Teleradiology practice soars on the wings of NightHawk

It's the rare company that can resist the temptation to cut costs on the backs of its suppliers. NightHawk top executive Paul Berger, a radiologist himself, said his company aspires to be that rarity.

He wants to boost the productivity of those who contribute to the success of this big and growing teleradiology firm with incentives for staff radiologists and with the fruits of technology developed by his firm. But it's not going to be easy.

Teleradiology providers cannot increase the number of CTs, MRs, or digital mammograms available to interpret. Only referring physicians can do that. As a result, most provider growth will occur through the acquisition of other teleradiology firms, an idea that NightHawk clearly has embraced.

The acquisition of Texas-based Radlinx Group, announced April 9, expands NightHawk's core off-hours business while increasing the number of radiology groups contributing interpretations. The group's 303 hospitals spread NightHawk's customer base to more than 1300 hospitals nationwide, representing 24% of all U.S. hospitals.

This was NightHawk's second major acquisition in as many months. On Feb. 9, the company bought Teleradiology Diagnostic Service of California, which serves hospitals throughout the Golden State. California is the largest market for teleradiology services in the U.S., according to NightHawk. Texas is the second largest.

More than just increasing gross revenues, acquisitions will lead to what Berger describes as "cross-selling opportunities." Through these, NightHawk will provide specialty services, including cardiac imaging and 3D reconstructions, to the customer bases it acquired along with TDS and Radlinx.

"We are constantly working on new opportunities," said Berger, NightHawk chairman and CEO. "We are building a very large business that will have all the moving parts to transform radiology to the benefit of radiologists and patients."

Boosting radiologist incentives for increased productivity is the key to this plan. And the company has plenty of tools for doing so, according to Berger.

NightHawk radiologists use a common software platform to make their interpretations and file their reports. Cost efficiencies can be achieved by migrating radiologists in the newly acquired groups to this platform.

"We have an excellent software program to work with, and there is assistance in the form of our quality assurance people, who allow the doctors to focus attention on their work," he said.

The company recruits "the right type of doctor" to work on this platform, Berger said, the kind that wants to be productive and responds to incentives that lead to increased productivity. He believes the radiologists with TDS and Radlinx are this type. He is planning to keep all radiologists previously affiliated with both companies in the NightHawk fold.

"Our goal is for them to utilize our systems to be more productive for the company, resulting in better compensation for them," he said. "We expect that, when they are given the ability, they will seize the day."

Berger dismisses questions about whether the company would use cost-cutting methods such as renegotiating the contracts of radiologists working with recently acquired firms.

"It's very important to us that the radiologists feel very comfortable about what they are doing," he said.

Tim Mayleben, NightHawk executive vice president and chief operating officer, described the radiologists who have been working with NightHawk's acquisitions and their combined relationships with customers as some of the most important assets these companies have.

"So we look to establish broader relationships with them, not renegotiate their agreements," he said.

Growing revenue and boosting productivity will keep the bottom line written in black ink, said the NightHawk executives, who were nonplussed by the suggestion that future growth for NightHawk is limited.

"Radiology is a $15 billion-plus business for interpretations," Mayleben said. "We have aspirations to continue to grow profitably."