FieldStrength MRI magazine
User experiences - April 2016
Insights from private practice in Germany and India that are planning on expanding their MRI capabilities
In a highly competitive marketplace, running an MRI service as a successful business goes beyond the provision of high quality imaging. Two owners of thriving MRI services in Germany and India share their insights into the key success factors of running and expanding a successful MRI practice.
“Especially in the private sector, uptime is very, very important.”
Dr. Gulati
Dr. Parveen Gulati
Dr. Parveen Gulati runs the Dr. Gulati Imaging Institute, a privately owned, multi-modality imaging center in New Delhi, India. Dr. Gulati’s institute offers MRI, CT, ultrasound, X-ray, and mammography. Dr. Gulati is planning to expand the Institute’s MRI capabilities, adding new equipment in the near future.
Mrs. Silvia Schiffer
Mrs. Silvia Schiffer runs Radiology Schiffer, a privately owned imaging center attached to a major hospital just outside Berlin, Germany. Radiology Schiffer currently offers MRI, CT, and X-ray services, and Mrs. Schiffer will soon establish a new fully equipped center with two new MRI machines, CT, X-ray, and ultrasound systems.
Clinical excellence and operational efficiency drive growth
The desire to grow an MRI service can arise from an increasing patient volume but also from demand for increasingly complex procedures. Expanding MRI services requires careful planning and strategic investment. This typically necessitates investment in innovative technological solutions that will enhance clinical excellence while boosting operational efficiency.
Clinical excellence in MRI is augmented by hardware and software solutions that deliver high-performance imaging, allowing for diagnostic confidence across the whole spectrum of clinical procedures from routine to advanced applications.
Operational efficiency is supported by MRI equipment that allows a high patient throughput to accommodate increasing demand for MRI scans. Such equipment ideally combines reliability and high uptime with a fast and comfortable operator workflow.
Cost considerations are paramount
An entrepreneur who is building or expanding MRI services, needs costs to be predictable and affordable. This applies not only at a day-to-day operational level, but particularly to ensure financial security and predictability over the entire lifetime of the equipment. It includes maintenance costs, system upgrades, application support, and also staff training. A proactive MRI service continually invests in developing staff skills to maintain excellence in the operation of equipment and to anticipate future trends in medical imaging.
The patient remains at the center of it all
Beyond any other considerations, the patient remains at the center of it all. Ensuring patient comfort during scans, improving patient satisfaction, and reacting to patient feedback are key objectives for any MRI service. Satisfied patients enhance the reputation of an MRI practice, attracting new patients and expanding business opportunities.
Providing quality for minimal cost in India
Dr. Parveen Gulati runs a highly successful multi-modality imaging center in the fashionable Hauz Khas Enclave in New Delhi, India. The Dr. Gulati Imaging Institute provides a wide range of services, including MRI, CT, ultrasound, X-ray, and mammography. “We do between 30 and 35 MRIs per day,” says Dr. Gulati. “This is a mixture of all kinds of procedures including brain imaging, joints, breast, and prostate. And we have two radiologists looking after the MRI unit.”
Providing an MRI service in India has some specific challenges compared with the West, Dr. Gulati explains. “In our country there are a lot of people who are below the poverty line who attend state-run hospitals that don’t have MRI facilities. So we need to provide them with imaging services at a concessional rate. The disease scenario is also a little different because in our country infection is very common, especially in the pediatric age group. We see a lot of tuberculosis patients who are probably not so frequently seen in the Western world.”
Dr. Parveen Gulati
Increasing competition drives need to stand out
Growing prosperity and rising costs in India are putting pressure on private MRI providers, says Dr. Gulati. “We were among the first to start an MRI practice in the private sector here. But over the years, with the improving economy and easy availability of funds, a lot of centers have opened. A major challenge right now is the increasing competition. Then there are increasing running costs of the centers, the costs of radiologists, technologists, and supportive staff, not to mention the infrastructure costs. Electricity in India is more expensive now. Patients rightly want the best care that’s available in the world, but they want it at a minimal cost.”
However, in this climate of strong competition, the quality of service provided can be a key differentiator, says Dr. Gulati. “Our center is one of the first centers in the country to receive accreditation by the Quality Council of India. We have also received an award by the Federation of Indian Chambers of Commerce and Industry for organizational competence. We are primarily staying ahead by focusing on quality.”
