Radiology Business’ most-viewed stories for June 2024

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From the Editor??

You’ll pick up on some themes in Radiology Business’ most-read stories for the month of June. Thousands of radiology practices have disappeared from the Medicare rolls since 2015 amid waves of consolidation in the specialty, according to new research published last month. The study didn’t attempt to ascertain the reasons why, but you can fashion a few guesses. Physicians are seeking greater leverage in negotiations with ever-more-powerful payers. Regulatory burdens are becoming more complex. And private equity’s appetite for practice acquisitions has only grown more voracious in recent years. Whether these trends are good for the specialty is still up for debate. Dozens weighed in last month, responding to a recent inquiry from the FTC centered around “corporate greed” in healthcare. Some are deeply troubled by where things appear to be headed, while others believe physicians are simply doing what’s necessary to survive today’s rapidly evolving imaging marketplace. You be the judge.

Imaging industry giant RadNet is sitting on nearly $700 million in cash after several recent financial maneuvers. CEO Howard Berger, MD, discussed how his company plans to deploy these resources during the Jefferies 2024 Global Healthcare Conference on June 5 in New York. The publicly traded, Los Angeles-based company was able to boost its balance sheet by raising $230 million through a public stock offering and?refinancing?over $1 billion in debts, allowing it to pay down balances and fuel growth. In Q1, the company recorded adjusted earnings of nearly $58 million, a 21% year-over-year uptick, with its debt-to-equity ratio a healthy 1x. Berger said the improved financial picture has placed RadNet in an advantageous position when holding conversations about expansion. RadNet is sitting on almost $700M in cash. CEO Howard Berger, MD, discusses how he plans to deploy it

Members of an east coast radiology practice, which recently partnered with private equity, are selling one of its imaging center properties in a leaseback deal valued at $5.8 million. However, US Radiology Specialists had nothing to do with the transaction.?Physician investors at South Jersey Radiology Associates in May unloaded the 20,000 square-foot facility in Turnersville, a suburb of Philadelphia with a population of about 3,000. The buyer was Port Washington, Pennsylvania-based Mediplex Property Group, which is now leasing the center back to South Jersey Radiology. According to county records, the practice bought the parcel in 1999 for $410,000 with the new sale price representing a 1,300% profit. SJRA is a member of US Radiology Specialists, which employs 400 physicians facilitating upward of 8 million radiological scans each year. Members of private equity-backed radiology group sell imaging center at a 1,300% profit

Six months after CMS suspended its Appropriate Use Criteria program, some radiologists are planning to carry AUC principles forward anyway. The aims of the program since its 2014 inception were sound: Reduce utilization of low-value imaging while increasing compliance with guidelines on what constitutes appropriate advanced imaging exams. Organizations spent substantial sums on preparing to meet program mandates. Alas, efforts to tie AUC implementation to reimbursement were marked by setbacks and postponements across the program’s 10-year lifespan. This time the pause appears indefinite if not permanent. CMS has?invited?providers and suppliers to cease including AUC consultation information on Medicare claims and stopped qualifying provider-led entities and clinical decision support mechanisms. Policy experts at JACR?have organized their thoughts on the subject around a key question: “What should radiology practices and healthcare institutions keep, dismantle or adapt from their prior AUC efforts?” AUC is dead. Long live AUC.

A southern state has made it easier for providers to add new advanced imaging offerings. Tennessee Gov. Bill Lee signed the?measure?into law May 21, removing certificate of need requirements related to MRI and PET, along with those pertaining to other healthcare facilities such as freestanding emergency departments or ambulatory surgery centers. Current Tennessee law requires providers to obtain a certificate of need before adding a new PET scanner in counties with populations of fewer than 175,000. But following the change, they only need to become accredited by the American College of Radiology within two years of being licensed, according to a?summary?of the bill provided by Holland & Knight. Meanwhile, the bill also removes CON requirements for initiating MRI services or increasing the number of scanners in the Volunteer State. State scales back certificate-of-need law, making it easier to add new advanced imaging services?

