Hospitals Face Continued Margin Pressure
Health systems are struggling to offset rising labor and supply expenses, keeping operating margins thin despite growth in ambulatory care. The persistent financial strain is accelerating the strategic shift of services, including imaging, to lower-cost outpatient settings to improve financial performance.
- While median operating margins for nonprofit hospitals showed improvement, rising to 1.2% in 2024 from -0.5% the previous year, they still have not returned to pre-pandemic levels. Persistent labor pressures contribute to this, with base salary and wage expenses increasing by a median of 6.9%. - The shift to outpatient imaging is accelerating, with projections showing a 14% growth in advanced outpatient imaging and 10% in standard outpatient imaging over the next decade. This move is driven by the potential for significant cost savings; shifting just 10% of hospital-based care to outpatient settings could save an estimated $125 billion annually. - Health systems are actively acquiring freestanding imaging centers to maintain subspecialized radiology coverage and expand strategic opportunities. This trend is often initiated by the imaging centers themselves, driven by reimbursement cuts, rising regulatory complexity, and the need for significant capital investment in new equipment. - Effective January 1, 2025, a new Medicare policy will provide separate payments for diagnostic radiopharmaceuticals with a per-day cost exceeding $630, a change from the previous bundled payment system. This is expected to improve patient access to advanced nuclear medicine scans by reducing financial disincentives for hospitals. - The mobile medical imaging services market is projected to grow from $17.31 billion in 2026 to $21.13 billion by 2031, with North America being the largest market. Key players in this consolidating market include Akumin Inc. (Alliance Healthcare Services), RadNet, Inc., and MedQuest Associates. - Staffing shortages remain a critical issue for imaging departments, with vacancy rates for CT technologists reaching an all-time high of 19.4% and MRI technologists at 17.4% in 2025. This is compounded by a broader radiologist shortage, with imaging volumes projected to rise 3-4% annually while the workforce growth is limited by retirements and a lack of residency positions. - The FDA is rapidly clearing AI-enabled medical devices for radiology, with 211 such devices receiving clearance between September 2024 and July 2025. Radiology-specific AI tools now represent about 81% of all AI medical device clearances. - Despite the influx of FDA-cleared AI tools, reimbursement remains a hurdle. Currently, the Centers for Medicare & Medicaid Services (CMS) has approved payment for only about 10 AI/ML-enabled devices, limiting widespread adoption.