“We are staying ahead by focusing on quality”
“Fast sequences are essential for us to increase throughput”
Dr. Gulati Imaging Institute New Delhi
Ease of operation facilitates high throughput
Operating within tight margins requires high patient volumes for profitability, and that calls for fast, efficient scanning. “Fast sequences are essential for us to increase throughput,” says Dr. Gulati. “In India we basically rely upon the volumes to make the project viable. For that we need a really high throughput."
“If you consider the cost of the equipment I use, the MRI machine price is the same as in the Western world. But if you just look at the cost of an MRI scan, in our country we only charge around 50 to 70 US dollars. In the West they may be charging something like 1,000 US dollars, maybe more. We can only compensate on volume, so it is very important for us that our equipment should be capable of doing scans that are fast. For that we need proper training, availability of faster sequences, good technical support, and good application support. The equipment should be user friendly, both for the operations at the console as well as for managing the patient at the magnet.”
High uptime is crucial for financial viability
“Especially in the private sector, uptime is very, very important,” says Dr. Gulati. “We do not want our equipment to be down for a single minute. Not even for routine servicing and preventative maintenance. We always prefer that this should happen either on a Sunday or at night when the working day is over. For me, service back-up is very important. What I want is the confidence that somebody is there to support me if my equipment goes down in the night. Those types of support are crucial.”
Confidence in image quality and lifetime support
“Next to cost, the main factor is the performance of the MR system. It comes down to confidence: my confidence in the image quality, my confidence in its user friendliness for my technical staff, and my confidence that I will get timely upgrades. But most importantly – which I want to give the maximum emphasis to – is the confidence that I have good application support and a service back-up.”
“I want the confidence that somebody will support me if my equipment goes down in the night”
“Predictable outflows of money are very important”
Predictable costs facilitate growth
The Dr. Gulati Imaging Institute has plans to consolidate its position as one of the foremost imaging centers in India with a program of expansion in the near future. “Before we can really think of expansion,” says Dr. Gulati, “as with any other business, we want to know the total cost of the project’s expected inflows and outflows. Predictable outflows of money are very important, and that includes the service contracts for equipment, and the scope and cost of future upgrades.”
Finding well-trained staff can also be problematic for an expanding business. “Even getting good technologists can be difficult. We need expert technologists who can manage the MR machines. In fact, I have suggested to the vendors that they should start their own training program for technologists. If they trained more technologists they would be an asset to established centers and the up-and-coming centers as well.”
Upgrades needed to stay at forefront
The ability to remain at the forefront of technological developments without frequent investment in new hardware is a key factor for a private MRI practice in India, explains Dr. Gulati. "Upgradability is a very important factor. In fact, every company should take that into account with their equipment. We cannot change equipment very frequently, but vendors are constantly coming out with newer features for MR, and those advancements should be made available to the customer at a reasonable price and with proper application support so they can exploit the equipment to its maximum."
Satisfied patients are the best measure of success
There are many possible measures of success, but Dr. Gulati explains that in his opinion, one measure far outweighs the others. “Success is a continuous dynamic process,” he says. "In any organization there are a number of parameters you can define, but for me the most important parameter is patient satisfaction. Our practice is totally patient oriented. We are basically doctors, so our primary goal is to keep our patients happy. And on the business front, if patients are happy they will bring you back another patient."
"If patients are happy they will bring you back another patient"
"It is not only equipment itself, but the total added value that comes with it"
Communication and management are crucial for building a thriving MRI practice
Mrs. Silvia Schiffer runs Radiology Schiffer, a successful, privately owned MRI practice embedded within a large hospital in Hennigsdorf, just outside the German capital of Berlin. She currently has one MR system and offers additional CT and X-ray services.
Radiology Schiffer is run as a small business, and Mrs. Schiffer identifies two important aspects that contribute to success. “Good cooperation and collaboration with the hospital and colleagues are required in order to maximize the utilization of our equipment. We work as a service provider for referring physicians, and the system has to be available and as reliable as possible.”
Another challenge concerns recruiting and retaining good staff. “One of the biggest challenges is the recruitment, the ongoing education and training, and the retention of the right staff that help us provide a top level of service.”
