Strategic Radiology: 15 Practices Align for Strength
Arl Van Moore Jr, MD, FACR, says, “I’m the 50,000-foot guy.” Van Moore chairs Strategic Radiology, LLC, a consortium of 15 major radiology groups linked to pursue cost savings, better patient care, data mining, and pure old-fashioned clout for radiologists. The trouble is that there are many 50,000-foot visionaries at Strategic Radiology. Incorporated in Delaware, Strategic Radiology has no headquarters and has only a single employee, paid as a consultant. It currently is seeking a nonphysician administrator. The bulk of the work at Strategic Radiology is shouldered by the member physicians and administrators as volunteers. Strategic Radiology is not, however, some agglomeration of amateur hopefuls tentatively moving forward. Its 15 members (see table) are all large, successful radiology practices. Their physicians (who number more than 892) and administrators know the professional radiology landscape. They have built their practices, over the years, from minor to major. Strategic Radiology, to them, represents a next step. The venture is so new, however, that nobody is sure what the next step will be. The group certainly isn’t saying that someday, the Strategic Radiology brand will be stamped on imaging centers across the United States, nor does it predict that Strategic Radiology will be contracting nationally with providers and payors for radiology services. These ideas are being discussed, but implementation of a thoroughgoing national imaging service of the megagroup sort is still a glimmer on most Strategic Radiology members’ horizons. What Strategic Radiology has concentrated on, thus far, is what Van Moore calls the low-hanging fruit of expense reduction: consortium-wide purchasing agreements for supplies and equipment, along with data sharing on malpractice insurance, billing practices, and other topics. Van Moore, who is a past chair of the ACR®, is president of Charlotte Radiology, a North Carolina practice that is one of Strategic Radiology’s 13 founding members. Two groups have joined since. “We’re just doing the basic block-and-tackle work at this point, having taken the long view of working more closely together,” Van Moore says, adding that savings to members so far “have been more than enough to pay for the capital calls to keep the organization running.” According to Steve Duvoisin, CEO of Inland Imaging, LLC (a Spokane, Washington, practice that is another of Strategic Radiology’s founding members), the savings seen through information sharing have, in some instances, been considerable. When Strategic Radiology’s members compared notes on malpractice insurance, he says, one group decided that the premiums for the coverage levels of $5 million per occurrence and $9 million per year were excessive. It followed the lead of most other members by cutting coverage back to $3 million per occurrence and $5 million per year. “It saved $140,000 per year,” Duvoisin says.
“As we saw the evolution of radiology, we felt it was time for radiology groups to start working more closely together. There had been wake-up calls that things were changing.”
—Steve Duvoisin, finance chair,
Strategic Radiology, Chicago, IL
Both Van Moore and Duvoisin (Strategic Radiology’s finance chair) stress that Strategic Radiology is owned and operated by radiologists; this is something that the founding groups, themselves radiologist-owned entities, demanded from the very beginning. “We saw a need and wanted it physician owned and run,” Van Moore says. Indeed, there is no doubt that the consortium’s fundamental reason for being is to retain a radiologist’s hand on the tiller as the industry is reshaped by health reform, pay for performance, sophisticated utilization management, and the increasing shifting of private physician practices into hospital ownership.¹ “We have no plans to go public,” Duvoisin says. “We’re there to serve our members.” How Strategic Radiology Began Whether Strategic Radiology was born abruptly or emerged from a long developmental process depends on who’s telling the story. The versions of administrators and physicians are not contradictory, however. According to Duvoisin and others, administrators from Strategic Radiology’s founding groups had been seeing and talking to each other for years at meetings. “As we saw the evolution of radiology, we felt it was time for radiology groups to start working more closely together,” Duvoisin says. “There had been wake-up calls that things were changing.” Among those warnings, he adds, was the “increasing intrusion of for-profit, public companies,” particularly teleradiology providers with a mandate to meet shareholders’ profit demands, into radiology.
“There is a level of trust between radiologists that’s higher than the trust level between radiologists and Wall Street.”
