Eight-radiologist Casper Medical Imaging in Casper, Wyo., has joined the Palmetto, Fla.-based Strategic Radiology, becoming the first small, rural affiliate of the 18-practice collaborative.

Arl Van Moore Jr., MD, chairman of Strategic Radiology, which now encompasses more than 1,300 radiologists in 15 states, explained the fit. The addition “represents a significant first step toward our goal of including independent radiology groups of all shapes and sizes as an integral part of our independent group practice collaborative,” Moore said in prepared remarks issued Oct. 20. “We believe SR has much to offer to CMI, but perhaps more importantly, we also expect their team’s knowledge base and expertise will enhance the SR value for all member groups and the specialty of radiology.”

RadiologyBusiness.com spoke with Geoff Smith, MD, president of Casper Medical Imaging, about what led up to the decision to join and where it goes from here.

RadiologyBusiness.com: What made joining with Strategic Radiology a good decision for you?

Smith: It doesn’t come as any mystery, if you follow what’s happening in medicine and in radiology, that, as time has gone on, there is the need—and also some market and other pressures—for groups to offer best-of-breed subspecialized care as a standard offering with whatever they’re doing in the community. And certainly, we haven’t been immune to that.

You have to have physicians who have their feet on the ground. They have to be participants in the local medical community. You can do some things remotely, but there are a lot of services that require a physician with boots on the ground and hands on the patient and interacting with medical staff. So, for us, there is still a compelling need to service our marketplace as a local radiology group. But we recognize that, as the world continues to evolve, it’s going to be necessary for us to ally ourselves with larger and more diverse groups and other locales, both to augment our fund of knowledge and to help us with business management. [So we are open to] alliances that will help us leverage the experience and talents of other groups around the country to basically further our goals and meet our obligations as a local group of physicians.

RadiologyBusiness.com: Will there be cross-pollination between you and SR with professional services as well as business expertise?

Smith: Yes, a little bit of both. I think that Strategic Radiology, like everybody else in all of medicine and in the radiology “industry,” is evolving over time. They’ve got a variety of different things that allow us to control costs through things, for example, as simple as purchasing agreements, shared business expertise for groups that are dealing with the same kinds of issues with billing and government regulation and advocacy and everything else that everybody is dealing with.

There are also quality issues. We have increasing requirements to perform active peer review and monitor quality of services, not only in terms of read accuracy and things as simple as, say, mammographic callback rates, but also more sophisticated indicators like wait times for patients and other things that you need to tend to in terms of patient access. And the kind of quality that people perceive through those kinds of things.

And then there are also access issues in terms of having availability of subspecialists who do rather esoteric exams that are commonly done in an urban locale with a population of a couple million people—for example, cardiac MRI or some other kind of uncommon procedures. Some of these things can happen at any time of the day or night, almost, and for a group of our size it is just not feasible to have direct access to a given subspecialist all the time.

So in terms of cost, trying to run our business efficiently, and in terms of quality—patient access and service access—we saw it as a winning proposition to become an affiliate.

RadiologyBusiness.com: Will you use the affiliation for branding or marketing? Some websites of SR affiliates prominently display the SR logo while others don’t show it at all.

Smith: I believe we will. I think that’s one of the things SR has been working on. They’re basically doing a lot of the things that groups do individually, except doing it across the whole consortium now. They’ve got marketing tools similar to the ones that some of the professional societies have taken a run at, but these guys have done it with somewhat of a different spin in terms of private practice radiology. They’ve also got some things that they’re putting together, and I think they’re still in draft form, essentially informational flyers and other things to help increase awareness both in local communities and also nationwide to payers and others. SR has advantages they’re trying to leverage by having a large group of physicians and, basically, having more people at the table.

RadiologyBusiness.com: Do you anticipate having to clear any operational or cultural hurdles before you’re able to make the most of the affiliation?

Smith: I’m in my mid-50s now, and most physicians in my age group had the opportunity or the advantage of growing up as the healthcare system evolved. When I first started in practice, everybody in the group did all the same things. All the work was shared completely equally, everybody had the same skill set, there wasn’t much very esoteric about what we were doing. Our business operations were, for lack of a better word, mom-and-pop. We had a bookkeeper, we had some outside help from a business consultant, but really, dealing with third-party payors was a matter of putting in a claim and/or sending a patient a bill and then doing collections as you needed. And that was it. Obviously, things have changed over the last 20-some years. Medicare has gotten reams more rules. There’s all sorts of things private payors are doing. And the whole business of doing radiology has become far more complex.

Some of the younger members of our group come in with very little training in business management, personnel management, how to run a company. Those things are not covered when you’re in medical training or residency. And that’s another part of what motivated us to join with SR.

Some of the things that SR offer, we could grow internally, but only piecemeal. So we think there’s a lot of opportunity in affiliating ourselves with a larger network of physicians who have a broader range of talents and essentially leverage that to help all of us look better and take better care of our patients, which is the most important thing.

RadiologyBusiness.com: Is there anything unique to the Eastern Rocky Mountains and the high plains of Wyoming that makes practicing radiology different from doing so anywhere else?

Smith: We’re physically isolated, and that has a bearing on what each doctor does. There are certainly other places in the United States that have that same factor. The first one that comes to my mind is Fairbanks, Alaska. That’s a town that’s really way out in the middle of nowhere. Frankly, if the doctors at a hospital in that kind of setting do not offer the services that people need for a wide variety of illnesses, you can do some things by flying people to Seattle, but there are some things that are just not sustainable or practical to do. At the same time, there are some things we can move around electronically and get help with, and I think that comes back around what SR offers us—a chance to affiliate with well-organized and secure groups that offer these kinds of services in different locales that can help us bring the same kinds of capabilities here, locally.