Radiology Meets the Brothers Marx

What can you do when you throw a party, and all of the wrong people arrive? Remember the sublime Margaret Dumont’s frustration with the Marx Brothers in the 1930 movie Animal Crackers?

Late last year, Radiology Business Journal and partner CliftonLarsonAllen (CLA) devised a survey that would be used to rank (and report on) the nation’s largest teleradiology providers. Since launching a survey six years ago to rank the country’s largest private practices, we have heard from a number of executives of large teleradiology practices, who have lobbied to be included. They argued that they provide everything that private practices do: final interpretations, quality measurements, management and technical operations, and full-service hospital coverage with on-site radiologists. 

Many of the larger companies, we maintained, have something that private practices do not have: outside investment. Because our definition of a private practice requires that the entity be wholly owned by the partners, with no outside investment, this left the teleradiology providers—even the ones that look a lot like large private practices—on the sidelines for six years.

As this sector evolves, though, it has become increasingly indefensible for a magazine that covers the business of radiology to ignore this segment of the industry. In anticipation of producing a ranking and report on the largest 20 teleradiology companies, we sent out the first email blast promoting the survey.

I admit that I was surprised—and a little hurt—when the first spreadsheet that I received from CLA contained not a single teleradiology company. I guess that I shouldn’t have been surprised: Groucho Marx said it best, when he refused to belong to any club that would have him as a member.

The Uninvited Guests

Who did participate, the first time around? The participants included small, medium, and large practices that I determined (through Web research) to be private practices, a prominent children’s hospital, and a leading cancer center. While they all professed to be in the teleradiology business, they were not eligible to participate in the survey because we expressly excluded private practices—unless they operated a managed-services organization for the purpose of performing teleradiology. 

To all of the uninvited guests: I sincerely thank you for coming and encourage you to participate in our annual survey of the largest private practices. To the radiologists of the pediatric hospital in Pennsylvania, I am sorry that we could not include your service, as it appears that pediatric radiology is the subspecialty offered by the fewest number of teleradiology companies: Go forth, and take care of the nation’s children.

Next, I did what any self-respecting inquisitor in the digital age would do: I googled the word teleradiology and started compiling a list. I also went through 10 years’ worth of business cards. 

When I had a list of 60 names, I started calling. What I learned encouraged me to continue. 

Teleradiology is a diverse and fluid segment of the radiology industry, a key link in the delivery chain of radiology services in this country. At the top of the list, there was extreme sensitivity to the teleradiology designation: One executive told me that he fined people for using the term; another said that his radiologists would be displeased to appear on such a list. 

New Terminology

Though many of the smaller companies did not share this aversion to the term teleradiology, we agreed to call the list the 20 largest radiology-services companies because the broader term better reflected the breadth of the sector. Still, a number of those large companies did not submit their data. We included them anyway—if their websites included the names (or total count) of their contracted radiologists. Some key players are missing because they do not reveal the number or identities of their radiologists.

Our first annual list might not be complete or accurate. We elected to include every qualified company willing to submit its data and bring radiology-services companies into an era of transparency. Please accept my sincere thanks for your participation.

This process—and our first annual report on the 20 largest radiology-services providers—was rife with irony and an element of Marx Brothers zaniness, with doors opening and closing along the road to the report. Many of the participants we sought gave us the cold shoulder; the ones we couldn’t use were happy to oblige.

A final irony is that radiology private practices and radiology-services companies are now fighting the same battle against commoditization and declining reimbursement. For this reason, it is more important than ever for radiology to develop shared, specialtywide standards and quality measures for which all providers can be held accountable. Articles in this issue on change management (page 12), incidental findings (page 26), and peer review (page 32) emphasize the complexity and challenges of clinical quality improvement. This endeavor is as dependent on culture and leadership as it is engineering and education. Like the Marx Brothers, physicians are notoriously hard to herd. 

Cheryl Proval