—Chad L. Calendine, MD, vice chair
It was a 2008 meeting called by a teleradiology company that served as the birth catalyst for Strategic Radiology, according to physicians now in the consortium who attended that meeting. Chad L. Calendine, MD, a musculoskeletal radiologist, is president of Advanced Diagnostic Imaging (ADI), a Nashville, Tennessee, group that reads for area hospitals and for three imaging centers that the group owns. ADI is one of Strategic Radiology’s founding members, and Calendine was one of several Strategic Radiology physicians to attend the Phoenix, Arizona, conclave. The teleradiology company that called the meeting was trying to put together a regional day-coverage service. Calendine recalls, “It wanted a premium from the groups it had called together to deliver this. Nobody was happy with that.” Calendine says that the teleradiology motive is an important one for Strategic Radiology. “In the larger context,” he says, “day-coverage and night-coverage services have become increasingly predatory in local radiology markets. We don’t want to support those companies that are displacing radiologists. We want an initiative to cover the nighttime readings within Strategic Radiology, so that groups no longer have to outsource them.” ADI already markets daytime subspecialty teleradiology services “from Maine to Washington,” Calendine says. He is licensed to read in 15 states, and he does not see licensure as a big hurdle for Strategic Radiology, should it move into the teleradiology arena. “Most think we should address the night-reading needs within Strategic Radiology first and build into day-coverage services among the groups, functioning under Strategic Radiology rather than under each of the groups. There is a distributed-reading push, and it’s a significant effort. There’s no firm commitment to have, nationwide, a giant reading worklist, but there is a definite commitment to share images across practices,” Calendine says. Megagovernance What will be done with teleradiology inside Strategic Radiology (and, potentially, as an outside service to nonmembers) is a looming question within the consortium. Another big question is how to implement and pay for an IT infrastructure that will allow the necessary image sharing. Ronald J. Ruff, MD, is vice president and director of outpatient imaging for Mountain Medical Physician Specialists (MMPS), a Salt Lake City, Utah, group that is one of Strategic Radiology’s founding members. Ruff serves as treasurer of the consortium. An executive committee of officers and committee chairs (including both physicians and administrators) is empowered to make nonbinding decisions. Binding decisions must be made by a board of managers composed of physician representatives from each of the member groups. Currently, each of the 15 members is represented on the board of managers, Ruff says, but there is a provision in the Strategic Radiology bylaws to curtail the size of the board if membership grows. There is also a provision that some decisions require a supermajority, while most require only a majority. Voting power is proportional, based on each group’s size. Technically, Ruff notes, since some states bar physicians from direct ownership of for-profit medical corporations, Strategic Radiology is owned through holding companies formed by each of the founding groups. “Mountain Medical Group is the holding company for MMPS,” Ruff says. “Each MMPS physician has an equal share in the holding company.”
Table. Physician and Nonphysician Leadership of the 15 Strategic Radiology Member Practices
Ruff declines to disclose Strategic Radiology’s original capitalization. “Right now, we have a budget,” he says. “We know how much money we have in the bank. Each holding company made a contribution to Strategic Radiology, proportional to the number of physicians in each group. That has been true for every group that has joined. Obviously, Strategic Radiology will have future requirements, and the board of managers will make decisions on how to fund those. We made an initial investment, and we haven’t had any more capital calls.” Duvoisin notes that collectively, the Strategic Radiology member groups complete about 12 million imaging studies per year. He estimates the original capital call as “pennies per image,” and he joins Van Moore in calling the capitalization “definitely thousands, rather than millions.” Teleradiology A question that Strategic Radiology members will have to answer soon is when (and how) to roll out any collective teleradiology or image-sharing capacity between the groups. Do they want a teleradiology presence only between Strategic Radiology members, or do they want to offer a broader service to nonmembers, too? The same question must be answered concerning subspecialty readings. There appear to be those, like Calendine, who want to move quickly into image sharing. He says, “If a group is having trouble, we will do everything we can to help. Would it join Strategic Radiology or become an affiliate? None of that has been worked out yet. We are never going to go in there and compete with radiologists in their own markets. If they need a partner that’s not going to take over, that’s what we could provide. There is a level of trust between radiologists that’s higher than the trust level between radiologists and Wall Street.”
