All of the clinicians I am seeing are looking for ways to align, because unless you are a little boutique concierge practice, it is very hard to survive as an independent physician on the Westside of Los Angeles these days.
Over the years, Tower Imaging Medical Group (TIMG) has earned a place in the firmament of Los Angeles-based radiology practices, with a complex practice genealogy that blends entrepreneurship with an academic flair. It serves two prestigious hospitals—Providence Saint John’s Health Center in Santa Monica and Henry Mayo Newhall Hospital in Valencia—and in joining the Strategic Radiology coalition, the highly subspecialized but relatively small 17-radiologist practice found a beachhead in the rapidly consolidating Los Angeles market.
“Strategic Radiology (SR) gives us the opportunity to present a larger footprint to Providence and Henry Mayo leadership,” says Bruce J. Yawitz, MD, president and CEO. “I believe it will allow us to continue what makes us special: having an ownership interest, always staying at the cutting edge, and not being employed physicians.”
Aside from providing subspecialized interpretations for its two hospitals, the practice operates joint venture imaging centers with both partners: Tower Saint John’s Imaging and Tower Imaging Valencia. TIMG has had an on-again, off-again relationship with technology ownership, jumping in, then out, and then back into outpatient imaging in arriving at a business model that has served the practice well for 15 years: Excellent hospital contracts and joint venture imaging center partnerships with those hospitals to achieve success in the outpatient market.
“As partners in the imaging centers, both the hospitals and Tower have skin in the game, and that aligns us more closely with the hospitals,” Dr. Yawitz says.
Technology ownership is both an income generator and a recruiting tool, enabling above-market salaries and the ability to attract top radiologist talent. “It is hugely important in L.A.,” Dr. Yawitz notes. “Our reimbursement rates are among the worst in the country and the cost of living here is among the highest in the country. That is a formula for difficulty in recruiting and retaining talent, so it turns out that having profitable imaging centers helps us twofold.”
A Storied Brand
In a practice that prizes quality and uses “imaging by specialists” as a tagline, recruitment is pivotal. “Maintaining our skills is very much a driving force in this group,” Dr. Yawitz says. “That has been our mantra from the very beginning. When I was in training and as a young associate, the members of our group included Jerrold Mink, Andrew Deutch, Dennis Sarti, and others who wrote the textbooks that I was studying. That set the stage for what we still are now: a highly subspecialized, academically flavored outpatient radiology group aligned with excellent hospitals. Part of our success is a storied brand.”
TIMG’s ability to subspecialize to a high degree for a 17-member group is driven in part by the tertiary-level care delivered by Providence Saint John’s and more recently at Henry Mayo—which initiated cardiac catheterization and cardiothoracic programs and includes a talented team of neurosurgeons—as well as its well-equipped imaging centers. “For a group our size, we may be unique in having a fully fellowship-trained cardiac radiologist,” Dr. Yawitz says. “We promise and, to a high degree, deliver on letting subspecialists do their specialty most of the time.”
When new employees become fully partnered, they are equal shareholders in TIMG’s companies, with no buy-in, another powerful recruiting tool. “Their buy-in is lower wages as they are ramping up to full Class A shareholder status,” Dr. Yawitz says. “The quality of our hospitals and the excellence of our imaging centers allow us to get some excellent candidates who might otherwise join bigger and deeper benches of talent.”
An emphasis on excellence colors the culture and values of a practice in which the mantra is “providing tertiary care in the community setting.” Fairness and equity are paramount, and all shareholders participate in recruiting radiologist candidates capable of self-determination. “Our people are given the opportunity to develop new service lines and be the cheerleaders for those service lines,” he says. “This is important to engagement.”
As a result, TIMG is performing procedures that are unusual for a group its size: cardiac MRI, coronary CT angiography, nuclear cardiology, calcium scoring, functional MRI, quantitative neuroimaging, mutiparametric prostate MRI, Axumin and amyloid PET/CT, Y90 radioembolization, prostate artery embolization, and, soon, rubidium PET/CT. It is engaged with a busy, internationally renowned neurosurgical service at Providence Saint John’s— the Pacific Neurosciences Institute—for which it provides all functional, anatomic, and quantitative neuroimaging.
The practice also is an active participant in research. GE provided the practice with the research key for sequences on its 3T MRI that are available only to research centers doing 4D flow in cardiac. TIMG radiologists intend to write research papers on the technique. The practice also was the largest provider of patients for the IDEAS (Imaging Dementia–Evidence for Amyloid Scanning) study on L.A.’s Westside and expects to be a big provider for IDEAS II when it launches.
On the technology side, TIMG adopted breast MRI 15 years ago and has one of the busiest breast MRI practices in Los Angeles. It is the first practice on the Westside of Los Angeles to acquire ABUS—automated breast ultrasound—and has been using it for about a year. It was one of the first to acquire digital mammography 12 years ago and more recently breast tomosynthesis. “We are always looking for the next best technology that will keep us on the cutting edge,” Dr. Yawitz says.
A Consolidating Market
TIMG is keeping an uneasy eye on the consolidating regional market, both on the hospital side and the radiology practice side. “Rad Partners buying Renaissance Imaging absorbed a lot of lives through all of the hospitals that they are contracted with,” Dr. Yawitz notes. “The Marina Hospital was bought by Cedars-Sinai a couple of years ago, and there are fewer and fewer independent hospitals. Henry Mayo remains one of the last independents in the market. I don’t know what their future plans are, but they are thriving as an independent in the Santa Clarita Valley.”
The acquisition of St John’s from a smaller Midwest order by the giant Providence has helped St John’s thrive, Dr. Yawitz says. The hospital has been growing its medical foundation through the acquisition of primary care doctors and surgeons many of whom have been loyal to Providence Saint Johns and Tower entities. “We are seeing more and more repeat customers because of the alignment happening in Los Angeles,” he says. “All of the clinicians I am seeing are looking for ways to align, because unless you are a little boutique concierge practice, it is very hard to survive as an independent physician on the Westside of Los Angeles these days.”
The entrance of corporate radiology into the Los Angeles market has unnerved the radiology community in Los Angeles, Dr. Yawitz says. The sale of Renaissance Imaging to Radiology Partners and the acquisition by Envision of the radiology contract at Providence–Tarzana Medical Center happened within months of each other. “Every single radiologist that is not aligned with a big entity is worried that we are going to lose our independence,” he remarks.
Meanwhile, TIMG is betting that SR will help the practice maintain its way of life, which includes practice and technology ownership as well as the pursuit of excellent patient care. “It helps people feel like they have skin in the game and shareholders are held accountable when we are all voting members in an entity in which we have ownership interest in assets,” he says. “Holding people accountable has been helpful in building and maintaining excellence. We think Strategic gives us the opportunity to maintain our independence.”
Hub is the monthly newsletter published for the membership of Strategic Radiology practices. It includes coalition and practice news as well as news and commentary of interest to radiology professionals.
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