).

Radiology Associates of Appleton, a 24-physician practice based in Appleton, Wis., joined the Strategic Radiology coalition of independent practices in November 2018, bringing with it the strong commitment to excellence and service to communities in Wisconsin’s Fox River Valley since 1968.

Shortly before its 2018 annual meeting, the Radiological Society of North America (RSNA) announced that Sina Tavakoli, MD, had been awarded the inaugural Strategic Radiology-RSNA Research Seed Grant. Dr. Tavakoli will use the $40,000 grant to investigate the role of quantitative 18F-fluoroglutamine PET in non-invasive metabolic imaging of macrophages in atherosclerosis. His attempt to characterize the immunometabolic features of atherosclerotic lesions could eventually lead to the more accurate identification of vulnerable plaques.

Strategic Radiology practices performed well in the first year of the CMS Quality Payment Program—100% of the SR practices that submitted data (representing 19 TINS) received a positive update, and 95% achieved the exceptional bonus. That compares well with the broader universe of participating practices, of which 93% achieved positive updates, 71% achieved the exceptional bonus, 2% achieved a neutral adjustment, and 5% received a negative update.

Andrea G. Rockall, MRCP, FRCR, had never heard of machine learning when she arrived at Imperial College of London in 2012. A working radiologist and researcher with interests in genitourinary cancer, image-based trials, and functional imaging and response assessment, she was asked to develop several machine learning trials. 

Naugatuck Valley Radiological Associates (NVRA), one of Strategic Radiology’s newest affiliate practices, has excelled at meeting the needs of the Waterbury, CT, community for 30 years. It has forged a tight relationship with St. Mary’s Hospital, founded in 1909 by the Sisters of Chamber and now a Level II trauma center. NVRA operates four outpatient imaging centers in the community—including two joint ventures with the hospital.

A commanding presence in radiology for many years, Arl Van Moore Jr, MD, FACR, FSIR, Strategic Radiology (SR) CEO, reached into his former Navy life—training and serving as an officer in the nuclear submarine service—to share leadership lessons from the military during SR’s Executive Education event in Fort Worth in September.

Kurt Schoppe, MD, talks about reimbursement the way others dissect a novel or an episode of a favorite TV show: players, motives, plot points, unintended consequences.  The ACR advisor to AMA’s RVU Update Committee (RUC) held attendees rapt at Strategic Radiology’s Executive Education event in Fort Worth in September as he delivered the first of three short talks that linked payment policy with relationship building and strategies to deal with the reimbursement uncertainty ahead.

As the hype behind artificial intelligence (AI) is replaced with a recognition of the barriers to adoption, radiologists increasingly are intrigued with AI’s potential to expedite, augment, and generally improve their ability to interpret medical images. To that end—and presumably to pre-empt a Wild West scenario—the ACR has created an AI framework for developers that would ensure that the tools created are reliable, useful, diverse, and pose no threat to patients.

United Imaging Consultants (UIC), based in the Kansas City suburb of Mission, Kan., grew out of a four-way merger in 2000 and the recognition that busier nights and the rise of subspecialization in radiology required scaling up in size. The practice has followed a steady path to delivering greater value to its hospital partners ever since.

Sharon Fremer, Strategic Radiology’s new vice president, revenue cycle optimization, is on a heat-seeking mission for results. Fresh from her first session with business analytics director Dave Polmanteer, she is preparing to bring 30 years of experience in revenue cycle to bear on improving member practice finances.

By Wayne K. Baldwin

In a prior life, I was General Counsel and Chief Development Officer for Comprehensive Medical Imaging, a consolidator of outpatient imaging centers across the country. It is interesting to me that consolidation has again become in vogue.

Ever wonder or worry about the toll reading room interruptions could have on the accuracy and/or efficiency of your personal practice?  A group of researchers that included Booth Aldred, MD, from SR member practice Austin Radiological Association, looked into those question and published their results in a recent issue of the Journal of Medical Imaging. Their research could improve reading room protocols in the future.