“Could there be something in the future, for nighttime radiology, or in a subspecialized way? Yes, but there are no specific plans. There has been no attempt to cross-license.”
—Arl Van Moore Jr, MD, chair
There is also a faction that wants Strategic Radiology to progress at a less-hurried pace. “Strategic Radiology, at this point, has no intention of going into night coverage,” Van Moore says. “Each member group is doing internal night reading in different ways. Could there be something, in the future, for nighttime radiology, or in a subspecialized way? Yes, but there are no specific plans. There has been no attempt to cross-license.” Rodney S. Owen, MD, is a body and musculoskeletal MRI specialist at Southwest Diagnostic Imaging (SDI), headquartered in Scottsdale, Arizona. SDI is the parent of Scottsdale Medical Imaging (SMIL), for which he serves as group president. The combined group has 69 radiologists and completes about 1.2 million exams per year, Owen says. SDI is a Strategic Radiology founding member, and Owen serves as secretary of the consortium. On one hand, Owen counts himself as a slow-growth advocate. He notes that all member groups in Strategic Radiology went through their formative periods. “We are learning to crawl before we walk,” he says of Strategic Radiology. “We are at our nascent stage. We’re crawling now, we plan on walking, and someday we plan on running, but when and where are yet to be seen.” Owen does see Strategic Radiology developing image sharing, probably sooner rather than later. He estimates the nighttime reading volume across the entire Strategic Radiology membership at about 100,000 studies per year. SDI/SMIL currently does its own night reading, as well as some day reading for other entities, Owen says. “Strategic Radiology will be able to do that better and more efficiently than we do it now,” he predicts. “Over time, we hope to link it all up through Strategic Radiology. The easiest transition should be consolidating nighttime services, and then will come the deeper consolidation of daytime services through Strategic Radiology’s IT infrastructure.” Of course, that infrastructure does not yet exist, but designing its implementation is underway. Building IT Chris (Kip) McMillan is CEO of Diversified Radiology of Colorado, PC, based in Denver. Diversified Radiology has 55 radiologists and covers 12 hospitals, along with 15 to 20 outpatient centers, five of which it once owned. Diversified Radiology is another founding member of Strategic Radiology, and McMillan serves as Strategic Radiology’s chair of IT. “I think I missed the meeting when they picked the IT chair,” he jokes, but in fact, McMillan is a former programmer.
“We all understood that the ability to share studies seamlessly was ultimately to be nirvana, so the question became, ‘Is that even possible?’”
—Chris (Kip) McMillan, IT chair
For McMillan, the push for image sharing comes from Strategic Radiology’s quality initiatives as much as from a teleradiology incentive. “In talking about quality of care and the ability to have an interchange between physicians for consulting, we all understood that the ability to share studies seamlessly was ultimately to be nirvana,” he says, “so the question became, ‘Is that even possible?’” One way to share would be for all Strategic Radiology members to adopt the same PACS and RIS and interface those, McMillan says, but that would be too expensive. “We asked, ‘Is it possible to build a clearinghouse where I take PACS A and send to PACS B (different PACS in different states)? Can we build a common clearinghouse that could move those images around?’ It doesn’t exist out there,” he says.
“We have the strong physician leadership assembled, but many believe it is time to seek strong administrative leadership fully dedicated to Strategic Radiology.”
