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In the mid-1980s, among the companies selling and servicing medical equipment in the southeastern Pennsylvania and New Jersey areas, Brandywine Imaging, Garden State Imaging (GSI), Radiology Imaging Services, and Deccaid Services had something special. The companies weren't competitors, exactly -- they were more like cousins. Being so close physically, and having similar goals, it was only a matter of time before, as Brandywine's Ron Laird says, a "handshake deal" established what was to become the Association of Medical Service Providers (AMSP). Today, the AMSP has 23 members in 15 states, and remains committed to advancing their common interests. From group purchasing contracts to technical support to advertising and networking, the AMSP is helping its members remain viable in an increasingly challenging business environment.

Progress and support

A lot has changed since 1986, when the AMSP was formally established. Perhaps most prominent is the emergence of new technologies -- multi-slice CT scanners, or the recently unveiled PET/MRI. The increasing prominence of healthcare information technology (HIT) has also posed problems. As GSI's Ed Ravenkamp says, "Without the AMSP, it would be extremely difficult to get through the minefield of software keys and different products coming out on the market. There isn't a product not locked up." The AMSP allows its members to share knowledge of these details, increasing the impact of new software on efficiency.

The replacement of film with digital has been of particular concern with some AMSP members. Brandywine used to do almost half of its business in film, but with the rise of direct radiography (DR), Ron Laird finds that the lack of consumables hurts his bottom line. As part of the solution to this problem, the AMSP has entered into negotiations with a Taiwan company to provide its members with DR equipment. According to Sal Aidone of Deccaid Services, Inc., the company's amorphous selenium arrays are less than half the cost of comparable American equipment. Also, Aidone says, they are willing to retrofit X-ray machines already in use.

Fighting the big boys

The relationship between independent service organizations (ISOs) and original equipment manufacturers (OEMs) has always been a contentious one. As Tim Wright of Virtual Medical Sales, Inc. says, "OEMs would rather we didn't exist because they would sell more equipment if we weren't here." There is competition for service contracts as well, but Aidone thinks that the instinct toward self-preservation often leads hospital technologists to go to OEMs for support. "They think, 'nobody can fire me if I call GE.'" Aidone thinks this goes against the technologists' best interests, as the OEMs will often bill the hospital for the work of three engineers while an ISO might only use one.

Still, many AMSP members find their relationships with OEMs beneficial, even friendly. Scott Wasson, President of the AMSP and member company Radiology Services LLC, says that it is "different with each OEM," but mostly "wonderful." On a scale of one to ten, Robert Probst, owner of Technical Prospects, rates his relationship with OEMs as "probably a ten." And Steve Hurley of ProActive Technology Solutions, Inc. (PTSI), says that OEMs will occasionally seek his assistance when they have a whole-hospital service contract, because certain ISOs can work on niches that OEMs have neither the time nor the resources to address.

The impact of reimbursement

Cuts in Medicare and Medicaid reimbursements for imaging procedures, the result of the 2005 Deficit Reduction Act (DRA), have sent shockwaves across the medical community. AMSP members, however, have a slightly different perspective: They think they stand to make a profit. According to Wasson, a reduction in reimbursements will "force [imaging centers] across the board to search for the best value in the industry," which often means service and refurbished equipment from AMSP members. While the DRA cuts do not apply to hospitals, all facilities and providers are also under cost pressures. Wasson relates the story of a large hospital he is currently trying to acquire as a client; he had assumed that with their size and resources they'd be buying new OEM equipment, but was surprised to learn that even they are in the market for used.

In addition to the DRA cuts, another force is at work in the imaging industry: CareCore National, an imaging management company. According to Shelley Weiner, MD, Director of CareCore's Imaging Center Assessment program, CareCore's goal is to "control the over-utilization of imaging services, and help direct physicians to appropriate use of imaging services." They do this by partnering with health insurance plans and integrating their own evaluations -- performed by a utilization management committee consisting of practicing radiologists, both academic and community-based -- into the insurers' decisions concerning reimbursement. Dr. Weiner says that CareCore's evaluations use standards stricter than those of the American College of Radiology.

Aidone, however, takes issue with CareCore's program, saying that they bypass existing regulatory and advisory bodies, and that their standards are too draconian. Ravenkamp agrees, saying that while CareCore's impact on GSI has so far been minimal, he foresees a problem in that "what [CareCore] is trying to do is force newer equipment, driving margins down for end-users. It's a double whammy for us... adding cost to the equation from two standpoints." Ravenkamp says that because CareCore forces end-users to purchase expensive new equipment, and because they charge insurance companies for their consulting services, prices are bound to go up across the board.

Yet not all AMSP members agree. Richard Stock, of Radiological Imaging Services, says of CareCore, "If anything it has given me more customers calling for newer equipment that could be available through my company or upgraded equipment that meets those requirements."

Unique among GPOs

The AMSP is far from traditional and far different from large GPOs. Members may choose to participate in the deals the AMSP sets up (only a handful of AMSP members plan to participate in the deal with the Taiwan DR manufacturer, for instance). Members avoid competition not by the conventional process of assigning territories, but by assigning modalities, ensuring no member loses a customer. And the organization's scope is purposely focused and contained. According to Wasson, the AMSP's slow growth is intentional -- its members prefer the "clubhouse" feel.

Having held its annual winter meeting (in Cancun -- these "business vacations" are a member favorite), the AMSP will next meet at the Medical Dealer Magazine Expo in October in Stone Mountain, Georgia. There they hope to close on some purchasing deals, and perhaps add some members. But only one or two.

The list of AMSP members below includes many DOTmed Users:

Accurate Recovery Systems, Huntingdon Valley, PA
Alexandria X-Ray INC., Alexandria, LA
Artec Imaging, Cornelius, NC
Brandywine Imaging Inc, Lincoln University, PA
Cal-Ray, Inc., Oshkosh, WI
Clinical Biomedical Services, Inc., Charleston, WV
Deccaid Services Inc., Deer Park, NY
Digital X-ray Specialists, Inc., Knoxville, TN
GSI Garden State Imaging, Inc., Atco, NJ
InterMed X-ray, Inc., Alachua, FL
MedicalDigital Imaging of Texas, Austin, TX
Medical Imaging Systems, Birmingham, AL
Preferred Diagnostic Equipment Service, Inc., Corona, CA
ProActive Technology Solutions, Inc., Dublin, OH
Radiological Field Sales, Clockville, NY
Radiological Field Services, Inc., Little York, NY
RIS Radiological Imaging Service, Hamburg, PA
Radiology Services, LLC, Evansville, IN
Radon Medical Imaging Corporation, Charleston, WV
SouthWest Imaging Inc., Las Vegas, NV
Technical Prospects, Greenville, WI
Universal Medical Services, Beaver Falls, PA
Virtual Medical Sales, Inc., Syracuse, NY