At Rosetta Radiology in Manhattan, effective management involves more than purchasing equipment and hiring staff. With only four doctors on staff, it’s a small center in a big city rich with hospitals and health systems that are constantly scooping up independent centers. To stay strong solo, the center had to explore alternative ways to get the word out to potential patients. In a typical week, employees may give input on a Facebook post, participate in a charity walk for cancer research or give a presentation at a local school.

“You don’t have to get one big billboard, you can do 10 small things,” says Deborah Bergsohn, physician relationship manager at Rosetta Radiology.

Besides the time the center has put into marketing and outreach, it also made a financial investment— Bergsohn was hired from a company that helps small imaging centers with their marketing efforts.

Even though Rosetta Radiology is staying independent, the office still connects with other doctors’ offices via Facebook and through group activities like charity walks. “The referrals are going to be 5 percent patients, 95 percent doctors offices,” says Bergsohn.

In total, sixty-six percent of the 6,514 imaging centers in the U.S. are affiliated sites, according to a survey from Radiology Business Journal. Despite lower reimbursements for radiology, the number of imaging centers grew in 2012, perhaps in anticipation of the potential patients to be added to the ranks of the newly insured under the Affordable Care Act. Most of that growth was among the country’s largest imaging center chains, led by RadNet, which owns 220 centers in California and on the East Coast.

Being part of a network has its economic benefits, but Bergsohn says independence has its perks, too.

“Besides the financial freedom, it’s nice to be able to say to existing patients, ‘we are going to remain the same dedicated practice that we always were,’” says Bergsohn. “We have patients who have been coming here for 20 years for their mammograms.”

The struggle for independence, or the choice to join a network, is just one challenge imaging centers face today. Lower reimbursements leave a smaller budget to deal with equipment purchasing, service contracts and staffing, forcing managers and employees alike to get creative and stay flexible.

Power to the people

Like Rosetta Radiology’s social media and community engagement efforts, Northern California PET Imaging Center in Sacramento, Calif. puts much of its focus on quality customer service. But sometimes it’s tough to maintain the manpower required to please everyone.

For example, the facility doesn’t have an automated phone system.

“We get 100 phone calls a day, so we ask, ‘how do we maintain customer service when we really can’t hire that many more people?’” says Ruth Tesar, CEO of the imaging center.

To make a smaller staff work well for the center, Tesar tries to hire tough people who can work independently while still following protocol.

“I try to hire people that are very flexible and that love to think on their feet,” she says.

Even in an economy full of eager job hunters, managers say it can be tricky to pick out the perfectly adaptable person.

“I’m always looking for multi-modality technologists,” says Viviana Ruscitto, director of diagnostic imaging at Westmed Medical Group in Westchester County, N.Y. “There’s always a dry spell with ultrasound and finding someone with experience.”

A smaller staff also means employees should be able to switch hats with ease.
“We have technologists that will run the front desk, and also scan and take X-rays,” says Julie Cassidy, operations manager at Tristate Imaging Consultants, with locations in New Jersey, Delaware and Pennsylvania.
The center applies that emphasis on flexibility to the center as a whole, Cassidy says. Because the center is privately owned rather than being hospital-based, Tristate Imaging Centers can offer flexible hours and days of operation to meet area needs, she says.

Keeping up with the Joneses

Facilities try to offer cutting-edge technology whenever possible to keep patients coming and provide the best care. But tighter budgets mean centers must be thrifty about investing in high-end machines.

Affiliated centers, for example, can leverage their numbers to get deals on new equipment.

“Because St. Vincent’s is part of Ascension Health, we can leverage the size of the organization with vendors so that we get extremely good pricing across the nation,” says Elaine Murtha, system director of St. Vincent’s HealthCare in Jacksonville, Fla.

Some centers go the well-traveled refurbished route to save money on large purchases.

“I always look for refurbished, or if it’s small equipment, like a portable ultrasound, if we can find a demo unit that’s great,” says Murtha.

Service agreements can also be a financial burden for imaging centers, Murtha says. Her center chooses in-house engineering over outside contractors to save money.

Murtha says her center tries to stay on a five-year replacement plan, but that sometimes, other projects push to the forefront.

Health IT, for one, often takes priority thanks to Meaningful Use initiatives. But even if initial investments are burdensome, facilities sometimes find that health IT can help address other problems centers deal with.

“Before, there was such room for error — loss of paperwork, the loss of films, getting fingerprints on your films,” says Westmed’s Ruscitto.

Sometimes HIT can add more steps to workflow, however. Northern California‘s Tesar noted that physicians often request results in a variety of formats depending on their HIT set-up, so the center’s PACS is equipped to deliver responses to a wide range of requests.

“There are some things that make life a lot easier,” says Tesar. “But even though we have efficiencies to get from the patient entering the door to getting the scan done, we still have a lot of steps along the way.”

Patient priorities

Cut budgets don’t preclude quality patient care, of course. Some imaging center goals, like dose management, may add extra items to an already crowded workflow, but are important industry developments that matter for patient safety.

St. Vincent’s began tracking dose by patient about a year and a half ago, Murtha says. Westmed is getting a software upgrade from GE that elicits a pop-up window when someone attempts to change dose.

Westmed also implemented a case management program to make sure patients are receiving the proper care, Murtha says.

“We’re an Accountable Care Organization, so we’re making sure that the patients are getting the best education they can and are getting the exams that they truly need,” she says.

With ACOs, health IT and dose management, paired with the constant specter of lower reimbursements, imaging centers look different than they did even a decade ago when the number of centers doubled between 2000 and 2008.

Tesar, who has been in the business for 20 years, says that some elements of imaging center management have in fact improved.

“People who have just entered the PET market might not believe that it’s gotten easier, but since I’ve been in it for so many years, the payment and coverage really has become much better,” she says. “It doesn’t mean that you’re going to get paid better. But I think the payers try to clarify much better what’s going to be paid for that modality.”

And while more complicated documentation and billing have been no thrill, Tesar says watching PET technology evolve has been an exciting part of her career as the modality becomes more effective and patient care improves.

“That makes our jobs really fun, and knowing that the patients are getting much better scans, and much better answers,” she says. “It’s constantly refreshing.”
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