—Rodney S. Owen, MD, secretary
To get an answer, Strategic Radiology asked two vendors of radiology interface software to come up with a proof of concept. Both vendors believe that interoperability (or distributed reading) can be accomplished across all the Strategic Radiology member sites, McMillan says, and that it probably can be adapted to the hospitals served by the various Strategic Radiology groups, so that the entire enterprise would be seamless. The radiologist at the workstation would not necessarily know where the image originated. “It’s a large architecture problem, but it can be done,” McMillan says. “As far as a roll-out goes, nothing has happened.” He says that’s because the effort would be costly, and the Strategic Radiology members are still weighing the benefits against the expense. He asks, “Do we need this great big functionality that we might not use all that often?” McMillan expects the demand for distributed reading to be stronger on the subspecialty side than for general night or day coverage. Diversified Radiology now uses outside teleradiology providers for night reading. McMillan says, “If I can do that better internally with Strategic Radiology and save money, I’ll do that. Am I looking for a way to get rid of my existing group? No; it provides a level of care I couldn’t provide from within my own group.” He adds that Strategic Radiology might first look at filling internal demand for subspecialization. Hospitals want the service, he says; in fact, hospitals have recently increased their requests for subspecialty readings to the demand level, but they don’t want the expense of staffing for them. “Can we (as Strategic Radiology members) have deeper staff support from subspecialists who are not in our own individual groups? Those are the directions in which our conversations are headed, but to do that, you’ve got to be able to move those studies,” McMillan says. The question of whether (and how) to initiate a distributed-reading capability within Strategic Radiology raises a sensitive issue. What, exactly, is Strategic Radiology’s mission? Is Strategic Radiology intent on providing fee-based teleradiology and subspecialty interpretation across its membership and beyond? Does it see itself becoming a service provider, or is its true mission to help its members using best practices, quality-control methods, and utilization standards that can be applied across its membership? Some Strategic Radiology leaders seem eager to enter into service provision, at least on the teleradiology side. Others seem less sure. “I can think of 100 ways to provide service,” McMillan says. “It’s not part of the business model yet. Right now, Strategic Radiology is providing services (ideas) just for the members of Strategic Radiology. It’s a bunch of CEOs doing conference calls.” Concerning whether Strategic Radiology should enlarge its staff beyond one consultant, McMillan says, “Strategic Radiology is pro bono. There’s not a lot of dedicated cost structure to Strategic Radiology. All our projects are trial studies, and it’s not costing anything to keep Strategic Radiology viable. If Strategic Radiology says we need to staff up, it’s going to be because of something that justifies staffing up; right now, I’d be hard pressed to tell you what that would be.” Recently, Strategic Radiology let it be known that it was seeking a full-time administrator willing to assume the ultimate challenge of marshalling not just one, but 15 different groups behind a common strategy. Owen says, “The success of the member groups is, in large part, due to both strong physician leadership and strong administration leadership. We have the strong physician leadership assembled, but many believe it is time to seek strong administrative leadership fully dedicated to Strategic Radiology.” Possible Conflicts The fact that some Strategic Radiology members are already marketing teleradiology services in the broader arena raises the question of what financial incentives there might be for those Strategic Radiology members to profit by selling services to other members. If more than one group can offer nighttime or subspecialty readings, who gets the work? The fact that Strategic Radiology has already engaged an Inland Imaging affiliate as a consultant raises the same sort of question. Do some Strategic Radiology groups stand to profit from by offering tools or expertise to other members? “Conflict of interest in service is potentially there,” Owen says, “but it hasn’t arisen. We’re trying to accomplish things most efficiently and effectively. If we find the best way to acquire a service is from one of the members, we’ll do it. First, we have to define ourselves better.” Duvoisin adds, “Inland Imaging is in a position to market its business and radiology services to other Strategic Radiology members, even though we all have fairly similar levels of infrastructure.”
“We are a privately held business, and we have all the resources of a business available for future funding. It could be a loan, or it could be a capital call; it could be a lot of things.”
