Still, many AMSP members find their relationships with OEMs beneficial, even friendly. Scott Wasson, President of the AMSP and member company Radiology Services LLC, says that it is "different with each OEM," but mostly "wonderful." On a scale of one to ten, Robert Probst, owner of Technical Prospects, rates his relationship with OEMs as "probably a ten." And Steve Hurley of ProActive Technology Solutions, Inc. (PTSI), says that OEMs will occasionally seek his assistance when they have a whole-hospital service contract, because certain ISOs can work on niches that OEMs have neither the time nor the resources to address.

The impact of reimbursement

Cuts in Medicare and Medicaid reimbursements for imaging procedures, the result of the 2005 Deficit Reduction Act (DRA), have sent shockwaves across the medical community. AMSP members, however, have a slightly different perspective: They think they stand to make a profit. According to Wasson, a reduction in reimbursements will "force [imaging centers] across the board to search for the best value in the industry," which often means service and refurbished equipment from AMSP members. While the DRA cuts do not apply to hospitals, all facilities and providers are also under cost pressures. Wasson relates the story of a large hospital he is currently trying to acquire as a client; he had assumed that with their size and resources they'd be buying new OEM equipment, but was surprised to learn that even they are in the market for used.

In addition to the DRA cuts, another force is at work in the imaging industry: CareCore National, an imaging management company. According to Shelley Weiner, MD, Director of CareCore's Imaging Center Assessment program, CareCore's goal is to "control the over-utilization of imaging services, and help direct physicians to appropriate use of imaging services." They do this by partnering with health insurance plans and integrating their own evaluations -- performed by a utilization management committee consisting of practicing radiologists, both academic and community-based -- into the insurers' decisions concerning reimbursement. Dr. Weiner says that CareCore's evaluations use standards stricter than those of the American College of Radiology.

Aidone, however, takes issue with CareCore's program, saying that they bypass existing regulatory and advisory bodies, and that their standards are too draconian. Ravenkamp agrees, saying that while CareCore's impact on GSI has so far been minimal, he foresees a problem in that "what [CareCore] is trying to do is force newer equipment, driving margins down for end-users. It's a double whammy for us... adding cost to the equation from two standpoints." Ravenkamp says that because CareCore forces end-users to purchase expensive new equipment, and because they charge insurance companies for their consulting services, prices are bound to go up across the board.

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