What the new Texas agreement actually says
Singleton Associates, P.A. — a Houston-based, Radiology Partners-affiliated practice operating for more than 65 years — and Blue Cross and Blue Shield of Texas signed a new multi-year in-network agreement, effective November 1, 2026, covering Singleton's hospital-based and outpatient imaging services across Texas, including 24/7 emergency radiology coverage. Dr. Byron Christie of Singleton Associates said the deal reflects BCBSTX "recognizing the realities of the severe, nationwide radiologist shortage" and the need for sustainable rates and access to emerging technology.
It isn't Singleton's first renegotiation. In April 2025, the practice signed a separate multi-year, in-network deal with Cigna that explicitly ended pending No Surprises Act payment disputes between the two organizations, rather than letting them run through independent dispute resolution case by case.
The contrast with how these relationships can go without a deal is instructive. Singleton separately pursued a multi-year arbitration fight with UnitedHealthcare that began in April 2022 over alleged underpayments; an arbitration panel at one point found UHC owed more than $153.5 million, before a later ruling vacated a $134 million portion of that award. A negotiated, multi-year in-network contract is the alternative to years of exactly that kind of dispute — for both sides.
Why radiology groups increasingly hold the leverage
Dr. Christie's reference to a "severe, nationwide radiologist shortage" isn't rhetorical framing — it's measurable. A Neiman Health Policy Institute study published in the Journal of the American College of Radiology projects the U.S. radiologist workforce will grow 25.7% between 2023 and 2055 if residency positions don't expand beyond 2024 levels. A companion study projects imaging demand will grow 16.9% to 26.9% over the same period, depending on modality. Supply and demand are growing at comparable rates — which means today's shortage is projected to persist, not resolve.
That scarcity changes the payer calculus. A health plan that lets a large, hospital-embedded radiology group go out-of-network doesn't just lose a provider — it risks disrupting imaging access for its members in markets where there may not be a ready alternative. The No Surprises Act adds a second pressure: research covered by Radiology Business found radiologists have been "especially successful" in independent dispute resolution, with a median prevailing offer roughly 500% above the insurer's qualifying payment amount — though that advantage is concentrated among larger and private-equity-backed groups with the scale to use the IDR process. Avoiding that volume of individual disputes, not just the headline rate, is part of what pushes payers toward a negotiated multi-year deal like the BCBSTX agreement.
Reporting performance is the leverage multiplier most groups underuse
Staffing scarcity explains why payers have less room to walk away. It doesn't fully explain which groups get the stronger terms. That's where reporting performance comes in — and it's already a tracked variable, not a hypothetical one. Hospitals frequently put radiology contracts out for bid specifically because of turnaround-time dissatisfaction, and RFP responses are increasingly expected to include measurable, trackable turnaround-time commitments rather than general assurances of quality.
The workforce data shows why turnaround time is under pressure industry-wide. A JACR study of Medicare fee-for-service claims found CT interpretation turnaround time rose 318% between 2014 and 2023, with most of the increase concentrated in 2022 and 2023. One of the study's authors, Cindy X. Yuan, MD, PhD, said the sudden 2022 shift suggests "there is no remaining capacity for the radiology workforce to absorb new workload" — the same capacity ceiling that underlies the shortage statistics above. A group that can read and report faster without adding headcount is, in effect, buying itself more volume capacity in a market where volume capacity is scarce. That capacity is what keeps a group large enough, and fast enough, to remain difficult for a payer to exclude.
| What a payer weighs | Why it matters to the negotiation | How reporting speed and completeness help |
|---|---|---|
| Member access risk | Losing a large in-network group can leave members without a nearby alternative | Faster reporting lets the same radiologist headcount absorb more referral volume |
| Dispute and admin cost | Out-of-network relationships generate NSA arbitration volume for both sides | A documented performance track record strengthens a group's standing when a multi-year deal is on the table |
| Contract renewal / RFP risk | Turnaround-time dissatisfaction is a documented trigger for hospitals to re-bid radiology contracts | Measurable turnaround-time commitments are a stated expectation in RFP responses |
| Workforce capacity ceiling | Shortage limits how much new volume a group can safely take on | AI-assisted report drafting extends effective capacity per radiologist without new hires |
Where AI-assisted CT reporting fits
The lever connecting the shortage data to the negotiating table is capacity per radiologist, not headcount alone — and that's the constraint AI-assisted CT reporting is built to address. A foundation model drafts a complete, structured report; xAID's in-house radiologist reviews every preliminary; the client's reading radiologist gets a ready-to-sign report rather than a blank page. For a group weighing its next payer renewal, the practical effect is more studies covered per radiologist and tighter, more defensible turnaround times — without the multi-year wait for new residency graduates to change the underlying workforce math.
Frequently asked questions
What did Singleton Associates and Blue Cross and Blue Shield of Texas agree to?
Singleton Associates, P.A., a Radiology Partners-affiliated practice based in Houston, signed a new multi-year in-network agreement with Blue Cross and Blue Shield of Texas, effective November 1, 2026. The deal keeps BCBSTX members' access to Singleton's hospital-based and outpatient imaging services, including 24/7 emergency radiology coverage, in-network.
Why do radiology groups currently have more leverage in payer negotiations?
A persistent radiologist shortage is the main driver. A JACR-published Neiman Health Policy Institute study projects the radiologist workforce will grow only 25.7% by 2055 if residency positions don't expand, while projected imaging demand grows 16.9% to 26.9% over the same period. With radiologists already the bottleneck for hospital imaging, insurers have less ability to let a large group go out-of-network without disrupting member access.
Does CT report turnaround time actually factor into payer contract negotiations?
Turnaround time is a documented performance metric in radiology contracting generally: hospitals cite turnaround-time dissatisfaction as a trigger for putting a radiology contract out to bid, and track it as a measurable KPI during renewals. A JACR study on Medicare claims found CT interpretation turnaround time rose 318% between 2014 and 2023, which researchers tied directly to the radiology workforce reaching capacity limits — the same capacity constraint that also shapes a group's standing in payer talks.
How does AI-assisted CT reporting affect a radiology group's negotiating position?
AI-assisted reporting that drafts a complete structured report for radiologist review can expand how much volume existing radiologists cover without adding headcount. That directly addresses the capacity constraint behind both slower turnaround times and payer-access risk, which is the leverage dynamic now shaping contract renewals like Singleton Associates' deal with BCBSTX.
Source: Singleton Associates / BCBSTX press release, as covered by Radiology Business and AuntMinnie; Radiology Business on the 2025 Cigna pact; Radiology Business on the UnitedHealthcare arbitration award and its later vacatur; Radiology Business on No Surprises Act dispute outcomes; and two JACR/Neiman Health Policy Institute studies, radiologist supply projections, imaging demand projections, and national CT turnaround-time trends. Figures are rounded as reported.