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Imaging Industry Challenges Remain

By Mario Pistilli

I am thrilled to be given the opportunity to connect with my colleagues through ICE magazine. Director’s Cut will be a monthly column discussing concerns in the imaging industry from my perspective as an imaging director. I plan on touching on a wide variety of topics from general leadership, operational issues, and general industry hot topics in the coming months. I would like to take a little of your time to tell you a bit more about me and my motivations for embarking on this monthly column.

I am currently the director of imaging and imaging research at Children’s Hospital Los Angeles which is located at the corner of Sunset Boulevard and Hollywood Boulevard in the area most commonly known as Hollywood. We are a 370-bed pediatric academic medical center. I have also worked on the adult side at Presence Saint Joseph Medical Center in suburban Chicago. I oversee all imaging modalities and all imaging research teams which are composed of about 250 employees. I have been in the imaging field for almost 30 years and started as a nuclear medicine technologist. I have an MBA focused on health care administration and business analytics from University of Saint Francis. I also completed a graduate education course in health care executive leadership at USC Keck School of Medicine. I am very involved in multiple organizations and serve on the national board of directors for AHRA: the Association for Medical Imaging Management. I publish and speak on leadership and imaging-related topics nationally. My involvement in the national imaging community has allowed me to hear concerns and challenges from colleagues around the country which is what I plan to bring to this column.

The ICE magazine staff was able to join the AHRA at our recent annual meeting in Denver at which the future of the imaging industry was one of the topics discussed. While current trends predict volume growth over the next decade, that does not mean there are not significant challenges ahead. The biggest growth is projected in ultrasound and interventional radiology with minimal growth in general X-ray and a small decline in nuclear medicine. The big concern was the impact that high deductible health care plans (HDHCP) will have on imaging. The projection is that HDHCPs will adversely impact volumes as patients delay or avoid imaging due to deductible costs. It will also increase the price sensitivity of patients, and create more price shopping and insurance steerage. This means that hospital-based imaging will be hit particularly hard and we will probably see price reductions in many of our hospital-based charge masters and the subsequent hit to the already thin hospital margin. We have not yet seen the full impact and current studies show that consumers are most reliant on their referring physician recommendations. This is changing and will continue to change as price transparency rules come into effect and as access to price information becomes easier. The transition to value-based care models and providers being held more accountable for total cost will also further drive down utilization. The insurance industry is also making authorization harder and the impending meaningful use criteria will soon be adopted by private payers. We have already seen Anthem-Blue Cross deny hospital-based care and other carriers offer financial incentives to subscribers to seek care at cheaper alternatives. There are also three other groups: independent referring provider groups, employers themselves and consolidated radiology groups exerting economic pressure on the industry.

It is now, more than ever, that we need the very best and most well-informed leaders in imaging. Success into the future will depend largely on operational efficiency, quality and pricing. As we all know, as the hospital bottom line shrinks so does access to capital equipment and staffing. Skillful use of staffing and equipment utilization will be required to an even greater degree. I anticipate even stronger connections with our vendor colleagues in the future to navigate some of these challenges together.

I will be exploring some of these specific topics and others more in depth in future columns. One of my core beliefs is that a true leader makes those around them better. My motivation for writing this column is to, in some small way, contribute to my peers. I also want all patients everywhere to get the very best care and know that imaging leaders are a huge component in that. I am excited to dialogue with ICE readers through these columns and in person at the next ICE conference being held in Scottsdale, Arizona this February. Conference information is available at

Mario Pistilli, CRA, MBA, FACHE, FAHRA, is administrative director for imaging and imaging research at Children’s Hospital Los Angeles. He is an active member and volunteers time for ACHE and HFMA organizations. He is currently serving on the AHRA national Board of Directors. He can be contacted at



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