Entrepreneur Marvin D. Kantor aims to demonstrate that a freestanding imaging center focused almost exclusively on women’s breast health can operate profitably in this era of managed care and diminished rates of reimbursement. However, to some observers it must appear that Kantor’s new venture, the Wendt-Bristol Women’s Health Center, Columbus, Ohio, is destined to drown in a sea of red ink.

Consider all of the value-added expenses. The architecture, decor, and landscaping are designed to soothe: patients arriving for tests or procedures at the 8,000-square-foot facility enter through a Japanese garden, then take a seat in a Zen garden waiting room, accented by attractive pieces of original modern art and the soothing sounds of Mozart and Chopin. Upon being escorted to an examination room, patients are provided cloth, not paper, gowns. Patients who lack transportation to the facility are picked up and later returned home by a Wendt-Bristol driver, at no extra charge, via one of five company cars and two vans. Lodging at a finer inn as guests of Wendt-Bristol is provided for those who journey from well beyond the clinic’s Columbus market area, because, for instance, positron emission tomography (PET) is not available in their town or they want to consult directly with the physician doing the mobile mammography reads.

Add to this the fact that breast imaging and treatment services at the Women’s Health Center are priced as much as 50% below the charges of some regional hospitals, and that Kantor has made it a rule that no patient is to be turned away for lack of insurance or inability to pay. According to Elizabeth Curran, marketing director, rates for a routine MRI without contrast were as high as $1,500 to $1,750 in the outlying counties whereas the fee at Wendt-Bristol is $925. “We see [the difference] primarily with PET and coincidence detection imaging,” Curran notes. “One hospital was charging more for coincidence imaging than we were charging for PET.”

Then there is the speed of test processing and interpretation. Typically, patients receive results that same day so they will know the outcome before they leave. Referring physicians are called directly with positive findings, and negative findings are faxed within 24 hours and delivered by courier as well.

To that end, the center is generously staffed with 10 technologists and two full-time radiologists working with state-of-the-art digital modalities (including ultrasound, MRI, and PET) for complete breast health services, including diagnostic mammography, stereotactic procedures, ultrasound-guided core biopsies, and ultrasound-guided cyst aspirations. Hours for the center, where a radiologist is always present, are Monday through Friday, 7 am to 4 pm. The adjoined imaging center, where all screening mammography is conducted, is open 7 days a week: 7 am to 11 pm, Monday to Friday, and 8 am to 3 pm, Saturday and Sunday. A trio of mobile mammography units roam the region, and there is one fixed-base satellite in a downtown Columbus YWCA facility. Last year and prior to the center’s opening, Wendt-Bristol performed 20,000 mammograms: 12,000 screening mammograms and 8,000 diagnostic mammograms.


The Women’s Health Center can and will be profitable (perhaps as early as mid-2000), Kantor insists, and his management and medical team agrees.

“Mammography is, of course, a rather poorly reimbursed modality, so the only way it can be viable as a business is if you attract a sufficient volume of patients,” says Dawn M. Milner, RT, administrative director of the Women’s Health Center. “The catch is that, in order to attract enough patients for the volume that is necessary, you must also provide a quality service. Quality not only means readily readable and correctly interpreted tests, it also means providing for patients an environment in which they will feel comfortable.”

The Women’s Health Center opened only this past June. Kantor expects as many as 25,000 women to pass through its doors within the span of a year. However, volume alone will not be enough to ensure profitability. Low overhead also is needed.

“Being focused on a niche market helps keep overhead down, and women’s breast health certainly is a niche,” Curran says. “But overhead is also kept down by the way we have structured our operations so that everything flows incredibly smoothly and rapidly. That is reflected in our ability to give same-day test results. Typical of our patients was a woman who had a mammogram, which turned out positive, came back the next day for an ultrasound, a biopsy the day after that, and was given a diagnosis of breast cancer 24 hours later.”

The low overhead permits the Women’s Health Center to establish low pricing. The low pricing, in turn, enhances the center’s attractiveness to managed care organizations and insurance companies, which are vital to the process of stimulating physician referrals of patients in volumes sufficient for the financial success of the enterprise, Curran says.