—Ronald J. Ruff, MD, treasurer
Antitrust violations aren’t something that anyone in Strategic Radiology seems concerned about, since the consortium’s 892-plus radiologists constitute a drop in a bucket, compared with the estimated 33,000 radiologists in the United States. Moreover, Van Moore says, “The only way we could violate antitrust is if we attempted to price products, and since we’re not going into that business, we don’t have to worry about antitrust. If we did try to price products, that would be a long way down the road, 15 or 20 years from now. Nobody can predict the future, but we’ve got a lot of other things to do before we try to do national contracts.” Nobody seems to think that Strategic Radiology gives its members an advantage in raising capital; money is available on the group level. “I don’t see Strategic Radiology raising capital,” Van Moore says. “I see the individual members doing that. They have their own governance structures and the ability to get their own financing. We don’t supplant the local practice. This effort is to help the local practices do a better job for patients.” The jumping-off point for Strategic Radiology in offering interpretation services (or edging toward a national practice) is certainly keyed to the creation of the ability to share studies. Once that is in place, a whole new range of options and choices will have to be deciphered and decided upon by Strategic Radiology’s member physicians and administrators. Strategic Radiology is approaching portability slowly. One reason might be that dividing the interpretation pie among the various Strategic Radiology members would be a tricky endeavor; this might create more hesitancy about infrastructure implementation than the infrastructure’s cost does. According to Ruff, capitalizing the infrastructure needed to share images shouldn’t be all that expensive. “As part of making any infrastructure decision, we would come up with a business plan to fund that,” he says. “We might look at what the income from that distributed-image solution would be and decide how much of that would go to Strategic Radiology to help fund the infrastructure,” he says. “We are a privately held business, and we have all the resources of a business available for future funding. It could be a loan, or it could be a capital call; it could be a lot of things. The nice part about the infrastructure is that other than a cloud-level interface to connect us all, most of us have the major components of an infrastructure in place. The capital outlay that people imagine is not as great as it might appear, at first glance.”
“We’re trying to identify those areas we all work in and then identify best-practice models and metrics that we can share. ”
—Mark Jensen, operations chair
While Strategic Radiology’s physicians and administrators mull the complications of a distributed-reading implementation, however, other Strategic Radiology officers are moving swiftly on a second front: a set of quality and best-practice initiatives to strengthen Strategic Radiology and raise its profile. Best Practices Strategic Radiology was formally incorporated in 2009. From the beginning, the corporation has stressed “a collaborative model in which data and best practices are shared [and] clinical practice information is interchanged.”² During the formative period when Strategic Radiology was being put together, McMillan says, a survey was taken that asked respondents to name the most important things that would benefit Strategic Radiology, its members, its client hospitals and clinics, and the patients they serve. “The top five issues for the physicians were all quality related,” McMillan says, “and the top five administrative issues were all related to cost containment. We merged those two lists.”
“We are sharing, at a high level, blinded data to benchmark and, ultimately, to identify best practices to bring back to each group.”
—Lisa Mead, RN, data-mining leader
The best-practice and quality-control initiatives at Strategic Radiology run deep. Van Moore suggests that one day, Strategic Radiology might offer a cafeteria plan of basic practice-management services (such as billing, malpractice coverage, and purchasing) to small radiology groups, perhaps as affiliate members of Strategic Radiology. He stresses, though, that the most important impact of Strategic Radiology’s best-practice effort will be to give an advantage to Strategic Radiology’s members and to raise the profile of radiologists generally. Strategic Radiology will cement radiologists’ eminence in the industry. Mark Jensen, COO of Charlotte Radiology, is Van Moore’s nonphysician counterpart and is chair of Strategic Radiology’s operations committee. He says that Strategic Radiology has already sent quality-standards surveys to its members and is about to analyze those. “We’re trying to identify those areas we all work in and then identify best-practice models and metrics that we can share.” Likewise, he says, a billing survey has also been completed. Analysis of those results is underway, too. “One of the things I see is that there’s not a clear set of quality metrics out there. There’s a lot of discussion of pay for performance and subspecialty value, but not a lot of evidence on how to measure those things. One of our goals is to determine what the measurable quality factors are, perhaps sharing those results outside of Strategic Radiology to the benefit of all radiology,” Jensen says.
“We’ve had many meet-and-greet discussions with radiology benefit managers (RBMs) and decision-support companies.”
