Riggs' center has also changed business practices. Solano once had satellite X-ray offices set up for the convenience of patients from various primary care facilities, but they can no longer afford the offices and on-duty techs, and so have consolidated those offices into a few larger centers.

Solano also relies on the advantages of PACS technology. Prior to the DRA, Solano could use either PACS or print out an image on film for doctors who felt more comfortable dealing with film. Now, his budget can't accommodate the expense of film, which Riggs says has led to solely using PACS. "Everything is digital. We don't have that [film] option anymore," Riggs observed.


Other business modifications include investing more in advertising and marketing, and working to ensure physician relationships are well-maintained. There will continue to be difficult changes, in part due to the added complications of the California Medi-Cal system. Riggs sums up the various problems in DRA cuts: "It can't continue to the point where no one can make money doing it."

Ward Hinger is the Alaska Area Administrator for Diagnostic Health Corporation in Anchorage, AK. Hinger oversees a full modality facility and a single modality site which primarily supports orthopedic physicians. Diagnostic Health is composed of a network of 47 free-standing diagnostic imaging centers in the U.S. Alaska's Medicare market does not mirror demographics in the lower 48, but nevertheless still feels the DRA's impact, including how it effects Hinger's purchasing decisions. He finds it beneficial to leverage the purchasing power of Diagnostic Health with certain OEMs for equipment, service contracts, and supplies. In proactive business tactics, Diagnostic Health focuses on eliminating waste and improving customer service. From Hinger's studies and experience, he believes the imaging industry can continue to be competitive by marketing to their strengths, such as ease in scheduling, same day access, ambiance, consultation, and value.

The "trickle down" effect now seen with payers as a result of the DRA, however, makes this, "an extremely 'deadly' piece of legislation for some free-standing imaging centers," Hinger says. On a national level, Diagnostic Health has seen the larger commercial insurers adopt new fee schedules that are based on the updated Medicare schedules. In addition, "a growing number of primary and specialty care physicians in Anchorage, our referral sources, are opting not to participate in Medicare as they claim that Medicare no longer covers the cost of rendering services," Hinger noted.

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