PE Practice Purchases Tick Up

Private equity acquisitions of radiology practices ticked up in 2024 after two years of declines. A new paper in JACR sheds light on PE purchases in radiology, which have raised concerns about the corporatization of medical imaging in the U.S.

Private-sector radiology historically consisted of independent imaging practices run largely by radiologist-owners who contracted with hospitals to read imaging exams.

  • That model has begun to break down as radiology attracts investment from private equity investors eager to roll up what they see as a fragmented industry into larger companies that can leverage market power.

But what’s good for PE investors may not be good for radiologists – or for healthcare. 

  • Private equity investment in healthcare providers has raised concerns that investors may be putting profits before patients.

The new study documents the rate of private equity investment in radiology from 2013 to 2024, based on queries of the Pitchbook and CB Insights databases, finding …

  • There were 113 PE-led radiology acquisitions over the full study period (out of a total of 4.3k radiology practices in the U.S. in 2023). 
  • PE radiology acquisitions peaked at 18 in 2021, fell for the next two years, and ticked back up to 10 in 2024.
  • Most of the radiology practices being acquired employed 50-99 radiologists.
  • PE-led acquisitions were most common in the South.

So what’s to make of the numbers? A total of 113 acquisitions over 10 years isn’t that many (although the authors caution that acquisitions of multi-state or national practices and imaging chains would be counted as a single deal). 

  • And the researchers acknowledge that there’s little data on the impact of corporatization on healthcare quality, at least in radiology (although they do cite a study showing that PE ownership was associated with an 8.2% increase in radiology prices).  

The Takeaway

Private equity investment in radiology practices may still be in the early stages relative to other medical specialties, but radiologists will watch PE acquisitions closely for signs of how the trend may impact them. The new study serves as an important baseline for tracking future activity.   

Medical Imaging in 2022

For our final issue of 2022 we’re reflecting on some of the year’s biggest radiology storylines, including some trends that might have a major impact in 2023 and beyond.

“Post-COVID” – Radiology teams thankfully scanned and assessed far fewer COVID patients in 2022, but the pandemic was still partially responsible for most of the trends included in this recap.

Imaging Labor Crunch – Many organizations still didn’t have enough radiologists and technologists to keep up with their imaging volumes this year, driving up labor costs and making efficiency even more important.

Hospital Margin Crunch – There’s a very good chance that the hospitals you work for or sell to had a tough financial year in 2022, placing greater importance on initiatives/technologies that earn or save them money (and address their labor challenges).

AI Evolution – If a radiology outsider read a random Imaging Wire issue they might think that radiologists already use AI every day. We know that isn’t true, but imaging AI’s 2022 progress suggests that we’re slowly heading in that direction.

New Mega Practice Paradigm – After years of massive national expansions, recent unfavorable shifts in surprise billing reimbursements, radiologist staffing (costs & shortages), and the lending environment seemed to have caused large PE-backed radiology groups to pivot their 2022 strategies from practice growth to practice optimization.

The Patient Engagement Push – Radiology patient engagement gained momentum in 2022, as imaging teams and vendors worked to make imaging more accessible and understandable, more patient-centric imaging startups emerged, and radiology departments continued to get better at follow-up management.

The AI Shakeup – Everyone who has been predicting AI consolidation took a victory lap in 2022, which brought at least two strategic pivots (MaxQ AI & Kheiron) and the acquisitions of Aidence and Quantib (by RadNet), Nines (by Sirona), Arterys (by Tempus), MedoAI (by Exo), and Predible (by nference). This trend should continue in 2023, as VCs remain selective and larger AI players extend their lead over their smaller competitors.

Imaging Leaves the Hospital – Between the surge of hospital-at-home initiatives and payors’ efforts to move imaging exams to outpatient settings, imaging’s shift beyond hospital walls continued throughout 2022 and doesn’t seem to be slowing as we head into 2023.

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