—Linda Wilgus, new ventures chair
Strategic Radiology also might try to create a billing solution usable by all its members. Jensen says, “If groups in Strategic Radiology have a way to drive down costs, how about sharing that information? There’s value in that.” He adds that Strategic Radiology’s members are sharing data on radiology workflow and radiologist productivity. “I think there’s enough variability out there that there is opportunity,” he says. “We’re trying to reconcile why that is: Is it subspecialty related, staff related, IT related, or because of the support staff?” To analyze the data it’s collecting from members, Strategic Radiology has contracted with a Colorado-based business-intelligence and data-analysis software company, Jensen says. “I think Strategic Radiology can be an industry leader in the quality arena,” he says. “I see early wins with economic savings, productivity savings, quality development, outcomes analysis, and best practices. Then, down the road, what are the opportunities on the revenue side? How might we market Strategic Radiology business-intelligence tools or quality programs? That’s so far down the line it’s hard to say if those things are feasible. IT and common platforms are going to have to be part of that solution.” Data Mining Lisa Mead, RN, is chief administrator for SMIL. She is a member of Strategic Radiology’s operations team, and when the effort ramps up, she will head the data-mining initiative. “Data drive good decision making,” she says. “Otherwise, you’re just doing anecdotal collection.” Mead says that the software company has already started compiling and arranging data for Strategic Radiology. “We have three years’ data populated from nine of the groups,” she says. The data do not include patient and practice specifics, she says, so there’s no chance of violating privacy rights or the proprietary interests of Strategic Radiology members. “We are sharing, at a high level, blinded data to benchmark and, ultimately, to identify best practices to bring back to each group,” Mead says. “We could create dashboards to gauge how our practices match up and then create an environment for sharing data and building relationships.”
“To coalesce in a single mission requires compromise and concession, and I just don’t see that happening unless the environment changes drastically. ”
—Philip Russell, CEO,
South Texas Radiology Group PA, San Antonio, TX
For now, Mead says, the software company is keeping access to the blinded data for each Strategic Radiology practice separated. A group can look at data on referral patterns, for instance, only for itself, but eventually, cross-practice benchmarks will be established, and groups will be able to query one another’s data, she says. “We have outlined three areas to mine: productivity, referral patterns, and collections or revenue cycle. Productivity will be the first big benchmark,” Mead says. Strategic Radiology had its first user-group meeting at the end of February 2010, when it identified areas to clean up, categories of interest, and strategies for matching the data. “We’ll be able to look at anything, eventually, except contract rates,” Mead reports. Already, she says, Strategic Radiology’s members are querying each other on aspects of practice, such as how the various groups define high-tech imaging. Mead says that comparing data within Strategic Radiology will yield better insight than trying to assess group performance by looking at industry data. “We participate in the Medical Group Management Association, but we don’t know who the groups are that are represented,” Mead explains. “Are they four-physician groups in Alaska or 70-physician groups in the Southwest? With Strategic Radiology, we know who we are.” Managing Utilization At the same time that it is undertaking data mining and development of quality benchmarks, Strategic Radiology is moving forward in the area of utilization management. How should it define and implement utilization-management best practices? If Strategic Radiology ever becomes a national practice, and if it has a well-developed utilization-management methodology, it could have considerable clout with payors concerning appropriateness screening for high-tech imaging. “We’ve had many meet-and-greet discussions with radiology benefit managers (RBMs) and decision-support companies,” Linda Wilgus reports. She is committee chair of new ventures for Strategic Radiology and is executive director and CFO of Northwest Radiology Network, PC, a 42-physician practice in Indianapolis, Indiana, that is a founding member of Strategic Radiology. In developing a utilization-management strategy for Strategic Radiology, Wilgus says, there are several key questions to answer. Should it advocate computerized decision-support systems to enable referring physicians to choose the most appropriate exam for a patient, or should it concentrate on working with RBMs in developing appropriateness-screening standards? Should it do both? Wilgus says that Strategic Radiology has met with two vendors of decision-support