The Pathway to Dominating Radiology and Imaging

Airpower and on the ground military power separately, cannot win a conflict. Together; however, the combination can be devastating. – Anonymous.

A report from Transparency Market Research recently stated that the global teleradiology market was worth approximately $0.92 billion in 2012.  The estimation is that this market will grow at a rate of approximately 22.3% between now and 2019, resulting in an estimated worth of approximately $3.78 billion in 2019. 

With this much money entering the market in such a short period of time, as stated in my previous columns, the pressure to dominate the market will be irresistible for corporate and imaging players alike; but who are the major players?  As the future of radiology will potentially be determined, or at least significantly impacted by what these groups do, radiologists should know who they are and their strengths and focus points.

The radiology/imaging market is difficult to parse and identify a specific percentage of market share.  Not only do you have to take into account size, but also growth, visibility, and the more ethereal quality of influence. Finally, you have account for the military dictum from above; airpower or on-site power alone cannot win. A win in this case would be a national radiology group.  This group will need a strong and/or dominating teleradiology system supporting and supported by a combination of local and regional on-site radiology partners who, in turn, dominate their markets.

My top picks for the four major players currently in the market include vRad/Mednax, Aris, Strategic Radiology (SR), and Imaging Advantage (IA). There are a number of mezzanine players and a myriad of small players also in the mix, but in my opinion, they do not have the numbers of radiologists, or the visibility or influence required to play at the national level.

The Major Players

vRad[[{"type":"media","view_mode":"media_crop","fid":"39295","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_3535833719850","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3937","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":" ","typeof":"foaf:Image"}}]]
vRad is well known to nearly everyone in radiology and imaging. The recent purchase of vRad by Mednax has provided additional capabilities for the future that are potentially powerful, but as of yet unclear. The current teleradiology company is the combination of two prior industry leaders, Nighthawk Radiology Services and Virtual Radiologic Corporation/vRad. It's hard to deny their visibility; they have the lion’s share of offsite teleradiology services. In fact, by all estimations, they are the world's largest provider of off-site teleradiology services. They reach all 50 states and according to their website, they have more than 350 radiologists. 

From the standpoint of combined power, vRad has attempted on-site operations with some success, though limited. Mednax with its ability to provide a range of on-site services now includes teleradiology; but, will this soon morph into providing on-site radiology and imaging as well? With vRad’s knowledge base primarily centered in teleradiology, the partnership between the vRad airpower and the Mednax ground power could be both disruptive in the market and potentially formidable. As usual, the devil is always in the details and implementation of a complete package, if realized, is still some distance in the future.

Technologically, vRad remains one the most aggressive radiology and imaging companies.  They continue to capitalize on their best resource – more than 15,000 interpretations per day from sites across the United States. Data mining and turning that raw material into actionable information is a goal of the technology focus. This, along with recent collaborations, including Metamind and Scriptor Software, to improve radiologist workflow and efficiency demonstrate that vRad is continuing to try and move toward an even larger share of the radiology and imaging pie.

Aris[[{"type":"media","view_mode":"media_crop","fid":"39296","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_6648077209626","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3938","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":" ","typeof":"foaf:Image"}}]]
Aris is fresh from its just-completed acquisition of Optimal Radiology Partners. This deal creates a national practice of more than 160 radiologists. It brings together an additional key component not seen to a great extent with vRad: on-site and teleradiology services. Aris is lesser-known than vRad, and to date has only been in the upper band of radiology companies vying for a higher profile and more market share. With the addition of Optimal, their reach and visibility increases. The true power and influence of the combined organizations is yet unknown. This will depend largely on what they do next.

Strategic Radiology[[{"type":"media","view_mode":"media_crop","fid":"39380","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9357245358017","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3946","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 42px; width: 300px; float: right; border-width: 0px; border-style: solid; margin: 1px;","title":"","typeof":"foaf:Image"}}]]
Strategic Radiology (SR), with its potential power and reach, cannot be overlooked. SR began as a concept that gained momentum and focus in 2007 when over a dozen of the largest radiology practices in the country came to Scottsdale, Arizona for a meeting of the minds. That meeting culminated ultimately in the formation of SR. The consortium consists of a combination of large and moderate-sized regional radiology practices. Currently there are 18 core and 5 affiliate practices.

