Inside Healthcare - RedCoat Publishing

After the Deficit Reduction Act went into effect in January 2007, American radiology providers had to scramble to deal with cuts in Medicare reimbursement that were as high as 37% on the technical portion of some procedures. In California, Truxtun Radiology Medical Group’s method of dealing with the cuts was not to go on the defensive. Instead, it continued to attack the market with the same gusto that made it the leading provider in the market.

“We’ve taken some bold risks in the last few years, even in the face of the Deficit Reduction Act,” said COO Chip Robinson. “Our strategy has been to expand our business in the fee-for-service and private insurance side to lessen our dependence on Medicare, streamline operations to reduce costs, and transition our physicians from a salary compensation plan to a productivity-based compensation plan.”

Chip Robinson, COO

Truxtun started in 1988, created by the company founder and sole owner Dr. Girish Patel, a radiologist and nuclear medicine physician. Currently, the company has 12 radiologists and five locations, although it is in the midst of consolidating one location into a new, larger facility. That means it will soon consist of four locations, all in the Bakersfield, Calif. market, where it is the market-leading radiology group. The company does about 165,000 procedures annually.

The first and the best
Truxtun has built its foundation in the Bakersfield area based on quality of service, being on the forefront of developments in technology, and bringing on the newest procedures earlier than its competition. It was the first radiology center in Bakersfield to offer screening mammography in the late 1980s and the first to offer stereotactic breast biopsy. Today, it has the only high-field open MRI of its kind in California. It is a 1.2 Tesla Hitachi open MRI, and the company also has one of only three Toshiba 320 detector CTs in California.

“Technology has been one of our calling cards and helps set us apart from other radiology groups in the area,” said Robinson.

As part of bringing new technology to the area, the company has always focused on helping area residents understand the quality and breadth of service Truxtun provides. Dr. Patel was the first radiologist to begin advertising direct-to-consumer in the late 1980s by promoting screening mammograms to the public, and the company still has an aggressive advertising strategy.

“We just completed a series of TV, radio, and print ads regarding Breast Cancer Awareness Month,” said Robinson. “We’ve also promoted the 320 detector CT, which we just installed in July, promoting its advantages of lower dose radiation during tests.”

Connected with the Toshiba 320 is a program called Vitria, which allows radiologists to see a three-dimensional view of anything the CT scans. The Web-based version of the program allows referring physicians to log in to Truxtun’s Web site to view images online.

“Over the last couple years, we’ve promoted the access to images and reports online heavily, and all of our referring physicians have access to both reports and images online,” Robinson said.

The company has also been touting is its new clinic, known as the Riverwalk Building, which opened last January. The new center has enough capacity that the company is able to fold in one of its existing locations. It is home to leading-edge technology in full-field, low-dose digital mammography, ultrasound, biopsy, and breast MRI and is designed to feel more like a spa than a medical office.

“We had a competitor open a new facility several years ago, so we needed a new space to improve our position that had a nice environment, and we needed more space to accommodate the volumes we were seeing,” Robinson said. “We also needed to offer new services that we hadn’t offered before, like the high-field open MRI.”

Simple decisions
The decisionmaking process for Truxtun regarding internal investments isn’t overly complicated. The company simply looks for industry-leading technology that will be unique to its market and makes financial sense. For instance, Robinson said Hitachi is the only company that makes a truly open MRI.

Other companies have created an MRI with a slightly larger opening and called it open. The Hitachi version doesn’t have a tube or a tunnel for the patient to go into. It has a flat top and bottom, and patients slide into the flat plane. When the company made the commitment to go with an open MRI, it wanted something appealing to patients that no one else had in the market.

“It is much better for claustrophobic patients, and you can position a patient better on a flat plane than you can in a tube,” said Robinson.

Similarly, when it came to the Toshiba 320 CT, Toshiba is the only company making a 320 detector unit. Robinson said the company had a good relationship with Toshiba dating back to investments made in older equipment, and the 320 detector unit allowed Truxtun to leap past the competition in the area and stand out in the local medical community once again.

Nuclear medicine is another area where Truxtun is distancing itself from other groups in the area. It recently put together a nuclear medicine department, bringing in the first 16-slice PET/CT in Bakersfield, as well as two new nuclear cameras, all equipment made by GE. The company had no prior relationship with GE, but Robinson had worked with GE representatives in his previous position at Bakersfield Heart Hospital and was able to bring Truxtun and GE together to advance the quality of nuclear medicine available in the area. In December, the department will be relocated to the Riverwalk Building.

With Medicare and Medi-Cal accounting for less than 30% of its revenue, Truxtun isn’t dominated by government reimbursement plans. Still, the uncertainties around cuts that may or may not come with healthcare reform are cause for concern. But Robinson said the company intends to expand into the rural areas around Bakersfield, having just announced it will work with the West Side Health Care District on the site of the former Westside Hospital in Taft, Calif. to operate the district’s radiology clinic. It recently began working with the Kern Valley Healthcare District in Lake Isabella, Calif., the second hospital it covers in addition to Bakersfield Heart Hospital.

“There are other local communities we are looking to expand into. We will also continue to focus on finding ways to expand our marketshare in Bakersfield,” said Robinson.

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