Technology Acquisition: Implementing the New Normal

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Reimbursement cuts, market consolidation, and health-care reform have sparked significant changes in the imaging-technology strategies being implemented across the radiology landscape. Practices, imaging centers, and hospital radiology departments alike not only are altering the manner in which they formulate decisions on imaging-equipment acquisition, but also are adopting different approaches to demonstrating the need for new technology, to acquiring capital for equipment purchases, and to maintaining the assets that they already have. Rick Long is COO of Center for Diagnostic Imaging (CDI), Minneapolis, Minnesota, which currently owns, manages, and operates more than 110 imaging centers throughout the United States. CDI’s network includes a mobile-imaging division, Insight Imaging (Lake Forest, California), and a collection of partnerships with radiologists, hospitals, and health systems. He says, “In many ways, it’s a very different ball game now than it was before these trends started taking hold. It’s definitely not all bad—and there are a lot of positives—but it is different.” The average age of CDI’s equipment has increased, Long notes, but not significantly—in part, because a slowdown in research, development, and innovation by manufacturers has made the prospect of upgrading technology a less compelling one for the imaging-center chain. Deciding whether or not to upgrade or replace imaging equipment has indeed become more difficult, however, with self-referral and the reimbursement cuts of the past eight years being the primary catalysts. “Overall,” Long explains, “we use greater discretion in our decision making, asking ourselves many questions before moving ahead with any initiative.” Such questions include how the technology being evaluated will improve patient care and whether it will deliver enhanced diagnostic capabilities to radiologists, along with better patient outcomes. Also addressed is the issue of whether the technology will meet the growing diagnostic requirements of referring clinicians. Similar criteria are applied to determining when (or whether) additional modalities should be introduced—or upgrades should be executed—at a particular imaging center or in a specific market. For example, a 64-slice CT system was recently installed at one imaging center to accommodate its high and increasing vascular-imaging volume, but another center will continue to use a 16-slice CT system because the nature of its imaging business does not warrant an upgrade. “We might have upgraded our scanners, 10 or 12 years ago, more consistently in step with clinical advances released by equipment manufacturers,” Long states. “Outside forces, however, have made it very important for us to look at whether there is a demand for a particular modality at every one of our facilities or if it is appropriate only for one (or a few) centers. We are very focused on the clinical need for technology and whether it will improve outcomes for our patients, but with research/development being slowed by equipment manufacturers, health-care reform, cuts to reimbursements, and the like, we are forced to make more discriminating choices.” In truth, Long says, high-quality diagnostic exams can be achieved as long as imaging-modality protocols have been optimized and staff members have been trained to tailor studies to the unique needs of the referring clinician and the patient. He adds, “Wholesale, systemwide upgrades are not a good use of capital, in today’s environment.” The Hospital Perspective An academic center has needs that are quite different from those of an imaging-center chain. When it comes to technology deployment, though, their needs are surprisingly similar, according to Geoffrey D. Rubin, MD, FACR, George B. Geller distinguished professor of cardiovascular research and professor of radiology and bioengineering at Duke Clinical Research Institute (and former chair of the department of radiology at Duke University School of Medicine). Duke Radiology (Durham, North Carolina), with which Rubin is affiliated, provides imaging services to Duke University Medical Center. In recent years, Rubin says, the hospital has seen a heightened emphasis on aggregating the value of imaging-equipment purchases across departments and lines of service. This helps facilities do more with less while maintaining high-caliber patient care; economies of scale are sought, wherever feasible. Richard J. Helsper, MBA, FACHE, is COO of Genesis HealthCare