Radnet: Dr. John Crues, Chief Medical Officer

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Radnet, which was founded in 1980, partners with advanced care organizations and insurance companies to provide services over a large geographic area. Approximately 180 fixed-site, outpatient diagnostic imaging centers are divided between the east and west coasts. They tend to cluster their centers in large metropolitan areas so that they can completely serve the population of patients for any given partner.

“The other thing we like to do is work with advanced care organizations that outsource their outpatient imaging to us so that we not only provide the service, but we manage the utilization. We have a whole group of physicians and nurses that are specially trained to know what the indications are for outpatient imaging and we do our own utilization management to determine what is and is not appropriate outpatient managing,” says Dr. John Crues, Radnet’s Chief Medical Officer.

Crues is a physician who has been with the company for thirteen years and also manages Radnet’s fellowship program and fills the role of chief compliance officer.

Remaining Neutral in Utilization of Services

The Radnet model delivers services based solely on the need of each patient. “Because both the pay-for-service and the non-pay-for-service referring physicians which we work with use the same criteria, we remain financially neutral,” says Crues. This avoids the bias of over utilizing radiology services to gain profit, as might happen when the diagnostic imaging equipment is owned by a medical practice, or underutilizing radiology services to save money, which can be the problem when determination of use is made by insurance companies.

“Since we have patients in both the managed group and the pay-for-service group, our determination of appropriateness is really independent of the financial consequences. I think this really distinguishes us from other people who are in the outpatient imaging center market,” says Crues. “Our bottom line is our orientation is to provide appropriate medical care.”

Expansion of Medical Imaging Services

“Science and the fact that so many medical imaging procedures have been shown to be cost effective—in medical delivery systems in every other western country, not just in the United States—lead me to believe that the need for medical imaging will continue to expand,” says Crues. “No one knows exactly what the new laws are going to be like, but I think there will be an increased demand for medical care, in general, because more people will be covered and will be in positions to get medical care in the United States.”

At the same time, Crues expects the continued decline of reimbursement for the industry, so demands to increase the efficiency of providing services in the outpatient setting are going to add pressure.

“Already, we’ve seen how this has occurred in the past ten years with mammography,” Crues says. “We’ve seen a large percentage of mammography providers in the United States go out of business because the correct business pressures weren’t placed on them. My guess is there will be a lot of pressures on outpatient imaging, and I think we are already seeing some of the smaller centers go out of business now. That’s going to be hard to sustain in a setting where there is continuing demand for more services. I think already we’re in an area where there is a major clash between containing costs and providing adequate medical care to people.”

Radnet is committed to a model of providing care to the general population, so catering to private pay clients to increase revenue is not on the company’s agenda. Crues expects that declining reimbursement will affect money to pay salaries, and this may lead to future issues with physician recruitment.

“I see this as persisting and getting more acute over the next couple of years until we end up with a system that is in more balance. We’ll end up with a system where we have adequate reimbursement and services for the patients who need them. There will be efficiencies developed over the next few years in the imaging sector which will allow more imaging at lower costs,” Crues says.

The Current State of Digital Imaging

The company, right now, is thriving. “Most of our current tech positions we are able to fund directly out of our revenues,” says Crues. “In the past, when we had to make requisitions, we had to borrow. Now we have an adequate income stream so that most of our acquisitions this year are actually going to come directly out of the operating revenues rather than increasing debt. We’re also paying off a lot of debt each year at a faster rate than we’ve been able to in the past.”

Radnet leads the way in the merging of information technology and imaging services. “We acquire digital information, process it, and distribute the processed information in the form of reports,” says Crues as a summary of their services.

Everything is done electronically. Paper is rarely used, and film is a thing of the past. “The IT department has a much more central role in medical imaging that it did several years ago, but this company has always been a leader in medical imaging,” says Crues.

Quality control in a large organization is always something that requires a lot of effort. “The best way of assuring quality is assuring that the people you work with are of high quality,” says Crues. “That is the single most important factor.”

Radnet has emphasized quality hiring practices in recent years and believes in putting resources toward the training of the personnel they hire. “We also have a number of programs in place where we evaluate the efficiency of our centers,” says Crues. “Turn around time, the amount of time patients are in our waiting room, and we also are working with the American College of Radiology in evaluating the accuracy of physician interpretations.”

“I really think one of the big issues right now in the business of medicine is that so many people involved in the business of medicine in the United States are really more interested in the economy, not the quality of the medical care that’s being provided,” says Crues. “Maybe I’m old fashioned, but I really think that the business of medicine in the United States should be to provide medical care to people. I think in this current environment, that’s not the emphasis. Medicine is being measured by things other than how well patients do … until we get back to making it the responsibility of medical companies to provide medical care; I think we’re going to continue to be in an area of uncertainty. People at all levels, including Washington, are going to be unsure about how to go forward in providing the most cost effective medicine.”

-by T.M. Simmons

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