If size were the only determinant of who would win the game of the most dominant national radiology group, SR representing more than 1,300 radiologists in its affiliated groups, would win hands down. From the standpoint of visibility, however, SR remains somewhat in the background. The primary focus, to date, according to their website, has been sharing “data and best practices, interchanging clinical expertise, and consolidating certain practice expenses.” There is also a very definite focus on quality and quality initiatives within the member groups.

A strong and very definite bright spot within the organization is its physician leaders, including Arl Van Moore, Jr, MD, its Chairman and CEO.  Moore was chairman of the American College of Radiology Board of Chancellors and a past president of the American College of Radiology. He was also president of Charlotte Radiology in Charlotte, North Carolina.  

Moore says that SR is highly focused on developing a coordinated teleradiology system that will benefit all of its members: "It takes a lot of collaboration and coordination, but we are committed to doing it right and handling cases in a clinically and cost-efficient way, no matter how much work is involved. Ultimately, we'll be able to provide integrated night and subspecialty final readings as well as some locums coverage across practices."

Moore and SR have developed a progressive, visionary group of leaders and an effective board of directors, primarily from amongst its large group partners. Together, they provide SR with the potential to bring significant capabilities for coordination between the groups and in development of a national, dominating radiology group. “Teamwork and leadership will be the secret to success; now and in the future,” Moore says.

SR, whose members are radiologist-owned and run groups operated by seasoned and focused administrative teams, stands at the opposite end of the spectrum from the mega-corporation, Mednax/vRad. The question remains how well any one or any group of people can mold such a large group of radiologists and radiology groups into one machine capable of sustained, coordinated action.

Imaging Advantage[[{"type":"media","view_mode":"media_crop","fid":"39298","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9542644600959","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3940","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":" ","typeof":"foaf:Image"}}]]
This brings us to the final player, Imaging Advantage (IA). IA was founded in 2006 by Chairman and Chief Executive Officer Naseer Hashim. Serving with Hashim are Chief Medical Officer Art Radow, MD, and President and Chief Operating Officer, Brian Hall, a former executive with Nighthawk Radiology Services.

Early in its history, IA had a reputation for displacing physicians and was primarily viewed as a threat to groups concerned about losing their contracts. Today, the company focuses on aligning the interests of physician groups and hospitals. This not only secures the local contract but provides more options for both partners through IA’s national network of contracts. Of its new operations effort, Hall says, "The IA solution starts with optimizing throughput and patient workflow, creating alignment with the on-site imaging and IR physicians, the referring clinicians, and the hospital. We augment the overall program with teleradiology and are measured on both clinical and economic outcomes. This combination aligns well with a wide range of the new outcome and quality based payment models."

IA has been growing. It currently reports to have over 400 radiologists with both on-site and teleradiology operations. Its recent acquisition of BRIT Systems increases its ability to provide a strong, unified, and proprietary RIS/PACS system, both on-site and for teleradiology. The combination of on-site, teleradiology, and infrastructure provides a potential springboard to launch an aggressive campaign towards a dominant position in radiology and imaging.

The Bottom Line
Whether created by radiologist-dominated or corporate-dominated groups, the first truly coordinated national radiology group will dominate the imaging/radiology market and potentially set the course and tone for the next 10 to 20 years. Third party payers and hospital systems alike would have to, and may actually jump at the chance to work with such an entity.

Corporate groups like Aris are merging their way to what may be a strong foundation from which to launch a national radiology campaign. The question is whether there is time to coordinate the new companies and make the move to the next level.

Radiologist-dominated groups, like SR, provide a different platform, taking advantage of regional power to dominate ever larger sections of the country. A strong, central command-and-control governance structure with the authority to make decisions for all will allow them to be more coordinated in their operations. An overlay of a strong teleradiology system coordinated both centrally and regionally is the next big step needed to dominate in their respective markets and make the entire system self-sufficient.

IA and vRad have the capital and potential power to make it to the top first. The distraction of the recent purchase may require some time for vRad to refocus, giving IA time to continue to maneuver and grow.

Regardless of which of these entities makes it to the top first, there is no doubt that radiologists and radiology groups will be different and will have to learn to function in this new paradigm.

Stay tuned for more…