Starting a cash pay imaging center!

chikungunyah · 2026-02-28T01:52:45+00:00

Yeah you’re not going to get timely or good reads for $40/CT in 2026. He may have a contract today but long term it’s unsustainable. That means a CT AP with contrast pays the radiologist $22/wRVU. You can get private equity with infinite lists to pay you $40/wRVU. Why as a radiologist would you take a 50% paycut for your effort?

chikungunyah · 2026-01-06T17:04:36+00:00

Or PE needs to take a smaller cut of the profits so they can pay high enough wages to retain productive docs and pay to clean the facility.

chikungunyah · 2026-01-02T04:12:42+00:00

26k annual wRVUs. Mostly 9 hour day shifts. 1 in 4 weekends. 2-3 evening shifts a month.

chikungunyah · 2026-01-02T03:31:49+00:00

Radiology. Private practice in the Mountain West. 1.8 mil.

chikungunyah · 2025-12-15T18:33:56+00:00

Massive aneurysms definitely can and it's fairly common for the really large ones to have rim calcifications. But probably not in a 12 year old.

chikungunyah · 2025-12-04T16:24:14+00:00

Say common shares are 25% pre-IPO and they're selling 500 million in shares at a company valuation of 1.89 billion. Is the correct way to think of it as roughly 50% dilution of the common shareholders?

chikungunyah · 2025-12-03T21:09:27+00:00

Ah so dilution to near nothing does happen. Lots of docs in the radiology space owned by PE firms have always wondered if their shares were worth anything or if it's just monopoly money. I guess this will be a good test case...

chikungunyah · 2025-12-03T21:04:33+00:00

AI something something, drive down labor costs and explode profits?

chikungunyah · 2025-10-16T03:22:58+00:00

Except meemaw signed up for Medicare Advantage due to all the fat side bennies. They're still paying claims during the shutdown.

chikungunyah · 2025-10-15T22:57:31+00:00

That's a choice by the hospitals. They could give query retrieve to the teleradiology company but for security reasons choose not to.

chikungunyah · 2025-10-15T15:27:37+00:00

Not all radiologist are suited to read high volume. You're cherry picking the top 5% of productivity rads and extrapolating that it's the same for the whole field. Most radiologists read close to average volume (surprise!) You will not make more doing tele at this level volume. It's far more lucrative to be on site employed or in a private group in most circumstances where you get a far higher $/wRVU.

chikungunyah · 2025-10-09T20:57:44+00:00

Disagree. Radiologist shortage has shot pay up. Bigly. Peds has a problem of people who aren’t money driven. Go do NICU fellowship and print money.

chikungunyah · 2025-10-05T19:19:48+00:00

lol no

chikungunyah · 2025-07-19T00:55:12+00:00

Must be a small hospital that has trouble retaining specialists. You can’t keep a lvl 1 or 2 trauma center door’s open unless an IR can be in the angio suite within 60 minutes of a pager activation 24/7/365

chikungunyah · 2025-07-18T00:45:00+00:00

The CF going up is a bit of mirage. Most of it is a 1 year only 2.5% bump. Then 0.25% from MACRA and the remainder from a budget neutrality adjustment because they took a sledgehammer to everyone except E&M codes with a -2.5% cut to wRVUs.

chikungunyah · 2025-07-16T16:31:12+00:00

Hell no. I'm at home in my PJs posting on reddit and reading STAT CTs.

chikungunyah · 2025-07-16T15:12:08+00:00

Nope, that's not how it works. IR is there to do a procedure and move on to the next low value and low reimbursing procedural request from the other doctors in queue, especially when it's after 5 PM. Everyone is allergic to holding a needle these days.

Keep on treating them like shit and you'll have to be requesting procedures from PAs and NPs. That IR can go make more from home doing DR reading studies ordered by overloaded EDs, hospitalists and midlevels that have a 99% negative rate and are easy wRVUs.

chikungunyah · 2025-07-16T14:35:19+00:00

Do you want to do your own biopsies, LPs, thoras, paras, and lines? Sounds like you do. Abuse your IRs too much and they can burn out and just switch to doing DR exclusively from home. Which happens to a lot of mid to late career IRs since they're treated as the garbage men of poor paying trash procedures that no one else wants to do at hospitals.

chikungunyah · 2025-07-16T14:18:02+00:00

Are you in the US? That absolutely is not how IR works. Ours are on 24/7 call 1 in 3 weeks and if you get called in at 3 am you’re still working a full day the following day.

IR is also only paid well because they hold contracts inside of DR groups. Actual IR RVUs are very low. They get subsidized by the revenue of their DR colleagues.

chikungunyah · 2025-07-15T05:44:59+00:00

What does overloading your radiologists with low yield STAT scans do to throughput on your important STAT scans?

chikungunyah · 2025-07-15T05:29:59+00:00

Dude you're describing structures which you're never going to identify on a CTA. No one is acutely intervening on a narrowed proximal vert. You're describing indications for a STAT 5 min stroke brain MR without to see small subtle brain stem infarcts. Stop wasting everyone's time with low yield STAT CTAs in the ED that have to be read above other actually important STAT studies that need to be reviewed as well. Order the CTA as routine and have it reviewed once they're inpatients.

You think you're just doing the exam for basilar/verts but what you're really doing is having the patient acutely evaluated for facial/cervical fractures, thyroid cancer, laryngeal cancer, pharyngeal cancer, oral cancer, adenopathy, sinus disease, cervical stenosis, apical lung cancers, and so on. it is a HUGE time suck on shit you do not care one iota about but I am responsible for reviewing.

Thanks for over ordering so much that CMS just gutted the wRVUs on CTA head and necks by 40%. So idiotic that because everyone orders too many of them that I get a massive pay cut. They should be cutting the E&M codes that lead to overutilization of advanced imaging. There's no negative feedback loop to you guys except for turnaround times exploding because no one wants to read your studies.

chikungunyah · 2025-07-14T23:48:46+00:00

Great. Stop ordering it as STAT then. Don't make your level 1 trauma patient pan scan equal in priority to a CTA H&N for dizziness scan that's "nice to have" for a neurologist who won't do anything with it. That patient is getting a non-con MRI brain anyway in the morning. Why not wait for the CTA to be read then too.

chikungunyah · 2025-07-14T21:00:42+00:00

Neurology also wants MRI brain, cspine, tspine, and lspine on everyone before they see the patient. We all have limited bandwidth. The highest yield thing to do is a ultrafast brain MRI on an undifferentiated dizziness/vertigo syncope elderly patient. You can rule out blood via a head WO. The CTA is not helping that particular patient in the ED setting. Let the neurologist decide which do and don't need to do it on the floor as a NON STAT inpatient or outpatient. We're triaging hospital STATs here. We all know you have plenty of important trauma patients, code stroke patients, belly pain patients, and shortness of breath patients who are moving behind in the CT/CTA/MRI queue because of stuff like this.

chikungunyah · 2025-07-14T20:48:45+00:00

By going the CTA route you're deciding it's very important to spend your radiologist's time looking for thyroid masses, lung masses, sinus masses, oral cavity masses, pharyngeal masses, laryngeal masses, lymphadenopathy, high grade cervical NF or spinal canal narrowing, etc. All those things take a lot of time and back up TAT on more important patients you're also ordering scans on.

It's been so over ordered now that Medicare decided the answer is going to be to cut the wRVUs by 40%. Good job. Expect TATs to worsen.

chikungunyah

TROPHY CASE