Outpatient imaging volumes have been sliding at many hospitals as patients migrate to freestanding imaging centers with lower copays, and radiology practice-management companies have responded by striking joint ventures with health systems to defend market share and gain access to capital.
The deals promise scale and stability. Two radiologists argue the same deals can just as easily erode the diagnostic quality they are meant to protect if governance isn’t built correctly from the start.
Dheeraj Gopireddy, MD, chair of the department of radiology at UF Health Jacksonville, and Mayur Virarkar, MD, associate professor and chief of the division of abdominal and body imaging at the same academic medical center, laid out a governance framework for these partnerships in a paper published Aug. 19 in Academic Radiology. The paper draws on three decades of joint-venture literature to identify where those deals have gone wrong.
“When financial incentives are not structurally separated from clinical authority, diagnostic quality degrades,” Dr. Gopireddy and Dr. Virarkar wrote.
The framework combines stakeholder governance theory with Avedis Donabedian’s structure-process-outcomes model for quality. It assigns clinical quality authority — accreditation, peer review, radiation safety and approval of new AI tools — exclusively to radiologists, while operational authority is delegated to hospital partners through co-chaired joint quality committees.
Several protective mechanisms are meant to keep that division intact. A “volume-quality firewall” would bar tying radiologist compensation to imaging volume. A physics veto would let radiology practices flag equipment failures before they affect patient care. A seven-trigger escalation protocol, calibrated to American College of Radiology benchmarks including a 3% maximum imaging rejection rate, would flag quality problems automatically, and the radiology department chair would have authority to arbitrate disputes tied to quality.
The blueprint doesn’t rely only on guardrails. A “Diagnostic Imaging Centers of Excellence” pathway is designed to link quality improvements to shared financial returns, giving both partners a stake in the same outcome rather than pitting operational efficiency against clinical rigor.
Dr. Gopireddy and Dr. Virarkar are careful to frame the blueprint as a starting point, not a finished contract. “A template, not a prescription,” they wrote, noting that joint ventures vary widely and will need to be customized to each health system’s structure and market.
For hospital and health system leaders weighing a radiology joint venture — or renegotiating one already in place — the paper offers a specific answer to a question that has mostly been settled informally, deal by deal: where exactly the line between financial and clinical authority should sit, and who gets to enforce it.
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