Teleradiology plays major role in rise of clinician-owned imaging centers

Teleradiology and the advent of advanced imaging modalities are driving the recent surge in clinician-owned imaging centers.

The maturation of MRI and the introduction of extremity scanners have played significant roles in the evolution of office-based physician-owned imaging.

"Many orthopedic groups, for instance, embraced the appearance of the extremity scanner in the mid-1990s as a way to offer new patient service, gain a competitive advantage, and augment practice revenue by capturing a revenue stream that they were previously referring outside to imaging centers or hospitals," said Dr. Walter O'Neill of Orthopedic Imaging Partners in Verona, WI.

Ownership of an in-office MRI unit under the office ancillary exception to the 1995 Stark law, which restricted physician ownership in joint-venture imaging center partnerships with radiology groups, became an attractive alternative to referring patients to outside enterprises, he said. Today, more than 800 orthopedic practices offer MRI as a standard in-house patient service. Some large orthopedic groups have created multimodality centers that rival hospital or major radiology imaging centers.

These physician forays into the imaging business have met with varied success. Most orthopedists find they still need the expertise of radiologists to interpret difficult cases and assist with postsurgical imaging.

When the level of local musculoskeletal expertise proves unsatisfactory in many cases, however, clinicians are forced to turn to teleradiology. Here, enterprising radiology groups have detected a market opportunity.

"Practices of fellowship-trained MSK radiologists began marketing their online reading services via teleradiology to orthopedic groups that were purchasing in-office extremity or whole-body scanners," O'Neill said.

Teleradiology allows orthopedic groups to enjoy the benefits of expert MSK radiologists, while at the same time performing imaging studies in their own offices by their own staff, with whom their patients are more comfortable, said O'Neill, who recently documented the advantages and challenges of the physician-owned imaging center (Orthop Clin North Am 2008;39(1):37-48).

"Today, this model is the standard in orthopedics," he said.

Radiologists provide physician-owned imaging centers more than remote reads. Radiologists who are friendly and supportive of an orthopedic group make great allies, O'Neill said.

"Radiologists not only provide remote expertise; they can provide guidance in the evaluation and purchase of imaging modalities, especially whole-body units," he said.