Thousands of imaging groups have lost their independence over the past decade amid waves of consolidation, according to research published June 5. Between 2015 and 2022, nearly 3,500 practices that provide radiology services disappeared from the Medicare Provider Data Log. This included roughly 2,300 practices (65%) that operated solely within the specialty, experts detailed in the?American Journal of Roentgenology. Across almost 3,900 physicians for whom their sole affiliation was a radiology-only practice that vanished from the Medicare rolls, 46% worked for a larger multispecialty group the following year. Meanwhile, the balance (54%) worked at a different radiology-only practice at the next turn of the calendar. Though the number of Medicare-enrolled radiologists increased 17% during the study period (up to 36,000), the tally of affiliated practices fell 15% (down to 4,300). Thousands of radiology practices have lost their independence amid waves of consolidation

Neuroradiology has topped the field among imaging subspecialties vying for new fellows to train, filling 287 of 316 certified positions—a 91% fill rate—across 87 fellowship programs. The strong showing prompted neuroradiologist Francis Deng, MD, of Johns Hopkins to?tweet: “Neuroradiology is at its hottest point ever.” The National Resident Matching Program announced the results June 12. Across all radiology subspecialties, 346 certified programs filled 706 of 920 positions, a solid 77% clip. Of subspecialties highlighted by NRMP, the runners-up were breast imaging (79%), musculoskeletal radiology (73%), interventional radiology (59%) and emergency radiology (30%). Following 2024 fellowship matching, neuroradiology said to be ‘at its hottest point ever’

The?American College of Radiology?said it needs more radiologists to fill out the?American Medical Association Physician Practice Information Survey because it will be used to update how Medicare reimburses doctors. As of the mid-May, of the more than 400 radiology practices sampled, less than 10 had completed the survey. “Results from the survey play a major role in establishing accurate practice cost data for radiology and other specialties. It will have a large impact on physician payment,” ACR explained. The survey aims to collect practice cost information for radiologists and other medical specialties and share that information with the?Centers for Medicare and Medicaid Services. ACR said data currently used by CMS in the?Medicare Physician Fee Schedule?has not been updated in over 15 years. The AMA, in coordination with Mathematica, has been promoting the survey since July 2023. Only 10 radiology practices completed survey used to adjust Medicare payments

A June 26 article in the?American Journal of Roentgenology outlines 17 ways to reduce the impact of the growing national shortage of radiologists. The piece presents multiple short-term strategies to increase the effective radiologist workforce or boost efficiency to alleviate current challenges. These strategies were derived from an analysis of possible practice-level changes in personnel, process and the working environment.?For example, in the category of people, the authors determined that if all 4,352 national part-time radiologists increased their work by one additional day per month, the equivalent of 261 additional radiologists would be added to the national workforce. "This article should stimulate practices to systematically try specific strategies and evaluate outcomes on the basis of objective metrics such as radiologist job satisfaction, burnout, rate of turnover or rate of retirement,” experts explained in a corresponding editorial. 17 short-term strategies to address the national radiologist shortage

Radiology stakeholders responded to a recent request from the Biden administration about how “corporate greed” impacts the specialty. In?March, the FTC and other agencies launched an inquiry into private equity and other corporations’ “increasing control over healthcare.” The deadline to submit comments was June 5, with respondents submitting 30-plus messages related to imaging. Strategic Radiology—a coalition of 40 independent practices encompassing 1,700 physicians—cited a recent?study, which found a 608% increase in the number of PE-acquired practices between 2012 to 2021. “This trend worries us, and it should worry you too,” wrote CEO Scott Bundy, MD. “The aggressive acquisition strategies employed by PE firms prioritize short-term profit maximization over long-term investments in patient care and infrastructure. They take on an enormous debt load, aggressively use leverage to buy medical practices using borrowed money, and try to increase profits through negotiating clout, suppressed salaries, and unsavory financial schemes.” Radiology stakeholders weigh in on FTC’s exploration of how ‘corporate greed’ is impacting the specialty?

GE HealthCare named a new president and CEO to lead its imaging division on June 11, one of several recent leadership moves in radiology. Roland Rott, GE’s former president of ultrasound, took over the title effective July 1. He replaced imaging leader Jan Makela, who left the organization to become CEO of hearing loss specialist WS Audiology. Meanwhile, Philip Rackliffe, president and CEO of image-guided therapies, assumed the ultrasound leadership role while continuing to oversee IGT. As part of the changes, GE HealthCare rolled the therapy division into ultrasound, forming a business worth more than $5 billion in annual revenue. In other leadership news, Bharat B. Mittal, MD, stepped down as head of radiation oncology at Northwestern University’s school of medicine, and Upstate Medical University named Arabinda Choudhary, MD, MBA, as the new chair of its Department of Radiology. GE HealthCare names new CEO of imaging, plus more radiology leadership moves

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