With the annual fall back-to-school ritual just a month away, September brings multiple, rich leadership education opportunities in radiology—the Radiology Leadership Institute (RLI) Leadership Summit in Wellesley, Mass, Strategic Radiology’s (SR) Executive Education Program, and SR’s bi-annual SR Quality Forum in Dallas-Fort Worth. “Radiology is facing many challenges right now,” said Arl Van Moore Jr, MD, FACR, chair and CEO, Strategic Radiology. “How do we preserve what we prize most about our profession—the ability to innovate, the willingness to seek better tools and techniques to improve the care for our patients and keep them first—yet improve the value our nation gets from our sector? New approaches will be necessary, and we need to initiate leadership education for the next generation of leaders earlier in their training.”

In July, the National Institutes of Health (NIH) Clinical Center released DeepLesion to the scientific community, a massive dataset that contains 32,735 lesions in 32,120 CT slices from 10,594 studies of 4,427 unique patients.  Its stated purpose was to help the scientific community improve detection accuracy of lesions.

By John Outlaw, CHC, CHBME

When I started my career in health care compliance nearly 15 years ago, compliance programs were just beginning to take hold outside of hospital systems and were a largely foreign concept for physician practices. Back then, they were strictly voluntary, but today compliance programs are a mandatory condition of participation in Medicare as part of the Patient Protection and Affordable Care Act of 2010 (ACA). At the same time, we have experienced tremendous expansion of government oversight of the health care industry that has dramatically increased risk for physician practices.

Providers that have stood on the clinical decision support (CDS) sidelines as the implementation deadline approaches received a strong signal that CMS intends to stand firm on the requirement to implement appropriate use criteria (AUC) and CDS with the July 12 publication of the proposed 2019 Medicare Physician Fee Schedule (MPFS).

Strategic Radiology’s CIO Jim Whitfill, MD, was recently installed as chair of the board of directors for the Society for Imaging Informatics in Medicine (SIIM). Whitfill, a clinically trained internal medicine physician, entered radiology by way of an informatics fellowship undertaken in the late 1990s, after which he took a position as CIO with a large radiology practice in the Southwest.

The 19 physicians of X-Ray Consultants (XRC)—Strategic Radiology’s newest affiliate practice based in South Bend, Indiana—have had a ringside seat on the consolidation that is reshaping the hospital landscape.  The group goes back to the 1940s, when one of its founders Wallace Buchanan, MD, served as president of the American College of Radiology.  In the early ’60s the practice became known as Lockhart & Beach until its incorporation as X-Ray Consultants in 1979.

The Strategic Radiology (SR) June Meeting returned to the idyllic mountain setting of Park City, Utah, last month to take care of coalition business and update member practices and the board of managers on progress toward the strategic plan and objectives of the coalition. Long days in meeting rooms ended in networking opportunities over the dinner table—establishing the trust and collegiality necessary to build a functional team requires interpersonal interaction and face time with all team members.

A dozen marketing directors responsible for marketing individual Strategic Radiology practices gathered in Nashville in June for their annual meeting prior to the RBMA Spark marketing conference—as usual, the three hours allotted flew by too fast. It was a great start to a conference that brought a number of marketing directors to the podium to both share their knowledge and collect awards. Content takeaway? We're all a little bit millennial.

No honor is sweeter than recognition by one’s peers, and that is precisely what happened in late May when Robert Epstein, MD, FACR, and William Keyes, MD, FACR, became fellows of the American College of Radiology during the annual meeting. Fellowship is an honor received by a slim 10% of radiologists and granted based on a radiologist’s contributions to the College, organized radiology, teaching, and/or research. The list of past recipients includes many luminary names, including SR CEO and chair Arl Van Moore, MD, FACR.

When neuroradiologist Bradley J. Bohnert, MD, MBA, isn’t describing brain tumors, measuring carotid stenosis, or interpreting spinal MRI studies, he wrestles with practice staffing issues and other management functions as CEO of Radiology Ltd., a Strategic Radiology (SR) member practice in Tucson, Arizona.  He also found the time to map nearly 1000 radiology CPT codes to their appropriate subspecialties as part of SR’s broader effort to aggregate and organize data for clinical benchmarking and business intelligence purposes. In its infancy, the subspecialty mapping project is the first step in an endeavor that Dr. Bohnert hopes will demonstrate the value of radiology subspecialization.

Over the years, Strategic Radiology's newest affiliate practice Tower Imaging Medical Group (TIMG) has earned a place in the firmament of Los Angeles-based radiology practices, with a complex practice genealogy that blends entrepreneurship with an academic flair. It serves two prestigious hospitals—Providence Saint John’s Health Center in Santa Monica and Henry Mayo Newhall Hospital in Valencia—and in joining the Strategic Radiology coalition, the highly subspecialized but relatively small 17-radiologist practice found a beachhead in the rapidly consolidating Los Angeles market.

