MICI Q4: Radiology admins’ confidence varies regarding medical imaging

Radiology administrators are not confident that their practices will have adequate reimbursement from Medicare in the months to come, but they remain hopeful that imaging will grow as a profit center.

The results are from The MarkeTech Group's Medical Imaging Confidence Index (MICI) fourth quarter 2025 report, which found that administrators' confidence is "neutral and consistent" with Q3 2025, although the "downstream impact of politics continues to be a concern, with many expressing uncertainty around reimbursement, government shutdowns, and the stability of future funding," the report noted.

The MarkeTech Group produces the MICI report using survey response information contributed by radiology administrators and business managers who are members of its imagePRO panel. The survey is made up of responses to questions about trends radiology administrators face in the coming year.

This fourth-quarter report included feedback from 105 imaging directors and managers across the following U.S. geographic areas: 17% in the West North Central region, 11% in the East North Central region, 11% in the Mid-Atlantic region, 13% in the South Atlantic region, 14% in the East South Central region, 18% in the West South Central region, 12% in the Pacific region, and 4% in the Mountain region.

As for hospital/facility size, 50% of survey respondents reported 100 beds or less, 32% reported 100 to 299 beds, and 18% reported 300 beds or more.

For the survey, participants rank their confidence on five topics, and The MarkeTech Group calculates a single composite score. Scores range from 0 to 200 and can be interpreted according to the framework below:

• 50 to 69 = very low confidence
• 70 to 89 = low confidence
• 90 to 110 = an ambivalent score (neutral)
• 111 to 130 = high confidence
• 131 to 150 = very high confidence
• 150 = extremely high confidence

For the fourth quarter of 2025, the report found the following:

By U.S. region, results were mixed:

• Participants from all regions reported overall high or very high confidence in monthly diagnostic and interventional growth.
   
• Participants from the Mid-Atlantic and South Atlantic regions reported neutral scores regarding confidence in reimbursement for diagnostic and interventional imaging, while those from all other regions reported very low confidence or low confidence in this topic.
   
• Only participants in the South Atlantic and West South Central regions reported high confidence that internal operating and staff costs will remain constant; all others were either neutral or low confidence.
   
• Participants from the Mid-Atlantic, South Atlantic, and East North Central regions reported high to very high confidence that they would have access to capital for imaging equipment and IT needs, while those in the East South Central, West South Central, and Pacific regions reported neutral scores, and those in the West North Central and Mountain regions reported low or very low confidence.
   
• Participants from all regions except Mountain reported high to extremely high confidence that radiology will maintain/grow as a profit center.

Graph courtesy of The MarkeTech Group.

The survey includes a free response section where administrators may comment on the five topics. Free responses included in this report mainly addressed topics for which respondents' confidence was low.

Regarding financial strain, reimbursement cuts, and political/government uncertainty, participants noted the following:

• "Medicaid and Medicare cuts have us worried about the future. The government shutdown isn't helping."
   
• "[Critical access hospitals] are struggling with the rising costs of all medical equipment and service contracts."
   
• "Expenses continue to rise while reimbursement is horrible."
   
• "We are in crunch because of government shutdown and tariffs."
   
• "Funding is on hold until they sort out Washington -- I'm uncertain about Medicaid/Medicare reimbursements."
   
• "Tariffs and cuts to Medicaid will cause annual losses and uncompensated care to skyrocket. Supply and labor costs are rising."
   
• "Reimbursement challenges continue and may get worse depending on legislation."
   
• "[It's an] unstable environment financially and politically. Commitments are not reliable."
   
• "Volumes will continue to rise while reimbursement will continue to drop."

Regarding staffing shortages and operational constraints, participants wrote:

• "Healthcare worker shortages are impacting our ability to grow."
   
• "Interventional radiology services [have been] suspended due to lack of radiologist support."
   
• "Staff costs continue to increase; many full-time staff are leaving for travel positions."
   
• "Workforce shortages and rising labor costs will be major issues next quarter."
   
• "Expanding outpatient imaging hours depends on hiring additional staff."
   
• "Emergency department patients will negatively impact resources and throughput."

Finally, regarding volume changes, growth, and department expansion, participants noted the following:

• "Expanding cardiac CT angiography volumes, interventional radiology volumes, TIPS/Y-90s [Transjugular Intrahepatic Portosystemic Shunt procedures and Yttrium-90 radioembolization procedures], and SPECT-CT."
   
• "Our volumes increased 19% from FY24 to FY25; on-site MRI coming in 2026; growth expected."
   
• "Market changes are driving volume fluctuations."
   
• "We are steadily increasing in imaging volumes."
   
• "We are expanding hours for outpatient imaging pending staff availability."
   
• "[There's] growing competition in our area."

The Medical Imaging Confidence Index (MICI) is produced by market research firm The MarkeTech Group using data from its imagePRO panel of radiology administrators and business managers.