Probably not yet, though data from the system's economic monitors is open to widely varying interpretation, much of it ugly.

But whatever a hospitals' woes--and there are plenty--it doesn't rival the upheaval, thanks in large part to DRA reimbursement cuts, felt by independent imaging and allied healthcare centers.

In fact, many larger hospitals have enjoyed a building boom in recent years, much of it to house new imaging equipment that then figures prominently in well-funded and extremely competitive marketing campaigns.
However, for every hospital transitioning from big to bigger, there's another closing its doors, usually at a rate of about once every ten days or so.

With a classic "only the strong survive" mentality, many hospitals are actively contributing to the financial problems besetting independent imaging centers; these hospitals are using their muscle to compete for business that otherwise keeps such alternative centers afloat.

Meanwhile, smaller, community based hospitals are either shutting down or being absorbed by regional and national powerhouses.

As for DRA cuts, some would say it's been a nightmare.

"Hospitals are regulated and get their rate but imaging centers don't," says Rob Manetta, vp, operations, Nationwide Imaging Services, Inc.
Over the next six to eight months, Manetta believes, change will continue apace in the independent imaging space. It will be a period marked by mergers, acquisitions, consolidations and the posting of "closed forever" signs to independent centers' doorways.

In fact, there's quite a debate about what, if anything, can be done to stem the high failure rate of these facilities, as evidenced by emails that have been circulating among the pre-owned sales and service set.

The campaign, such as it is, urges all interested parties to petition the House and the Senate to repeal DRA cuts for a two-year period, allowing further analysis of the cuts' economic impact.

"Ask that they (Congress) vote on these bills as soon as possible before there is no early diagnostic testing available outside a hospital setting," urges one email.

"We need to be proactive," says Pamela King, JP International. "Is there a surplus of centers? Probably, but the whole matter is not as simple as it looks."

King's seen proof of that from emails from fellow medical equipment executives, some of whom eschew this grassroots effort to overturn or modify the cuts. Instead, some executives argue that market forces will determine who survives and that a shakeout of weaker players is positive, making for healthier business climate for those left standing.

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