Mrs. Silvia Schiffer
Expansion requires predictability of costs
In the near future, Mrs. Schiffer plans a major expansion. “I’m currently setting up a completely new practice, at a different location, with two new MRI machines, a CT, an X-ray, and an ultrasound system.” Among the many considerations when embarking on a new venture, solid financial forward planning is essential. “The predictability of costs throughout the lifetime of equipment is extremely important to run a practice in a profitable way on an ongoing basis,” Mrs. Schiffer says. “Beyond just the MRI machine price, we need to have a clear forecast of future costs that will occur. This includes service costs and the cost of application support, which are very important to maximally use the possibilities that these expensive systems offer – which is again critical for standing out in the market.”
"Keeping patients to schedule demands a high uptime"
A thriving MRI service balances quality and throughput
Maintaining that balance between quality and throughput has many associated factors, but it is facilitated by the ease of daily operation of MRI scanners, Mrs. Schiffer explains. “We keep our staff well trained, but having machines that are intuitive to use, that are quasi-self-explanatory, with a well-structured operating interface, is very important to support our fast and efficient workflow.”
“For a private practice,” says Mrs. Schiffer, “the balance between the quality of imaging and patient throughput is critical. A private practice needs a high number of patients to succeed. To a certain extent, we have to keep the duration of an exam as short as possible with the highest possible quality. This is a difference between a private practice and a hospital, which may not be so focused on this aspect.”
High uptime is essential to success
Sustaining a high patient throughput requires keeping MRI scanners in continuous operation. “Minimizing downtime is essential for us, because we have a fully booked schedule of patient exams and waiting times. We feel it would offend referring physicians and patients when we have downtime and then need to reschedule patient exams,” says Mrs. Schiffer. “Keeping patients to schedule demands a high uptime. Maintenance should be limited to those hours where the practice is not open, in order to ensure the optimization of uptime. It is important also for the reputation of the practice, and for maintaining referrals. High uptime gains trust and confidence in the practice.”
"The balance between quality of imaging and patient throughput is critical for a private practice"
Upgradability helps maintain a competitive position
Staying ahead of the competition means staying ahead in terms of technological advances, explains Mrs. Schiffer. “The ability to upgrade equipment from time to time is essential to provide a state-of-the-art level of service. There are practices here in Germany that are still using 20-year-old, 0.5 tesla equipment to generate images and results. And as long as the patients are not harmed, this is fine. But that’s not the point. If the images are not of the highest quality, then the results derived from those images, which are handed back to referring physicians, are also not of the highest quality. Providing the highest possible image quality, and therefore optimal results and diagnoses, is how we want to earn our position in the market.”
"It is not only equipment itself, but the total added value that comes with it"
Total package, not just MRI machine price, determines best offer
To conclude, Mrs. Schiffer summarizes what she considers crucial for building a thriving practice. “I believe that the success of a radiology practice is ultimately based on the combination of being a knowledgeable radiologist and at the same time being an entrepreneur. Staff management is very important and so is finding your niche in the market. It requires branding and evidently a lot of communication, with the manufacturer, but also particularly with referrers and colleagues. After having been preparing this for a year, I can clearly say that marketing, networking, and good management of a practice are certainly different from just taking a physician’s viewpoint.”
How does a private MRI practice make purchase decisions? “It is always the total package that determines what the best offer is,” says Mrs. Schiffer. “It is not only equipment itself, although that is obviously very important, but also the added value that comes with it – the future collaboration, service, and support on technical as well as operational matters, and hopefully, also support for the marketing aspects. Branding of the practice is an important consideration, but also cooperation with the right vendor. Both are important if I am to gain a premium position for my practice compared with the competition around me.”
Expanding MRI services requires a balance between cost predictability, high quality and high throughput.
Despite regional economic and demographic differences, these case studies in India and Germany reveal much common ground. Dr. Gulati and Mrs. Schiffer are both entrepreneurs providing private MRI services and seeking to expand in the future. They mention similar key issues, including the need for fast, high quality imaging, high uptime, predictable costs over the lifetime of equipment, upgradability, good service support, an intuitive and efficient operator workflow, and comfortable and easy patient setup.
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