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THE 20 LARGEST OUTPATIENT-IMAGING CENTER CHAINS | Consolidation and Hospital Alignment operations from A to Z, and we get the benefit of their managed care contract- ing, which helps to keep our equip- ment up to speed and RIS/PACS cur- rent. It’s a good combination, a model that we like and has worked well.” Outpatient Imaging Associates, Nashville, Tenn., ranked at sixth and an early practitioner of the JV model with hospitals and health systems, has 34 centers, 25 of which are JVs with hospitals. “Hospital joint ven- ture partnerships were the model on which OIA was formed fifteen years ago and that remains our primary model today as much as ever,” reports Creighton Cook, OIA senior director of business development. “We have had more hospitals reach out to us over the past twelve months than ever before to learn about our JV model and the need to get off campus at a value price point.” Cook reports that a growing num- ber of hospitals are reaching out for help in developing a multi-imaging center strategy. “We’ve seen a lot of hospitals building these big box out- patient destinations, with 50,000-, 75,000-, 150,000-sq-ft buildings with imaging, flex offices for physicians and swimming pools,” he reports. “They are going into these new com- munities and putting up these big boxes, and we are talking to a cou- ple of hospitals about putting imaging into these centers on their behalf.” Hospitals, nonetheless, remain fearful of cannibalizing their on-cam- pus outpatient business. “As such, even though we often recommend to hospitals that they need a near cam- pus location to combat leakage, they (perhaps rightfully) want imaging as far away from campus as possible,” he says. “They often want to use imag- ing to stake claim to emerging growth areas, which is a more risky strategy.” Is the end near? Hospitals will continue to protect their hospital-based business as long as Table 2. The 20 Largest Outpatient-imaging Center Chains 2015 Rank Company Headquarters 1 RadNet Los Angeles, CA 2 CDI/Insight Imaging Minneapolis, MN 3 MedQuest/Novant Health* Alpharetta, GA 4 SimonMed Imaging/Dignity Health* Phoenix, AZ 5 Touchstone Imaging Mesquite, TX 6 Outpatient Imaging Affiliates Nashville, TN 7 Envision Radiology Colorado Springs, CO 8 Solis Women's Imaging Addison. TX 9 Tristate Imaging Group Rockledge, PA 10 Shields Quincy, MA 11 Catholic Health Initiatives Englewood, CO 12 Southwest Diagnostic Imaging Scottsdale, AZ 13 ProScan Imaging Cincinnati, OH 14 Tenet Healthcare Corp/ United Surgical Partners Intl Dallas, TX 15 Wake Radiology Raleigh, NC 16 Charlotte Radiology Charlotte, NC 17 Progressive Radiology Falls Church, VA 18 Doshi Dignostics Hicksville, NY 19 A1 Medical Imaging Diagnostic Centers Sarasota, FL 20 Austin Radiological Associates Austin, TX the HOPPS rates exceed MPFS rates, which is in danger of vanishing. The HOPPS premium is under attack from the Medicare Payment Advisory Com- mission, which has urged CMS to adopt a site-neutral payment policy. “In my opinion, the writing is on the wall for the HOPPS rate to be reduced probably quite significantly over the next couple of years,” says Dale Skrnich, VP Imaging, outpatient services division, Tenet Healthcare Corp, Dallas, Tex. 32 Radiology Business Journal | August/September 2015 | Working with healthcare private equity firm Welsh, Carson, Ander- son & Stowe, Tenet recently com- pleted a merger with United Sur- gical Partners International, Dal- las, blending its 24 imaging cen- ters and 49 ambulatory surgical centers, with USPI’s 200 ASCs and 19 short-stay hospitals in 29 states. Although it involved relatively few imaging centers, the deal has the potential to make a significant impact on the market.