Strategic Radiology’s newest member 214-radiologist Advanced Radiology Services  in Grand Rapids, MI, has been busy since it departed the coalition four years ago in preparation for a period of rapid growth. It added one new health system, eight individual hospital clients, merged with four smaller private radiology practices, and entered a joint venture with Michigan State University (MSU).  The group just launched an interventional radiology residency program with MSU and its primary health system, Spectrum Health. Simultaneously, the company’s MSO—Strategic Administrative and Reimbursement Services (STARS)—grew too, adding 80 employees and significantly increasing its ability to support clinical growth and efficiency.

“With the complementary growth of ARS and STARS, the practice is uniquely positioned to continue expansion,” says Ryan Duhn, MD, ARS President. “This is a time in which we are looking at a more national landscape, and we see Strategic Radiology as a strategic initiative.”

Achieving the Benefits of Growth

ARS was formed in 1998 through the merger of two Grand Rapids based practices of 10 and 13 radiologists. The groups had a shared mission of maintaining the independent private practice of radiology. “They instantly found three key benefits to the initial merger,” says Dr. Duhn.

The first benefit was improved work/life balance.  “Having the additional team members resulted in less evening and weekend shifts which improved schedules for all,” he notes.

The second benefit was that physicians were able to read more in their subspecialty areas of neuroradiology, body, mammography, nuclear imaging, cardiothoracic, pediatric, musculoskeletal or emergency radiology. “Our fellowship trained radiologists got to spend more time in their focus area—this improved job satisfaction for the radiologists but also contributed to improved patient care,” he says. “We firmly believe that subspecialization in radiology drives quality.”

The third benefit is improved financial performance. The newly merged entity performed better financially.  Overhead expenses were allocated more efficiently and shared amongst a larger number of radiologists.  “Those three key benefits have been a constant throughout our growth from 23 to 214 physicians," says Dr. Duhn. "This helps both our patients and our radiologists and allows us to provide enhanced service to our hospitals and ordering providers."

The Role of IT

In January, the radiologists of ARS fully achieved one of their long standing goals when they brought their largest customer, Spectrum Health, onto their PACS reading platform. “This was a transformative event for us,” reports Dr. Duhn. “Our growth strategy has been based on the idea that we can function more efficiently and provide better patient care if we can change the economies of scale at which we are operating.  Other ARS clients have integrated with our PACS within a few months but we maintained independent systems with Spectrum for many years.  Both sides have benefitted since we accomplished this in December.”  

“Our sophisticated IT capabilities allow us to provide a 24/7 subspecialized distributed reading model that rivals the large national teleradiology companies, but we are not a teleradiology company," Dr. Duhn adds. "We are a boots-on-the-ground, private practice radiology group, with local presence and local relationships. Surgeons should be able to review the case with the radiologist they know.  We expect our physicians to attend tumor board and clinical conferences and participate in medical staff leadership."

"We use our distributed reading model to help our on-site radiologists be present more often,” explains Duhn. “We can distribute second and third shift coverage on a larger scale so that on-site rads spend more of their time representing the practice within the hospitals.”

Addressing the Challenges of Growth

The benefits of scale do not come without challenges for a group that covers locations throughout the state of Michigan. “It is challenging to get radiologists to agree on making the necessary investments to support practice growth,” Dr. Duhn allows. “The reason that so many private practices are selling to private equity entities is because they can’t build consensus internally to invest in the required IT infrastructure. It can be an appealing option to take on an outside investor when faced with this large expense.  In the long run, though, we will all be better off if we invest in ourselves now.”

Creating a unified culture as a practice expands is another well-known challenge. “The IT and financial challenges are big, but those are quickest to be solved,” Dr. Duhn notes. “Merging groups with different cultures can be difficult. It has to be very intentional and requires constant communication to adopt a unified culture and mission.  We work hard to engage and inform our physicians with regard to our corporate initiatives,” said Dr. Duhn.

STARS as Growth Engine

Dr. Duhn attributes the practice’s ability to grow to the high-level of support and service provided by STARS, the MSO operated by ARS. “There have been many operational and IT challenges as part of this growth, and STARS has been instrumental in providing solutions,” he says. “STARS has done a fantastic job developing the IT platform and finding the economies of scale through billing and operational support under Rita Westphal’s (CEO) leadership. We can grow clinically and increase the number of studies that we read, but STARS has to be able to move with us and provide the support to make all of those things happen.  Our overhead costs have to be proportionally lower, and the service has to be better, too.”

“STARS has developed a strong culture that is very supportive of the physicians,” Dr. Duhn continues. “They are excited about the growth of the business. Our IT infrastructure is flourishing and the support they offer is increasing which creates a stimulating environment for our employees.”  

Looking Ahead

While some radiologists view artificial intelligence as a threat, Dr. Duhn sees the future.

“Radiologists have a long history of innovation and disruption of the medical status quo to improve patient care,” he says. “With artificial intelligence, radiology has an opportunity to be innovative and to make the technology work for the patients, but we have to be willing to change with the technology.”

In returning to the Strategic Radiology coalition, Dr. Duhn and the ARS shareholders are looking forward to the opportunities to collaborate. “We have long been supporters of Strategic Radiology’s mission and vision,” he enthuses. “We have rejoined the group a stronger company and look forward to working with our colleagues in Strategic Radiology to advance the independent private practice of radiology.”