Charles W. Gervais, MD

Retail radiology made its debut on the Oprah Winfrey show in 1999, with an appearance by screening proponent Harvey Eisenberg, MD. Just 4 years later, the segment is showing some wear and tear. A major chain with a prominent medical director and ambitious growth plans went into bankruptcy and disappeared off the radar screen last year. A real estate developer who planned to open centers in New York, Boston, and Florida early this year abruptly canceled plans and withdrew from the market. This is what his business consultant said: "There is a huge amount of competition. On a stand-alone basis in a mall environment, the business is not a winner. Those companies with the ability to involve themselves with a hospital, that is where the success is."

What happened in the interim? An economic downturn coupled with many eager entrants into the field clearly created more competition than the retail radiology market could bear. And the cost of consumer marketing campaigns (including discount two-for-one "sweetheart" deals on Valentine's Day in major metropolitan newspapers) apparently proved too great to sustain. A study published in the August Radiology surveying whole-body CT scanning centers that accepted self-referred patients and were identified using the Yahoo and Google search engines (a total of 88 centers) did not investigate marketing methods or costs. The researchers from the Stanford Center for Biomedical Ethics instead reported on the screening services offered, their fees, the modalities deployed, the methods of results reporting, and a general demographic and geographic profile of the centers. They found that the areas in which the centers were located had a higher than average median income and a higher percentage of people with advanced degrees. Based on that profile, perhaps the price-based marketing strategy was misconceived. Interestingly, the greatest percentage of the centersalmost half at 49%found through the Internet search concurrently offered conventional physician-ordered diagnostic services. Another 14% offered an array of screening tests, including nonradiologic tests. The remaining 37% offered radiologic screening tests exclusively. More than half of the centers accepting self-referred patients were radiology practices and departments for whom this business is just another service line.

The Stanford researchers called for a controlled study prior to what they called "the broad adaptation" of screening centers for whole-body CT to assess patient risk and downstream costs to the health system. The researchers also called for clinical guidelines for self-referral, and this is an idea whose time has come. There is a world of difference between self-referral for the controversial whole-body scans and self-referral for other emerging screening studies such as lung cancer screening and virtual colonoscopy (see "Benign Intervention" on page 37), for which clinical evidence of effectiveness is mounting and for which reimbursement is restricted or nonexistent. More and more cardiologists and internists are suggesting to middle-aged patients with high cholesterol that they be scanned for a calcium score. After receiving an elevated cholesterol reading, one woman was told by an internist to lobby her insurance company to pay for a calcium scoring scan on the grounds that a positive result would cost less than a year's prescription for Lipitor.

The difficulties experienced by retail radiology are really no different than those being felt right now by department stores and fast-food outlets: discretionary dollars are tight and competition is stiff. With a $401 billion federal deficit projected for this fiscal year, however, and employers struggling to hold the line on the escalating cost of employee health care packages, the number of people willing to pay for screening studies is likely to grow.

Cheryl Proval

Cproval@medpubs.com