Shortly after joining the Strategic Radiology coalition, the leadership of Orlando, Fla.-based Medical Center Radiology Group attended the coalition’s twice-yearly Quality Forum and made a note: Designate a patient safety lead for the practice and initiate a formal quality program. Back in Florida, MCRG leadership reached out to Diana Stillwell, a nuclear medicine technologist who had just completed her MHA after going back to school and was working for one of their hospitals at the time. When they asked her to lead the program, she hesitated: “I didn’t feel that I had the knowledge that I needed,” recalls Stillwell, director of quality improvement and risk management, MCRG.  “But I knew that I was a resourceful person and thought it was a great opportunity, so I dove right in. I have been in the role for about two and a half years now.”

A self-described militant pragmatist, radiologist Kurt Schoppe, MD, the ACR’s RUC advisor, is not one to shy away from unpleasant economic truths about medicine. Schoppe, a body radiologist with Strategic Radiology member practice Radiology Associates of North Texas in Dallas/Fort Worth, shared some plain-speak on medical economics in a recent column called “Unpopular Opinions” in the Journal of the American College of Radiology.   

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).

Linda Wilgus, MBA, CPA, has spent more hours than she can count over the past 20 years reading physician fee schedules, state and federal laws, and other legal and regulatory documents impacting the business of radiology.  On April 5 in San Diego, Wilgus was recognized for her work as a member and chair of the RBMA Federal Affairs Committee by its president Thomas Dickerson, EdD, when he awarded her with the association’s Global Achievement Award.

Since 1930, Inland Imaging, Spokane, Wash., has provided radiology services for Providence Sacred Heart Medical Center & Children’s Hospital, a 719-bed quaternary care hospital, and Providence Holy Family Hospital, a 197-bed community hospital, owned by Providence Health & Services. The radiologists and hospitals deepened their relationship in 1998, when they entered into an exclusive outpatient imaging center joint venture (JV) contract that committed them to a 50-50 ownership of all of their outpatient imaging services in a prescribed geography.

In a unanimous vote, the Strategic Radiology (SR) Board of Managers approved a business plan to implement three sweeping national initiatives that will greatly enhance collaborative activity and services for members, 22 privately owned and independent radiology practices. “We have a clear direction, we know where our compass is pointing, and we know what to do,” said Arl Van Moore, MD, FACR, CEO and chair of SR.

Quality operatives from Strategic Radiology member practices gathered at the March Quality Forum recently, held in Phoenix at the Wild Horse Pass Resort, to share best practices and provide input on future quality initiatives. Lisa Mead, Strategic Radiology PSO and Quality Director, kicked things off with a review of the regulations governing Patient Safety Organizations (PSOs) listed by the Agency for Healthcare Research and Quality for the new participants in the room.

When a leading patient satisfaction survey provider announced changes to its survey tool that reduced its value to radiology practices—particularly those that operated outpatient imaging centers—one member wondered if Strategic Radiology could develop a more relevant and useful tool.  Working together, Lisa Mead, RN, MS, CPHQ, executive director, SR PSO Quality and Safety, initiated a Quality Workgroup to develop the questions, and Dave Polmanteer, director of analytics and business intelligence, developed a survey tool that could be customized for each practice.

By Arl Van Moore Jr, MD

Last year’s record-breaking deal-making activity among hospitals and health systems suggests that the market is entering a new era of collaboration as consolidation continues. Size and scale have always propelled merger and acquisition (M&A) activity, but the 2017 deals were different Strategy not finance drove the deal-making, according to a report from Kaufman Hall & Associates.

Nine interventional radiologists (IRs) contributed to an enlightening guide to the Twitter IR ecosystem recently published in the Journal of the American College of Radiology special issue on Social Media and Medicine. Among the authors was one of Strategic Radiology’s more active users of the platform, Diversified Radiology’s Peder Horner, MD, @IR_Doctor.

Have you ever wondered how much time the radiologists in your practice spend on nonclinical, unreimbursed activities? When you meet with clients to negotiate contracts, do you struggle to accurately quantify the hours your radiologists spend on tumor boards, hospital committees, patient safety activities, and other contributions?

