Elias Gerth, MD, is the medical director of Key West Diagnostics, a freestanding imaging center that he helped to create out of frustration with the alternate radiological services in the area.
Elias Gerth, MD, is the medical director of Key West Diagnostics, a freestanding imaging center that he helped to create out of frustration with the alternate radiological services in the area.

Like many physicians throughout the United States who are frustrated with the lack of highly trained subspecialty radiologists in their practice area, Elias Gerth, MD, had reached the end of his rope. Too often, this respected Key West, Fla, internist and critical care physician referred one of his patients to a local hospital for a radiological exam, and his patients would return dissatisfied and concerned about whether they were receiving the high quality of care that Gerth strives to offer his patients.

The physician also worried that he could not meet his personal commitment to provide the highest standard of care for his patients. Gerth, who sees an average of 30?40 patients per day, routinely fielded almost as many complaints as the number of exams he ordered. Instead of receiving answers, he was managing more problems. Instead of solutions, he was getting the cold shoulder.

“From my perspective as a practicing, community-based physician, I need certain things: attentive radiologists, quality equipment, quality technology, compassion and quick service for my patients, fast turnaround, and reliable results,” Gerth explains. “Essentially, the facility that was providing radiological services here was not meeting my needs in these critical areas.”

Identifying the problem was pretty easy?Gerth just asked his patients about the outcome of their radiological referral visit. The patients’ complaints were constant. Doing something to overcome the problems caused by the lack of service and support from the community hospital, however, would prove a logistical and medical challenge.

Problems Abound

The Florida Keys may be one of America’s favorite winter escapes, but the remote locale?separated from the Florida mainland, and 150 miles from Miami?gave its 30,000 permanent residents (50,000?60,000 during the winter season) few options for radiological services. In fact, the only choice was the local hospital, and according to Gerth, the process was flawed from beginning to end.

The more Gerth looked into the problem, the more he realized that he was not alone. After reaching a point of “absolute frustration,” he spoke to other Key West physicians who expressed similar dissatisfaction with the local radiological offering. That’s when he talked to friend and retired consultant Bob Dias, who helped Gerth assemble a group of local investors that could help bring an independent, freestanding diagnostic center to the area.

“We needed to find community people willing to invest in the right technology and hire the well-trained technologists who could deliver the product, but, at the same time, would listen and understand our needs,” Gerth explains. “We also needed people who would understand why it was important for us to connect to the virtual network, thus bringing in radiologists from all over the country on a digital basis.” Dias?the co-founder of Mail Boxes Etc?was committed to help solve the problem. “We can improve the radiological services for our community,” he says. “So we decided to do something about it.”

In fact, Dias shared more than a friendship with Gerth; he too had a frustrating experience while waiting for a routine radiological procedure at the local hospital. “It took hours to get through their outpatient services department for a simple X-ray,” Dias remembers. He soon discovered that every member of the investors’ group?including a retired physician?recounted similar experiences while receiving treatment.

Solution Within Reach

While Gerth concentrated on the technical needs of the new diagnostic center, Dias dedicated his expertise to the physical side of the business. Although Dias says he started from scratch, he remembers being impressed with the flow and d?cor of a dental office he visited in Providence, RI. Some of those ideas made their way to the new Key West Diagnostics, which opened in 2003.

Meanwhile, Gerth turned his attention toward finding a subspecialty radiology vendor that could provide expertise in a variety of areas and meet the full range of needs that only a state-of-the-art diagnostic imaging center can deliver. “[Key West] is a standard community that has definite special needs and requirements,” Gerth notes. “But take someone like me who is an internist. I have needs across the board. To provide the standard of care that our patients deserve, we needed someone who could attend to all of us with consistent, reliable, in-depth subspecialty expertise.”

The choice, Gerth and Dias agreed, was Franklin & Seidelmann Subspecialty Radiology (F&S of Beachwood, Ohio), a leading national virtual subspecialty radiology provider in the United States. Although several vendors were considered, F&S was the hands-down winner. Both Gerth and Dias remember being impressed with how well the F&S team listened to their needs, understood their challenges, and demonstrated the ability to deliver what Gerth and other physicians had wanted for many years.

“Both [Peter] Franklin, MD, and [Frank] Seidelmann, DO, came to Key West, met with potential owners, and explained the kind of service they could provide,” Gerth says. “They were the most enticing group for us. We looked at others, but we felt F&S was the best prepared to serve our needs. They had a rich history of digital virtual radiology, they were willing to come to our kind of community, and, most importantly, they pledged a commitment to meet our needs.”

A Personal Touch


Franklin & Seidelmann Subspecialty Radiology (F&S of Beachwood, Ohio) is a leading national virtual subspecialty radiology provider in the United States. Headquartered just outside Cleveland, F&S serves imaging centers, in-office practices, specialty clinics, and small hospitals.