software and three RBMs. “The decision-support vendors talk to us as a potential customer,” she says. “We’re in a lot of markets, and they have a product to sell.” With the RBMs, the contacts have only been discussions. Wilgus says, “We basically introduced ourselves and talked about our ideas and where we think the future of radiology is going. The future is utilization management, whether it’s through an RBM or using decision support. In the market, the RBMs do have a negative association because appropriateness screening creates a barrier. The RBMs hope that by conducting a dialog with us, maybe some of that negativity will fade.” Wilgus says that Medicare and private payors will rely increasingly on utilization management, going forward. “We want to help with appropriateness criteria for the greater good. We don’t have a defined plan or even a discussion of validating, rubber stamping, or putting our seal on anything,” she says. Before the Strategic Radiology members push too hard in any one direction, Wilgus says, “We need to pause and get to know one another. Nobody knows what the future holds. We don’t have preconceived ideas of where Strategic Radiology is going to take us.” There are those who wonder whether Strategic Radiology will take its members anywhere at all. “Call me a skeptic,” Philip Russell says. He is CEO of South Texas Radiology Group PA, a 60-radiologist practice that covers 12 hospitals and 21 imaging centers in the San Antonio area. “I guess I’m old enough,” Russell adds, “to be skeptical. As difficult as it is to hold 50 or 60 radiologists together, it’s hard to imagine, when you’ve got hundreds from different parts of the country, how they’re going to accomplish much.” If Strategic Radiology were to form a national practice, Russell asks, who would buy its services? “I understand the concept of nationwide coverage for a vendor organization, but I still hang on to the old adage that all health care is local as an important factor.” He notes that national-footprint teleradiology vendors have not yet put themselves in a strategic position to contract with third-party payors. “I don’t know if this organization would, either,” he says. Even if it did, he argues, it would be little more than an independent practice association on a different scale. He says that if Strategic Radiology set price points, the geographic differences in payment per region (even using Medicare percentages as a guide) might leave some member groups happy, but would leave others feeling grossly undercompensated. “Some would be in the ballpark, and some would refuse to join because they wouldn’t want their rates to get beaten down so low,” he comments. Russell says that he’s in a circle of radiology-group CEOs who informally discussed an entity like Strategic Radiology. His group was even invited to join, he says, but he declined. He doesn’t see Strategic Radiology as a potential threat to his group’s practice, however. “I’m no more threatened than I am every day, when I wake up knowing there are these teleradiology companies that, because of the pressure of public funding, are required to grow.” He doubts that Strategic Radiology can coalesce to the point where it will have a mission of growing exam volumes. “To coalesce in a single mission requires compromise and concession, and I just don’t see that happening, unless the environment changes drastically,” he says. Nonetheless, he wishes Strategic Radiology well: “I hope it succeeds,” he says. If Strategic Radiology is able to establish transferable quality measures and best practices, it would benefit all of radiology, he adds, and smaller groups might be served by any practice-management standards that Strategic Radiology develops. “Radiology, as a profession, still has far too many radiologists who are not well served, from a management standpoint,” he says. Commitment It’s not as though the administrators and physicians guiding Strategic Radiology fail to see the pitfalls that skeptics such as Russell enunciate. “The ongoing challenge is commitment,” Jensen says, “but every day, there is more confidence that this is a worthwhile effort, and the confidence is growing that we can execute our vision.” Can Strategic Radiology become a national megagroup? “It might happen,” Calendine says. “It’s not the intent or the focus of what we’re doing, but it might be one day in the future.” For now, Calendine and other Strategic Radiology respondents say that they are content to see the consortium pursuing more modest goals. “Ideally, we’re refining best practices, improving cost savings, and adding business opportunities for our groups, along the way, that might not have been there otherwise,” Calendine says. “We’d like to be good stewards in our groups across the country.” Whatever Strategic Radiology does in the future, there is a sense among its leaders that the high-level networking has already paid dividends. Van Moore says, “I think we’ve all surprised ourselves at how far we’ve come.” George Wiley is a contributing writer for Radiology Business Journal.