It’s been a phenomenal year of growth for one of Strategic Radiology‘s newest members, Summit Radiology in Fort Wayne, Ind., which grew from 60 to 80 subspecialized radiologists and from 21 to 26 hospital contracts in the past 12 months. President Daniel Branam, MD, attributes the surge to three things: 15 years of investment in building IT infrastructure and personnel, vigorous experimentation in radiologist practice models, and a confluence of current radiology events.
 
Dr. Branam joined Summit Radiology in 2009 straight out of an MSK fellowship at Indiana University. He wasn’t planning on moving to Fort Wayne, Indiana, but a good friend urged him to interview at Summit, where he was quite impressed by several progressive partners with uncommon ambitions. He never looked back. 

Investment in IT  
Summit Radiology was formed in 1995 from a merger of two groups in Fort Wayne that joined together so that they could offer all of their hospital clients 24/7/365 service. When Dr. Branam arrived in 2009, the group had just made the decision to invest in IT infrastructure in the interest of building a distributed reading solution to better serve an increasingly broad geographic coverage area—and to continue to keep night coverage in-house. The group purchased PACS, RIS, and an HL-7 engine to incorporate all disparate hospital systems into a single worklist. 

The next milestone occurred when the group began to experiment with time-zone-shifting of radiology between 2008 and 2012, taking an approach articulated by Jim Collins in his book Good to Great: First shoot bullets to figure out what works; then  shoot a cannonball when you have empirical validation.

“We shot several bullets,” Dr. Branam explains. “We had a radiologist here and a radiologist there, and it really worked out well. They were Summit radiologists, not with another firm but part of the family.” 

One teleradiologist was at the end of his career, but the other was younger. “He still works for us, so it was fairly early in his career that he decided to go half-time and move West where his wife is from,” Dr. Branam said. “That is when we decided to expand that business and open a reading room in Hawaii—at one time we had five radiologists in Hawaii.” 

A Business Model Evolves 

Eventually, Summit determined that the Hawaii office was not cost-effective. “We realized it was an expensive way to do things, and that it was much better to have everyone at home with redundant internet connections,” he explained. “That is also when we started the Synergy business.” 

In 2012 Summit Radiology launched a new service line, Synergy Radiology, to provide after-hours teleradiology coverage. “Synergy was about cost sharing and expanding that night service and our teleradiology offerings in order to support our growing local business.” 

The launch of Synergy paved the way for Summit to expand its footprint considerably in Indiana, bringing on several new contracts and continuing to hire more off-time radiologists. Over time, the practice brought on 26 hospitals in Indiana, many critical-access hospitals among them. 

“This has really become our niche—offering full-service radiology to small hospitals in the Indiana market,” Dr. Branam notes. “We are able to send radiologists at the appropriate time to do procedures, and then backfill with our offsite radiologists. This has become something at which we excel.”  

Employment Model Innovation 

The linchpin on which the new model turns is a flexible employment model popular not just with new radiologists, but with current partners as well. “We have an in-house mantra and that is, ‘Pick your partnership’,” says Dr. Branam, who served on the Summit board for 11 years before being selected to lead the group in 2019. “We have a very creative group and board of directors who kept asking, ‘How can we use our strengths with IT and distributed worklists to maximize our flexibility in offering different employment models.’”

Dr. Branam emphasizes that the group has invested considerable intellectual capital to create an equitable formula that everyone supports. “This can cause problems in a group because everyone has to believe they are being treated fairly,” he said. “We have gone to great lengths to figure out how to value different parts of our practice and allow people to choose the type of work-life balance that they want—and that is why we have been so successful in hiring recently.” 

Paying the appropriate amount has implications beyond practice harmony. “We have to be comfortable that we are not paying too much or too little for a service,” he said. “That is the hardest part: Are we paying appropriately or are we going to over-pay and go over budget at the end of the year?”  

Keeping Clients Happy 

Satisfying more than two dozen hospitals over a coverage area that spans most of Indiana is no small feat. Summit Radiology has been able to achieve this through responsive service, leveraging technology, and tempering the expectations of clients. 

“We are very responsive but are not perfect by any stretch of the imagination,” Dr. Branam says. “During this incredible shortage of radiologists, we have been able to take on several new hospital clients. When we are behind, we are quick to apologize. We encourage the technologist to find out when the patient has their follow-up appointment so that we can get it read before their appointment. If an exam priority needs to be bumped up, we always accommodate.” 

Summit Radiology keeps its fingers on the pulse by tracking various metrics and detailed reporting to hospitals. Hospitals receive detailed reports on turnaround times, good or bad, and a dedicated employee sifts through the data to trouble-shoot and report on root causes. 

“At Summit we talk about being available, accurate, and affable,” Dr. Branam says. “We try to reinforce that with our radiologists and our staff as it really touches all facets of our company. Picking up the phone is part of being available. Affability is trying to be helpful to the care of the patient, which for a radiology company is primarily through our interactions with the hospital, the technologist, and the clinicians. Then, of course we must be as accurate as possible, all of the time.” 

Challenge and Opportunity 

Dr. Branam sees more room to grow in Indiana—if Summit can add more radiologists. “We have business that we are turning away at the moment because we can’t in good conscience offer our typical level of service,” he says. “Everyone across the country is hiring. We must differentiate ourselves in the marketplace to attract the talent so that we can capitalize on this opportunity.” 

Investment in IT enabled the practice to optimize a workforce of 80 full- and part-time radiologists, a mixture of on-site and remote. “One of the most integral decisions as a company was to invest in our IT and human capital around 2008,” Dr. Branam states, adding that small hospitals typically do not have advanced imaging IT expertise or large IT budgets. “We can show up and say, ‘Give us your information and data feeds, and we’ll figure out how to get it done.’ They really like that—it takes a lot of headaches off of their plate.” 

Summit Radiology is looking forward to participating in Strategic Radiology’s activities and programs. “There are a lot of initiatives being spearheaded by Strategic Radiology that also are of interest to Summit,” he shares. “Whereas we are very good at IT and after-hours coverage, things like malpractice and health insurance are huge issues that a group even of our size wrestles with, and to be able to do that and not have to go after corporations for backing is very appealing to Summit.  There is much institutional knowledge within Strategic Radiology member groups in areas where we may not have expertise.”

“I really felt like Strategic was a like-minded group to Summit,” he added. “Its focus on physician-led practice and independence felt very familiar.”