However, with the Women’s Health Center, the idea is not to appeal in the main to payors and referral sources but to consumers. In Kantor’s view, the woman who needs breast imaging services is the one with the greatest influence over where the health-care dollar will be spent.

“The delivery system of diagnostic radiology has changed because the consumer has become more involved,” he says. “The consumer is more aware of the environment in which radiology services are provided. As such, it is no longer feasible to run diagnostic radiology the way it was run years ago, out of the basement of a hospital. The consumer has as much right to the choice of a medical environment pleasing to her needs as she does the choice of a restaurant. This is manifesting itself now more than ever in the trend of consumers directing their physicians as to where they want to go for breast imaging. And where they want to go in Columbus is our Women’s Health Center.”


The Women’s Health Center is the most recent change of direction for Wendt-Bristol Health Services Corp, a $21-million public company that began approximately 100 years ago as a pharmacy and medical supply house. Kantor acquired a majority stake in Wendt-Bristol Health Services in 1979 and became its chairman. In 1987, he broadened the company’s scope with the launch of a freestanding, multimodality diagnostic imaging center, the first such facility in Ohio to be unaffiliated with a hospital or institution. Four other imaging centers and two radiation therapy facilities were added since then; all are operated by Wendt-Bristol Diagnostics, a subsidiary of Wendt-Bristol Health Services. Last year, the diagnostics unit reported revenues of $12 million, about 80% of that from managed care and the remainder from fee-for-service business.

Around 1989, Wendt-Bristol Diagnostics began providing mammography screenings. At that time, managed care organizations and insurance companies that covered screening mammography were rare, Curran recalls.

“Wendt-Bristol Diagnostics was instrumental in convincing payors of the importance of early detection and treatment as a way to contain costs while improving the quality of the patient’s life,” she says. “Once payors here agreed to reimburse for screening mammography, we were able to go out to the community, to physicians’ offices, and begin promoting the service. As we began to attract more and more patients for mammography screening, we decided to look at ways we could close various gaps in the breast health services these women were receiving subsequent to a positive finding on the screening mammogram. We found it most distressing that a woman with a positive finding typically might have to wait weeks for final word from a hospital imaging department.

“So, we determined to create a center that would satisfy the clinical needs of the patient through the expertise of a dedicated breast health specialist but also one that would be able to expedite appointment scheduling and the availability of the end diagnosis. To achieve this, we recognized we were going to have to create a continuum of care for breast health.”

The idea was brought to Kantor by Milner and radiologist Katherine M. Cyran, MD. Kantor invited Cyran and Milner to put together a formal proposal for action by the Wendt-Bristol board of directors. The one stipulation he made was that the resulting new facility be, as he put it, “the definitive women’s breast center for Ohio.”

“The concept we presented and that was approved envisioned a place that would truly dignify women,” says Cyran, who serves as medical director of the center. “Our position was that women want something more than just a battery of tests. They want personalized examinations, personalized discussion of their condition. So, now we have a center that accomplishes exactly that. We do not just focus on the patient as a consumer, but as an individual in a time of need. We proceed from the assumption that every patient walks into the center convinced she has cancer and needs to be interacted with beginning there.”

The center was built as a wing of one of the Wendt-Bristol general diagnostic imaging centers. In the event a woman needs imaging services not related to breast health, she simply walks across the small campus to the other facility where the expertise she needs will be available. “The facility on Kenny Road represents our anchor center,” Curran notes. “It is our oldest facility and has the broadest range of modalities. It was the first freestanding imaging center in Central Ohio.” The Breast Center was also a natural extension of the Kenny Road facility, because it was doing more screening mammograms than any of the other imaging facilities.


Marketing of the Women’s Health Center occurs on three levels. It begins with marketing to referral sources. Four full-time representatives travel assigned territories to visit physicians’ offices daily and make presentations about the services offered or to discuss new capabilities and explain how these will bene-

fit referred patients. Importantly, the representatives function as troubleshooters, helping physicians address and resolve problems they might be encountering with managed care organizations or employer plans concerned about costs and outcomes of diagnostics and treatments.

