Adding Ancillaries: Radiology services

December 16, 2005

This is the fourth in a series of articles on specific ancillary services that can boost your bottom line and keep you and your practice busy in a competitive market.

Agrowing number of practices are adding radiology services as a means of boosting revenue. "We're seeing a lot of interest," confirms John C. Stanley, administrator of South Sound Radiology in Olympia, WA. And some managers have seen how much of a difference radiology services can make to the bottom line.

Betty Prescott, administrator of Jefferson Family Physicians in Jefferson City, TN, says incorporating X-ray capability into the practice was a great move, and notes a hike in revenue of almost 7 percent.

Of course, when CT, ultrasound, and MRI are added, revenue goes up. Debra Wiggs, director of Practice Administration Services at the Patient Education Center in Fort Dodge, IA, was the CEO of a group where CT and MRI bumped up net annual revenue by $11,000 per doctor. But these services are cost-prohibitive for solo or small group practices; the only imaging service from which they may be able to profit is X-ray. Even then, the failure rate is high, so before you spend a penny, do some serious number-crunching.

Traditional film screen X-ray requires cassettes, film, dark room, and film storage capability. It's the least costly but has inconveniences, such as environmental regulations for waste disposal, ongoing replenishment of chemicals, and maintenance of the processor.

Computed radiography, or CR, utilizes a "cassette" which contains materials that react to the X-rays. The cassette is loaded into a CR reader, which converts the image into a digital format. The images are stored in a digital archive, often part of an EHR, burned to a CD, or printed with a dry laser imager. The digital images are much more portable than traditional X-ray images.

Digital radiography has the detectors built into the X-ray table and wall Bucky (a holder for the X-ray plate that's attached to the wall) and images are sent directly to the computer. It's more costly than CR but is faster, which makes it ideal for high-volume applications.

Space needed

You'll need roughly 280 square feet (about a 17' x 17' space) to hold the equipment and perform the service in a wheelchair-accessible room. For a dressing booth, you can get by with as little as 26 to 30 square feet, basically a cut out with a draw curtain and bench seat.

The chemicals and processor will fit in a dark room about the size of a restroom. The amount of space required for film storage depends on volume. Stanley notes, "Most small offices have about 260 square feet in film storage and racks that go up to the ceiling."

Staff/training required

You'll need to hire a radiologic technologist to operate the machinery. While the median national annual salary is $64,811, and the hourly rate is $23.30, according to the American Society of Radiologic Technologists, salaries will differ depending upon your locale.

In addition to salary, factor in $11,000 or so for benefits. Also, because of radiation concerns, X-ray is heavily regulated by the state department of health or environmental quality department, so film badges, tube registration fees, and regulations and fees relating to technologists' registration come into play.

Costs

Prices range greatly, depending upon the manufacturer and a machine's features. Siemens' Multix Pro is a film screen X-ray that sells for $75,000 to $85,000. Computed radiography pricing depends upon the number of viewing, capturing, and processing workstations, and Siemens offers these systems through original equipment manufacturers for $135,000 to $155,000. Its Axiom Multix M is a digital radiography system that ranges from $299,000 to $330,000.