Private Practice: When paying more for your equipment pays off

By Stephen M. Bravo, MD
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In this era of fiscal restraint brought about by falling utilization and downward pressure on per-exam reimbursement, capital-equipment purchases have become a growing cause for trepidation and hesitancy among many private practice groups throughout the U.S. This is certainly evidenced by the overall decline in purchases of big-ticket technology such as CT, PET/CT, and MR scanners. Many private practice groups are increasingly espousing the notion of maintaining functional, albeit slightly outdated, technology rather than assuming the higher costs of more sophisticated technology.

Oftentimes, however, that policy may be penny wise and pound foolish. Indeed, the growing sophistication of technology, while requiring capital expenditure can, in the end, more than justify its expense with improved and more robust relationships with a variety of different referring subspecialties. While expensive, the numerous applications available with more sophisticated technology may ultimately represent the most intelligent investment a radiology group can make—and result in a correspondingly robust return on that investment.

It certainly has proven to be true for our practice.

When we first entertained expanding into a more competitive demographic region, we decided the best marketing strategy would be to invest in, and advertise, the advanced sophistication of the imaging technology at our facility. To this end, we acquired 64-slice CT technology with a Siemens Definition AS 64-slice CT scanner, and 3T MR technology with a Siemens Verio magnet. We did debate significantly over putting less sophisticated, and therefore cheaper, equipment into a community where we had little presence. Ultimately, though, we decided that technological superiority would trump familiarity.

The technological investment has been especially helpful to our practice in accruing and consolidating relationships with all the region’s physicians associated with women’s health care. Our women’s imaging service is the only freestanding outpatient service within our catchment area that offers all diagnostic tools for detecting and diagnosing breast carcinoma. Investing in the most sophisticated magnet and coil hardware and software technology has allowed us to produce images with far greater resolution and markedly improved conspicuity of subtle breast abnormalities. This has yielded higher confidence in our diagnoses by referring doctors and, subsequently, it has markedly increased our women’s imaging services volume and enhanced our recruitment of referring doctors. No referring physician wants to be in a position where the diagnostic imaging center can identify an abnormality but is then unable to biopsy that abnormality, which often can be visualized only on MRI, to provide a conclusive diagnosis and disposition. The investment in coil technology which has allowed us to perform these procedures has resulted in our dominance of the women’s imaging market in our catchment area.

This dominance has had a domino effect. Women are often the healthcare decision makers of their families; their experience with a practice can translate into increased referrals of their husbands, children, siblings and parents. Indeed, our satisfaction surveys demonstrate significant positive impact on our other diagnostic imaging business, including neuroimaging. Our decision to invest in inline bold, fMRI, and diffusion tensor imaging techniques has allowed us to image a variety of disease processes, especially multiple sclerosis, seizure disorders and post-concussive syndromes, at a level which many of our outpatient-based competitors cannot match.

Our technological investments have also significantly improved our cardiology referrals. Leveraging syngo-via AV software, our ability to provide objective, reproducible, scientific evaluation of the coronary arteries with CT arteriography has generated a significant increase in this procedure for our practice. Coupled with our ability to provide high-resolution cardiac MR imaging for a variety of different cardiac conditions, as well as pre-ablation evaluation for arrhythmias, we have been able to capture the entire cardiac imaging business of all of the nonhospital- employed cardiologists in our catchment area. This dominance could not have been attained without our investment in the 64-slice CT, 3T MR and syngo-via AV technology.

The CT and MR technology has also helped us to provide local otolaryngologists and gastroenterologists with greatly improved morphologic detail on high-resolution temporal bone CT examinations and both CT and MR enterography examinations. Indeed, the reconstruction algorithm of the 64-slice CT, with its ability to yield markedly improved images of the temporal bones, has enabled us to interrupt a 10-year relationship between one of the largest ENT practices in our area and a competing radiology practice. The CT and MR enterographic images have allowed us to successfully capture all GI imaging from one of the largest gastroenterology practices in this state.

Investment in new technology has also made our practice more efficient and profitable. The higher acquisition speed of the new machines lets us accommodate a greater patient load. We have subsequently replaced our 1.5T with a Siemens Skyra 3T, and we have replaced an older CT with a 64-slice Biograph PET/CT. We can accommodate 70 to 80 patients per day between the two MR scanners and an even greater volume between the CT and PET/CT scanners. We are able to perform five to seven PET/CT scans per day without adversely impacting our CT schedule or our ability to accommodate stat CT add-on exams. This growth would not be possible with less sophisticated machinery.

In the end, the economic decision is never straightforward when it comes to acquiring or replacing high-technology machinery. Our group has opted for a model of higher break-even cost with more sophisticated technology, and that has paradoxically yielded a far greater return on our investment.

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Private Practice: When paying more for your equipment pays off.  Appl Radiol. 

September 05, 2014
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