“Some of the big physician groups that were accustomed to one type of delivery concept were hesitant to embrace our new concept at first,” Cyran says. “They were afraid of losing control of their patients. But as they have gotten to know us, they have been quick to embrace us. In fact, some of the groups have decided they want us to play a role in managing their patients.”

Because of the extent of the center’s in-the-field interactions with physicians, many managed care organizations are seeking to make it an exclusive provider, Curran says. “Our representatives are able to not only offer information to the physicians, but to also glean information from them,” she indicates. “This information that we take away from the visits is coveted by managed care organizations that are desperate to get their imaging and cancer costs under control without resorting to the step of denying services to large numbers of members. They believe that if they better understand what is going on in those physician offices, they will be able to find solutions.”

Marketing to those managed care organizations constitutes a second level of outreach. According to Curran, Wendt-Bristol representatives were instrumental in bringing renal spiral CT, cardiac MRI, and PET to the attention of managed care in Central Ohio through supporting literature.

Utilization management through physician profiling is another service that managed care clients are keenly interested in, Curran reports. “Across the board, one of their biggest challenges is managing diagnostic imaging costs,” Curran says. “Previously, the trend was to precertify, but they were approving so many that the requisite infrastructure and bureaucracy were a waste of resources. Now they are looking at negative rates and targeting particular referring physicians for education. We are exploring ways to help them with that.”

The third level involves outreach to consumers. Primarily, the center runs print advertisements and publishes a newsletter that it mails to women throughout the market area. It also is engaged in a marketing partnership with the YWCA.

“We have a technologist at the downtown YWCA 5 days a week to operate the equipment and answer questions,” Curran says. “The YWCA is a very important contact point for us because the organization is so very active with women from all walks of life and at all levels of society. In particular, it enables us to reach women we have not had a lot of access to in the past, such as uninsured or underinsured women.”

The relationship with the YWCA is beneficial as well because the Y, being a nonprofit community service organization, can generate news media publicity for Wendt-Bristol programs and events that the imaging chain, as a profit-oriented business enterprise, would otherwise be denied.

“The YWCA brings to the picture the opportunity to participate in community outreach events,” Curran says. “But it is not a one-way relationship. It is one of mutual benefit, symbiotic. We provide support to the YWCA to help them put together and market programs of their own to help women in ways that only the YWCA can.”


Eyeing the future, Kantor and the Women’s Health Center team are talking about bringing aboard a pathologist. This, Cyran says, would further streamline the center’s work flow, which should lead to even faster turnaround times for the diagnosis of abnormalities.

One aspect of operations that appears to need no streamlining is patient-and-staff interaction. To Cyran, it is evident that most women who come to the center arrive in possession of considerable knowledge about breast cancer. Even so, she says the staff find ample opportunity to build upon that base of information in the course of one-on-one interactions with the patients.

“I believe it is important to interact with patients intellectually, but, in this environment especially, to also interact with them on a deep, emotional level,” Cyran says. “For that reason, we devote as much attention to patient psychology as we do to patient education. I am not the only person here who is involved in addressing patient psychology. Everyone here is involved. And it is an involvement that begins the minute the patient arrives and continues nonstop until she departs.”

Staff, from the receptionists on up, are continuously keeping an eye open for patients who seem unusually ill at ease, Cyran says. These are singled out for immediate special attention, usually by a supervisor or someone of higher rank.

“Taken as a whole, what we have done here is eliminated for patients the ordeal that customarily has gone along with breast care,” she says.

Kantor adds: “We are attempting to make a partner of the patient, and are shifting the burdens off of her and onto ourselves in the process of discovery and treatment of breast cancer. We want to do everything possible to remove barriers that might inhibit a woman from coming in for mammography and enabling us to catch problems at the earliest conceivable juncture so as to give the woman the greatest chance of being cured of her breast cancer. The concept is to provide easy, quick, reliable, and dignified access to mammography and treatment services. We are proving successful at this, and it is the reason why we are convinced the Women’s Health Center will be profitable.”


Rich Smith is a contributing writer for Decisions in Axis Imaging News.