By Clint McClurg

Before I began my career with Diversified Radiology in Denver, I really never gave much thought to what a radiologist was, and I certainly didn’t think it mattered. After all, if they got their doctor of medicine degrees, weren’t they the same as any other physician? My second day on the job gave me a clear indicator that I was very misinformed. In a small, dark room with a bank of large monitors, I witnessed something completely unexpected.

Twice a year, Strategic Radiology’s CEO Arl Van Moore, MD, FACR, packs a bag and travels to a destination somewhere in the United States to represent radiology in the House of Medicine—the American Medical Association’s House of Delegates (HOD). He has represented radiology as a member of the American College of Radiology’s delegation since 1996.

At the conclusion of 2017, contributions from Strategic Radiology (SR) member practices exceeded the halfway milestone toward funding their $800,000 gift to the RSNA Research and Education (R&E) Foundation.  The commitment will fund annual Strategic Radiology Research Seed Grants for 20 years in support research conducted by young investigators and push the specialty into the future.

Located in the Silicon Valley, Stanford Radiology has an enviable vantage point from which to advance deep learning in radiology. Curtis Langlotz, MD, PhD, director of Stanford’s new Artificial Intelligence in Medicine & Imaging (AIMI) laboratory, was one of three academic radiologists to share their institution’s approach to AI during a standing-room-only How I Do It session at the November 2017 meeting of the Radiological Society of North America (RSNA),

During the 2017 RSNA meeting, Jennifer L. Kemp, MD, a body imager with Strategic Radiology member practice Diversified Radiology, Denver, CO, was awarded with the Minnie Award for Scientific Paper of the Year from Aunt Minnie editor-in-chief Brian Casey.  Kemp received the award as lead author of a paper published in Radiology[1] that described the findings of an RSNA survey exploring radiologists' opinions about patient-centered radiology. 

In June, one of Strategic Radiology’s most visible symbols of the value of collaboration, the Patient Safety Organization (PSO), will celebrate its fifth anniversary. Since it was listed by the Secretary of the Department of Health and Human Services and the Agency for Healthcare Research & Quality (AHRQ) on June 19, 2013, SR’s PSO has stood as the first and only radiology-specific PSO in the United States.

If you hadn’t noticed, you may be surprised to see that Strategic Radiology has a brand new, mobile-responsive web site.  Take a few minutes for a test drive. On the home page, you’ll see that there are four user experiences to meet the needs of our primary visitors: radiologists, hospital executives, payers and other partners, and patients. Each section is designed to provide information that helps visitors understand the value that Strategic Radiology practices contribute to health care. 

On September 18, 2017, CMS made available the 2016 Annual Quality and Resource Use Reports (QRURs) to every group practice and solo practitioner in the nation. SR PSO Quality and Safety Director Lisa Mead took that one step further and provided those Strategic Radiology (SR) practices that submitted their data to SR’s Patient Safety Organization with an additional benchmarking document showing them how they compared with their SR peers.

In January 2018, physicians will receive a positive, negative, or neutral update in their Medicare reimbursement rates based on their final score based calculated from 2016 data for the Merit-based Incentive Payment System (MIPS).

Although CMS gave no indication in the proposed 2018 Medicare Physician Fee Schedule (MPFS) that cost would be included in the 2018 calculation—along with quality, improvement activities, and advancing care information categories—the 2018 MPFS Final Rule allotted 10% of the total score to where radiologists fall on the cost spectrum. What does that mean?

Interest—and concern—about artificial intelligence ran so high at the 2017 RSNA meeting that fully 20 minutes prior to the start of “Deep Learning in Radiology: How I Do It,” all seats were occupied and the room was ringed by a standing-room only crowd. Luciano M. Prevedello, MD, MPH, Curtis Langlotz, MD, PhD, and Bradley Erickson, MD, PhD, repaid their eager audience with a rare gift in these times of high AI anxiety—they demystified a powerful new tool.

In his president’s address at the annual RSNA meeting in Chicago, Richard L. Ehman, MD, posed the following rhetorical question: “Is it time to reinvent radiology?” The 103rd president of the RSNA left no doubt that he believes the time is now, and he urged, cajoled, and implored radiologists to roll up their sleeves and engage in the transformation of the specialty.