As Carilion Clinic comes under growing criticism for reducing local health care competition, the billion-dollar not-for-profit announced Friday it had purchased two Roanoke independent medical facilities.

In a deal finalized Thursday, Carilion became the sole shareholder of the Center for Advanced Imaging, which provides MRI and CT services, and the Center for Surgical Excellence, an outpatient surgical center.

The purchase price was not disclosed by the sellers or Carilion.

Although employees of the two centers were informed of the sale Thursday, Carilion waited a day to announce the deal because Carilion employees were not told until Friday morning, Carilion spokesman Eric Earnhart said.

The deal, however, was confirmed the same day a scathing Wall Street Journal report claimed Carilion's monopolistic dominance of local health care is driving up prices by eliminating competition.

Earnhart said the acquisitions fit with Carilion's approach to patient care as it transforms health care services from a traditional hospital setting to a physicians-led, multispecialty clinic.

"We looked at the opportunity and thought it was something that would have value to our patients and something that we were interested in being a part of," Earnhart said.

Two weeks before the sale, the Center for Advanced Imaging, which opened in 2003, garnered state approval to add a third MRI to its facility at 2923 Franklin Road.

That approval had been in the works since the center applied for a certificate of public need March 31.

Earnhart said Carilion would look at the best use for the new scanner and determine where it's needed. That could be the new clinic center being built at the corner of South Jefferson Street and Reserve Avenue.

Discussions between Carilion and Marty Helkamp, chief executive and managing partner for both the sold centers, began in the spring.

It was with plans to expand services at the Center for Advanced Imaging that Helkamp approached Carilion about working together to see the plans come to fruition.

"I think our next phase of development was going to cost [millions of dollars] in capital to implement, and we were looking for a partner," Helkamp said of approaching Carilion CEO Dr. Ed Murphy.

The Center for Advanced Imaging broke even in 2007, losing $446.83 on revenues of $6.4 million, according to information filed with the state's Health Planning Agency of Southwest Virginia.

Initially, Helkamp said he was seeking to partner in a joint venture, but the result was selling to Carilion.

By July, the Center for Advanced Imaging had indications from the state that it would obtain approval for its project, which specifically sought to add a third MRI machine at a cost of $1.45 million and a 4,000-square-foot addition.

Ultimately, Helkamp said, the goal was to open a dedicated program for breast and women's medical imaging. According to the state documents, the proposed breast health program would likely compete with Carilion's breast health program.

Earnhart said that services will not change at either of the centers.

"We are committed to keeping what's there," he said.

That includes not changing the cost of procedures, which are significantly cheaper than at the hospital.

A Carilion colonoscopy at the hospital costs $3,260, more than three times the cost at the Center for Surgical Excellence. Similarly, a neck CT scan costs $1,606 at Carilion verses $675 at the Center for Advanced Imaging.

Also on Thursday, Carilion filed a letter of intent with the Health Planning Agency of Southwest Virginia saying it will file an application to relocate a mobile positron emission tomography/CT scanner to Salem. Earnhart said it was unrelated to the imaging center purchase and that it would allow Carilion to perform a specialized cancer treatment.

In addition to evoking questions about competition in radiology, Carilion's purchase came only days after it announced plans to purchase Southwest Virginia's largest independent cardiology practice, Consultants in Cardiology.

Physicians worry about Carilion's dominance

Several independent physicians voiced concern over Thursday's sale.

"It makes me very sad for patients and for their private physicians when a monopolistic attempt of owning everything by Carilion seems to advance," said Dr. Larry Monahan, a physician with Jefferson Internal Medicine Associates.

"And especially when Carilion, a not-for-profit organization, has accumulated so much money that it can virtually walk in anywhere and buy anything at several multiples of the fair market value to satisfy their needs, desires or greed to own everything."

A Roanoke physician who supported state approval to open the Center for Surgical Excellence said Friday that he, too, was concerned.

"I thought it was very important that there would be a low-cost alternative provided by a completely independent full service ambulatory surgery center," said Dr. Frank Cotter, an ophthalmologist with Vistar Eye Center in Roanoke.

"We felt so strongly about it that we actually forcefully supported a direct competitor because we thought it was a benefit to the public."

Cotter has been a vocal opponent to Carilion's clinic transformation.

Helkamp said he was more concerned about growing competition with Lewis-Gale Medical Center.

That Lewis-Gale also received state approval on Aug. 15 to open an outpatient imaging center was a contributing factor in the decision to sell, Helkamp said.

"They are opening a center two and half miles from ours," he said. "The health care climate is changing, and we are health care providers, but we are also businessmen. ... We feel very good about the whole thing."

Lewis-Gale's CEO said he will continue with plans to open a new outpatient imaging center, Roanoke Imaging, by May at 4330 Brambleton Ave. in an approximately 7,000-square-foot building at a cost of about $1.4 million.

"We have a strategic plan related to that development, and this doesn't impact that plan," Victor Giovanetti said.

Giovanetti added, however, that the sale of the two centers to Carilion does affect local health care competition.

"It takes the competitive health care marketplace to a new level," he said. "But I think it is important to know that the acquisitions that Carilion has made are entities that were already our competition."