The F&S network of more than 20 physicians across the country includes board-certified neuroradiologists; and musculoskeletal, body, and cardiovascular specialists with advanced training in 3T and 1.5T MRI, multidetector CT, and PET/CT.

Founded in 2001, F&S interprets more than 130,000 subspecialty studies annually from its 140 customers, which include a client base of physicians who support several NFL, NBA, NHL, NCAA, and WNBA teams.

Here’s how the process works: A patient goes to Key West Diagnostics with a radiology order from a referring physician. Typical Key West Diagnostics services include MRI, MR angiography, CT, CT angiography, ultrasound, and X-ray. Images from the specific study are then transmitted digitally to F&S’s headquarters. Those images, along with the patient’s demographic and clinical information, are sent to an F&S radiologist for interpretation. Once the report is transcribed by an F&S transcriptionist, it is then signed by the radiologist and distributed to the ordering physician. The report is archived at F&S as well.

“What we have brought to Key West Diagnostics,” explains Frank Seidelmann, DO, “is the experience of having a broad base of radiological expertise available at all times to handle the needs of every clinician no matter what their specialty is.”

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Seidelmann, whose company interprets more than 130,000 subspecialty studies annually, says that he, as well as other radiologists from his group, made numerous trips to Florida to familiarize themselves with the referring physicians.

“We met with them and gave lectures so that by the end of the day, we felt as close to them as if they were right down the street,” says Seidelmann, who co-founded F&S in 2001. “When I call on a referring physician, it’s on a first-name basis. Even though we work in a virtual world, we get to know the referring physicians intimately.”

Dias, who had been involved in the planning of a Scripps Research Institute satellite clinic in Escondido, Calif, adds, “F&S helped with everything, from technology and equipment selection to marketing. They were very receptive. Every time the group’s team left [Key West], they had a list of things I needed, and they delivered very quickly. That gave me a lot of confidence that they could deliver what they promised.”

And then some, according to Gerth. “While F&S could be reading images for a professional football team on the one hand, they also could be taking care of basic fundamental issues that might apply to any patient in our community. That was critical for us,” he says. “They were available through their resources to supply whatever we needed and tailor the expertise to the physicians.

“Looking back,” Gerth continues, “as our new facility evolved, the technical team at F&S helped our technical team set up our modalities, and we were up and running with ease. They consistently deliver excellent reports on a timely basis; they are imminently available for consultation; and we crafted a payment structure that is more affordable for our patients. In fact, we have been able cut patients’ costs by as much as 30 to 40 percent.”

Instant Success

The investors’ group poured an estimated $3 million to outfit Key West Diagnostics with state-of-the-art digital imaging equipment, which was an idea long overdue in the area. The diagnostic center?located next door to Gerth’s practice?includes several modalities, including a 1.5T MRI scanner, a 4-slice CT scanner, a digital X-ray room, a digital bone-density room, and an ultrasound room. The facility is staffed by four full-time radiologic technologists, five full-time office-staff members, and one administrator. Within 3 months of its opening, Key West Diagnostics was turning a profit.

Today, the freestanding imaging center prides itself on getting the patient to the examination room in 30 minutes or less. The volume of patients handled is impressive: In 2004, the facility logged 6,000 cases; in 2005, the caseload jumped to 10,500. According to Gerth, the facility would have eclipsed the 11,000-case mark in 2005 had it not been for the four hurricanes that swept through Florida and cost the facility a month of operations.

Reflecting on 3 years of success, Gerth says that marketing Key West Diagnostics to area physicians was as simple as delivering on what it had promised. “The truth is, we really never had to market. We communicated with local physicians through open houses, contacts, and brochures,” he says. “When they found that they could get terrific service that was as good as or better than the competition?and less expensive to their patients?it was difficult to justify not using us.”

Initially expecting referrals from around 25 area physicians, Key West Diagnostics now receives constant business from more than 50 physicians. Also, the center has branched out to serve the US Deptartment of Veterans’ Affairs, the US Navy, local municipal entities, and several cruise lines.

“The major thing,” Gerth notes, “is that we deliver on what we promise. We are available, and we focus first and foremost on the patients and the doctors.”

A National Need

Dias and the Key West Diagnostics investors’ group are taking their philosophy on the road. Realizing that the radiology situation found in Key West could be just as common in other isolated areas of the country, Dias spearheaded the formation of Physicians Imaging LLC, which hopes to develop and manage full-service diagnostic centers across the country based on the Key West Diagnostics business model. One of its first moves was appointing Seidelmann to the board of directors.

“We have found that the same dynamics that existed in Key West are prevalent in many communities across the country,” explains Gerth, adding that three such diagnostic centers currently are being developed in the South. “The need for better service is what drove us. The actions of similar facilities around the country is creating an environment that will lead to other freestanding diagnostic facilities willing to put patients and physicians first?solid business proposition for investors, physicians, and patients alike.”

Dave Cater is a contributing writer for Medical Imaging.