Outpatient IR Centers of Excellence: Trends in Practice Expansion

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As radiology practices react to the impact of the DRA, some are tapping into the potential of interventional radiology to expand their outpatient services

An older medical oncology patient had undergone the paracentesis procedure once before at a hospital. After she had it a second time at Sarasota Interventional Radiology (SIR), Sarasota, Fla, she met with Gerald Grubbs, MD, SIR’s founder, to let him know that his billing company had made a mistake. “She had her bill in her hand and told me that we had not charged her enough,” Grubbs says. “She had paid $8,000 to the hospital the last time, and our bill was only $500—but I told her that the bill was correct, which it was.”

Reduced patient costs are but one advantage that is fueling the growth of outpatient interventional radiology (IR). Other factors include the continued shift of inpatient imaging to the outpatient setting, as well as the subspecialty’s notorious ability to reinvent itself continuously in response to market needs and technological innovation.


If the DRA has had any benefits, the best one may be that it has propelled IR into the outpatient realm by forcing an increasing focus on the business side of outpatient imaging. This business perspective—the trend toward reviewing financial and staffing metrics in a more focused and more frequent manner—has led to the strengthening of those centers that were already doing well and the improvement of those with marginal results. More than that, however, it has led to a heightened level of entrepreneurial activity.

A Natural Evolution

Some leaders of outpatient IR enterprises acknowledge the lack of sophisticated or formal market analysis prior to opening. They gave these projects the green light because they perceived a void in the marketplace, because they wanted to improve patient care, or both. Thomas Lombardi, MD, of Riverside Radiology Associates in Columbus, Ohio, says, “We opened the center because we saw a need for pain patients and other elective cases in a hospital setting typically having delays or getting bumped from the schedule. We wanted to facilitate a more convenient setting for the patients in a more comfortable environment. We wanted to house both the pain management and the pain therapies in conjunction with diagnostic imaging in a more upscale, spa-like setting.”

The natural cycle of any successful business includes product and service expansion. Just as obstetrician/gynecologists have added aesthetic services, and as anesthesiologists are becoming a force in pain management, many outpatient imaging centers have turned to a broader service line of procedures—not only to attract new referrers and patients, but also to maintain the viability of existing relationships.


These conscious decisions to invest (and, in some cases, to invest heavily) in what could, arguably, be called a gamble have launched a new era in outpatient imaging. One hallmark of this new era is a deeper reach into the surrounding community—one that attempts to attract a broader range of referrers and that often is dependent on a direct-to-consumer marketing effort to help ensure success.

Marcia Flaherty is Riverside Radiology’s CEO. With Lombardi and others in their business, she has overseen the creation and development of a four–year-old facility, Premier Medical Imaging, that is expanding in both size and scope.


The center has focused on pain management and vein therapies, with specific plans to add more services in the near future. “When we set this up, we had pretty high quality standards,” Flaherty says, “so I can’t tell you that there is any different approach to our quality based on this center than what we would typically do based on the quality processes that we would normally apply within this group.”

Medical Diagnostic Imaging in suburban Milwaukee opened the Milwaukee Vein and Laser Center (MVLC) several years ago. Carol Martin, executive director, says, “We opened the vein center in 2003, before laser vein treatment became popular. I don’t believe there were even approved CPT® codes for reimbursement at that time. It was challenging to receive payment; overall, receiving preauthorization for these treatments is probably our biggest hurdle.” She adds, “One of the reasons we opened was to diversify ourselves from medical imaging, which requires a company to rely on payors for an appropriate level of payment. The vein center allowed us to go into a more self-payment type of cosmetic retail