9 Ancillary Services That Can Boost Practice Revenue

Leigh Page

Disclosures

August 07, 2014

In This Article

6. Performing Radiography

Radiography machines are notoriously expensive and require continual oversight, but Aburmishan said that reimbursements can far exceed operating costs if you have sufficient volume and good management.

In order to have sufficient volume, you may need to extend hours to evenings or weekends to get enough patients, she advises. "People want to know right away whether they have broken a bone, or if it's just a sprain," she said.

Carole Williams, sales consultant for Custom X-Ray Digital Equipment Sales and Service in Phoenix, Arizona, said that a radiography machine is often the biggest-ticket item a practice buys. A full-fledged radiography system, complete with a generator and wall-mounted bucky, costs $60,000-$70,000. Then it will cost $5000 to install lead-lined drywall and put in a control booth with a lead window. However, she said a portable radiography machine, costing $7000-$20,000, may be sufficient to detect simple fractures, and Aburmishan maintains that portable devices don't require lead-lined walls.

Aburmishan calculates that a 4- to 5-physician practice could provide sufficient volume to justify purchasing a portable radiography machine. States require inspections of radiography equipment once a year or every other year and oversee radiography technicians. Tennessee, for example, requires that such technicians undergo "appropriate educational program" training and pass an approved examination.

With digital radiographic images available within 1 minute, the physician can report preliminary results immediately. If the practice bills for the technical cost of making the radiograph and the professional cost of reading it, called the "overread," revenues can be 5 times greater than costs, according to Thomas J. Grogan, MD, an orthopedic surgeon writing in AAOS Now.[6] Nonradiologists can get training in reading radiographs, and Medicare will pay them for the overread.

But Aburmishan said PCPs typically provide the initial reading and send the radiograph to a radiologist for the overread. That means the practice charges for just the technical fee, but that can still be enough to make money on this service, she said.

The American Academy of Family Physicians (AAFP) maintains that PCPs can charge for at least some overreads. A 2006 AAFP position paper states, "Studies suggest that a second reading by a radiologist is not always necessary and selective request for radiology consultation is appropriate in some clinical circumstances."[7]

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