Opening Arguments Berkshire Radiological Continues Battle With ‘800-pound Gorilla’

A new battle has begun for Berkshire Radiological Associates, P.C. (BRA) of Pittsfield.


The private facility, which provides radiological imaging services for Berkshire County, has garnered its share of headlines since its inception in April, 2003 for the medical advances it has fostered, but also a series of challenges facing the practice.

Those challenges began with some bad blood between BRA and Berkshire Medical Center (BMC), where all three of BRA’s founders, Drs. Jerome Auerbach, Stuart Masters and Robert Geehr, once served as senior radiologists. The three partners once thought the outpatient facility they opened would be joint venture with BMC – but the hospital and its parent organization, Berkshire Health Systems, decided otherwise.

Despite that decision, BRA has charted new territory in the region’s health care field on its own, with developments such as the addition of state-of-the-art equipment and the creation of Berkshire County’s first women’s imaging center.

In June, 2004, BRA began offering magnetic resonance imaging (MRI) scanning services using a brand-new ‘wide-open’ MRI; but because of a new state law championed in part by Berkshire Health Systems, which prohibits BRA from installing the equipment in their Pittsfield offices, patients are now being rerouted to New Lebanon, N.Y. – just over the state line – to receive care.

Now, Auerbach, Masters, and Geehr contend that Health New England, a Western Mass.-based HMO with approximately 12,000 members in Berkshire County, has created another considerable hurdle by deciding not to add BRA to its list of covered facilities for members.

In essence, Health New England’s decision will require that its members residing in Berkshire County use only Berkshire Health Systems – the only facility the HMO has a relationship with in the Berkshires, and BRA’s only competitor – for any and all radiological procedures.

“We have an 800-pound gorilla on our doorstep,” Masters said of BMC. “And I think it’s fair to say that BMC has spent a large amount on advertising to foster a monopoly and use it to restrict patients from coming here. Health New England has never reimbursed us for the technical parts of our services, and now we are basically being informed that our patients won’t be able to come here at all.”

James Kessler, vice president and general counsel at Health New England, said the company offered to maintain a relationship with the three doctors as professionals – Geehr, Masters, and Auerbach could be reimbursed for professional services, and not for the technical expenses of running BRA’s equipment – but the three radiologists have, to date, rejected that proposal, citing the monopoly they think it helps create within the county. Kessler said that the three doctors will eventually be terminated from the network if Health New England’s offer remains unacceptable to them.

“We believe that the community should have significant concerns about Health New England’s decision to exclude providers other than BHS,” said Geehr, adding that he and his partners at BRA agree that healthy competition could help decrease the cost of services and increase the quality of care for members of Health New England.

Health New England, however, disagrees.

“Adding new facilities would increase overall costs rather than decrease them; everyone has to be concerned with that,” Kessler said. “There is no question that when a physician owns the equipment he uses, it gets used more. It’s not that we don’t want to work with these doctors. But we don’t want to add their facility to our network because of those increases.

“In general, we always look very carefully at any physician who wants to bring a new facility into our network,” he continued. “We have no ill-will toward these physicians.”

Kessler added that Health New England did not take the existing tensions between BMC and BRA into account when making the decision.

“That squabble is between them,” he said.

Auerbach, Geehr, and Masters have all worked in the Berkshire area for nearly three decades. All have served as chairmen of Radiology at local hospitals – Geehr and Masters at BMC, and Auerbach at Fairview Hospital – and all three have worked with Health New England since the HMO first entered the Berkshire County market in the 1980s.

Geehr said that until very recently, he was confident that Health New England would add BRA to the HMO’s network of health care providers.

“We had discussions and we sent patient and physician surveys to Health New England to show them that we are accomplishing our goal to provide the highest quality services,” he said. “We really thought they were going to work out a deal with us.”

He added that BRA’s goal to provide quality outpatient services for Berkshire county residents began long before the facility’s doors opened in 2003, and has become the driving focus for BRA as it navigates a bumpy road. While still employed at BMC, Auerbach, Geehr, and Masters hoped to offer outpatient services like BRA’s through the medical center.

“During that time, we felt the community was underserved without an imaging facility for outpatients,” Auerbach said.

But talks regarding those plans failed, and soon the three senior radiologists found themselves in a position to pursue plans for a new facility on their own.

“We were in negotiations to open an outpatient facility, but those negotiations led to an impasse, and BMC terminated our contracts,” Auerbach said. “But we still felt the community needed an outpatient imaging facility.”

The three radiologists opened their private practice on North Street in Pittsfield, just one block away from BMC. Soon after, the practice was specifically affected by the legislation that barred the doctors from installing the ‘wide-open’ MRI machine in their Pittsfield office.

Despite setbacks, though, the three physicians say their practice continues to flourish, and with the introduction of some new services and a recent accreditation from the American College of Radiology (BRA is the only facility in Massachusetts with that distinction), the radiological center is heading toward clearer skies.

“We have tried to make this a first-class facility, and that will continue to be our goal,” said Auerbach. “For the three of us, this is an ideal practice.”