The Top 20 Imaging-center Chains

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It seems clear that the number of US imaging centers has stopped expanding, and that imaging-center chains are no longer as eager to snap up as many centers as possible. This is not bad news, however. Procedural volumes per imaging center are growing—so the combination of greater demand for imaging and fewer centers competing for those referrals means that even lower reimbursement will be easier for today’s busier imaging centers to withstand.

Radiology Business Journal and SDI, Plymouth Meeting, Pennsylvania, are cosponsors of this look at imaging-center chains and the larger environment in which they (and their independent competitors) operate. SDI provided the data on which this report is based, as well as comparison information1 that the company had collected and analyzed in earlier years.

Table 1.Top 20 Chains

The top 20 imaging-center chains added 65 centers between 2008 and 2010, for a growth rate of 7.5%, but a slight majority of the top 20 chains either added no imaging centers or lost some (Table 1). RadNet, at the top of the stack, also added the most centers (24); Tri State Imaging Consultants, the 10th largest chain, showed the second largest growth, adding 18 centers. The fourth largest chain, Center for Diagnostic Imaging (CDI), added 16 centers, and 15 centers were added by SimonMed Imaging, bringing it up to 19th position among the largest chains. Five other chains added smaller numbers of centers.

Figure 1. US imaging centers (by state and region), 2010.

Two chains neither added nor subtracted centers, one was new to the top 20 list, and eight lost three or more centers. Insight Imaging (the fifth largest chain) and Diagnostic Health (in 12th position) thinned their ranks most, losing 13 centers each.
A small decline was seen in the total number of imaging centers (Figure 1), which includes centers that are not allied with any chain. Between 2008 and 2010, there was a 1.8% decrease in the number of US imaging centers, representing the elimination of 120 centers.

The Southeast region had the largest reduction, losing 56 imaging centers, and the Mid-Atlantic, Pacific, and Rocky Mountain regions also registered losses. Only the Southwest Central region showed a gain, adding eight centers. There was little change in the number of imaging centers operating in the Great Lakes, South Central, North Central, and Northeast regions (although individual states within those regions showed more noticeable gains and losses).

This represents a major change in the trend that favored growth in the number of centers in previous years; for example, between 2003 and 2008, all regions exhibited growth, with some showing increases of more than 30%.

The same five states have the most imaging centers as in 2008, although their relative rankings have been juggled a bit. In order, the top five states in 2008 were Florida, California, New York, Texas, and Pennsylvania; for 2010, they are California, Florida, Texas, New York, and Pennsylvania. Of these, only Texas had added imaging centers since 2008, with 16 new centers opening there.

Figure 2.Growth/decline of US chains, 2003–2010.

Since reaching a peak of 1,066 in 2008 (Figure 2), the number of imaging-center chains has declined, dropping to 945. This 11% reduction over a two-year period was accompanied by a decrease in the number of centers that are affiliated with (defined as owned, managed, or leased by) chains from the 2008 high of 4,703 to the 2010 level of 4,433. This two-year decline of about 6% does include an increase of 50 in the total number of centers over the 2009 total, however.

Figure 3.Growth/decline of the top five chains, 2007–2010.

The top five imaging-center chains do not appear to have pursued similar expansion strategies over the past five years, with growth and shrinkage alternating (Figure 3), but all showed decreases in affiliated centers between 2008 and 2009. This might have been a cautious pause taken while they waited to observe the effects of the DRA on their revenues. By 2010, three of the five chains were again acquiring imaging centers, with RadNet adding 32 centers, CDI adding 17, and HCA adding five. Insight Imaging showed the greatest reduction in centers among the top five chains, shedding seven centers between 2009 and 2010.

Table 2. Growth/Decline of Imaging Centers (by Region), 2008–2010

The overall regional changes in total imaging centers have been small between 2008 and 2010, with no region