New Way or Doomsday

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Since the third week of May 2009, a radiology forum at has been on fire. At issue is the takeover of radiology services at a network of Toledo, Ohio, hospitals by Imaging Advantage LLC, Algonquin, Illinois, which calls itself “a nationally recognized radiology management company”1 in a press release. What ignited the forum fire was that the Imaging Advantage takeover occurred with little warning and deposed a radiology group that had been reading at the Mercy Health Partners (MHP) hospitals for more than 30 years.

The second factor that upset some radiologists who posted comments was that Imaging Advantage’s business model incorporates a hybrid between on-the-ground radiologists at a hospital and teleradiology services acting as an overflow valve. This is not just teleradiology for night interpretations, but teleradiology deployed as a full-blown adjunct to the on-site staff. Posters fear that other radiology practices could fall prey to companies like Imaging Advantage that would commoditize radiology by using teleradiology as a tool to cut deals with hospitals that are too lucrative for those hospitals to refuse.

The threat of such takeovers involving teleradiology is not a small concern in the radiology community. In this case, the point was driven home by the resignation of one of the early pioneers of teleradiology from NightHawk Radiology Holdings, Inc (Coeur d’Alene, Idaho), a major teleradiology provider that does work for Imaging Advantage. On June 8, the very day that Imaging Advantage deposed Consulting Radiologists Corp, Toledo, and took over at MHP, Paul E. Berger, MD, resigned as NightHawk’s chair.

In his resignation letter Berger cited “significant differences” with NightHawk management. “These are more than simply philosophic and business-strategy issues and relate to the fabric and core principles that I have tried to inculcate into the mission of the company as a founder, and former president and CEO,” Berger wrote.

Berger wouldn’t say whether one of the core principles he adhered to was that NightHawk should not invade other radiologists’ turf. In its early days, NightHawk had been careful to depict itself as a night-reading service only, designed as an aid to existing radiology groups. Berger makes no reference to NightHawk’s involvement in Toledo, although he calls a lot of the AuntMinnie postings “correct.”

“I can’t be more explicit than what I said in the letter,” Berger says. “I might be the wrong one on how I think the world is going, but I don’t want to be part of thinking that other way.”

Imaging Advantage

Imaging Advantage CEO M. Naseer-Uddin Hashim says, however, that there is a lot of excitement attached to thinking another way. “Radiology, the way it’s practiced, is very static,” he says. “I think it should be dynamic; that’s our model. Give the local physicians the tools, the technology, and the resources to serve the patient better. I believe you, [the radiologist], are part of a dynamic system throughout the United States. I’m going to put you into that network.”

Hashim describes himself as a former practicing attorney turned entrepreneur. Imaging Advantage began in 2006, he says. He was reluctant to discuss Imaging Advantage’s clients other than MHP, but agrees that the number could be called “several dozen.”

Imaging Advantage, Hashim says, might partner with a radiology group, take over the group, or (as in the case with MHP) take over the radiology service contract with the hospital. Whenever it has taken over the contract, he says, it has always offered jobs to the radiologists in the existing group, which it tried to do with Consulting Radiologists Corp in Toledo. He says that it was unusual for radiologists in the existing group to turn Imaging Advantage down cold, as the Consulting Radiologists Corp physicians did. “This is the first time this has ever happened, where the whole group has decided they’re going to hold off,” he says.

Hashim denies that what Imaging Advantage was doing amounted to a predatory commoditization or corporatization of the practice of radiology. “We’re exactly the opposite,” he says. “I start by working with the local radiologists and saying, ‘Let me make you indispensable.’” Adding teleradiology into the mix, he says, eases the burden on the local radiologists and improves turnaround times on reports. “When you improve turnaround times, you serve patients better,” he says. “The other thing is that you’re removing stress because