More imaging procedures combined with a shortage of radiologists and expectations of high-quality interpretation around the clock makes remote reading an attractive option for facilities of all sizes. Some organizations are now contracting for subspecialty services and daytime coverage—adding to their needs at night and to accommodate vacations.
Be prepared. That’s the lesson Tony Gore, director of imaging at Rush Medical Group in Meridian, Miss., lived to tell — thanks to careful planning. When four of the five radiologists at Rush Medical Group left the practice over a short timeframe, Gore was glad he had signed on with Virtual Radiologic Corp. (VRC) for remote reading services. When a committee was reviewing potential vendors, Gore asked each if they would be able to provide final reports in the event that he lost radiologists. Only VRC could and that became crucial. Gore says that there has been a radiologist shortage in general but “we were sort of immune to that for a number of years.” When the four radiologists left, due to retirement, medical problems and a new job, the overall radiologist shortage finally caught up the organization.
Rush signed on with VRC three years ago, primarily for night-time coverage and preliminary reads. The organization acquired two more hospitals and will soon add a third. Now, VRC coverage is used extensively for those facilities.
Flow and volume
Advanced Radiology, a group practice in the Baltimore area with 80 radiologists, covers six hospitals. Doug Brunner, MD, also provides coverage in the Washington D.C., area. The group began contracting for radiology reading services with NightHawk Technologies about six months ago.
“The reasons to do teleradiology are basically fundamental to radiology today,” Brunner says. “People keep coming to the ER in the middle of the night and expect x-rays to continue to be read. Now, most ERs operate around the clock. We do quite a few CT scans and x-rays in the middle of the night. Patients continue to flow through the ER and volumes have gone up dramatically over the past 20 years.”
Patients aren’t the only ones with high expectations. Gore says that he has one physician who likes a lot of measurements and other numerical data in his reports and the remote reading service was able to match him with someone who specialized in producing a similar style of report. “The radiologist was extremely pleased with the reports he got,” Gore says.
Stemming the shortage
Richard Collins, MD, president of Salem Radiology Consultants, a 16-member practice in Salem, Ore., was an early adopter of remote reading services 10 years ago. Now a client of NightShift Radiology, Collins says that larger groups can pool their resources and hire a night-time radiologist. But, that is difficult for small and moderate-size practices. “The shortage of radiologists in general means that you work harder during the day and your days get longer and longer,” he says. “Trying to work at night on top of that burns people out very quickly. People will start to look for other jobs or a group will start to implode.”
The practice sends various exams to NightShift who then send them to the radiologists and within half an hour, receives a faxed report listing preliminary findings. The faxes go to the hospital or the emergency department, depending on who ordered the study. Collins says that the emergency department physicians are quite happy with the process. “They like to get that written report in a timely fashion.” Plus, a written message can go on the patient’s chart. The ED physicians also like avoiding phone conversations with a sleepy, grumpy on-call radiologist, he says.
Collins also likes the company’s quality review process, which includes peer review information on all its radiologists and a smooth system for managing discrepancies between the teleradiologists’ readings and his colleagues’ readings. NightShift maintains all of the equipment involved in transmitting studies and can perform most maintenance remotely.
Remote reading has helped Collins address several problems resulting from the radiologist shortage and an increase in procedure volume. The practice has a busy interventional service and the doctors are still on call for interventional procedures, so eliminating other night-time responsibilities helps. Plus, “younger physicians coming out of residency and fellowship have gotten used to this as a style of practice, so it becomes a recruiting tool of sorts,” he says.
Elias Gerth, MD, medical director of Key West Diagnostics in Florida and owner of Physicians Imaging, a chain of imaging centers, began working with Franklin & Seidelmann Subspecialty Radiology about five years ago. “Using the technology available today is how we bring quality interpretation to our patients. It’s absolutely stunning and impressive technology. I think it’s going to be the technology of choice as time goes on and people become more comfortable with it.” Gerth recently upgraded to 64-slice CT and is the first Franklin customer to contract for cardiology imaging.
Remote reading’s future
“I think that as long as there’s no contradictory governmental interference, the only way to adequately take care of the American population is to enhance the digitalization of radiology,” says Gerth. “There are just not enough radiologists to service 300 million Americans. There certainly are not enough radiologists to physically service all of the burgeoning communities in our country and there’s no reason someone in a small community shouldn’t get just as good of care as people in larger communities.”
Local and federal governments, however, are interfering with the growth of remote reading, Gerth says. “They should be promoting it, not trying to diminish it. I see right now that there’s a tendency to interfere and make it more difficult.” He says Medicare prefers that radiological procedures occur in hospitals. That’s a bad idea, however, because “a lot of hospitals don’t operate efficiently and we don’t have hospitals in all communities.”
Brunner sees remote reading services growing at double-digit rates for the foreseeable future for several reasons. First is the expectation of full radiology coverage around the clock. When radiologists on call overnight used to physically come to the hospital for emergency cases, the ED physicians were more conscious of the interruption which often limited how many times they would call. The move to remote reading made it seem to the ED doctors that they were imposing less, Brunner says. “Back in 1996, we decided to eliminate the practice of having eight or nine doctors up at night and replace them with one doctor up all night. That’s the premise behind teleradiology. It is all about aggregating business to provide enough business to keep somebody fully busy and worth staying up all night.”
Another reason for growth is that while demand for imaging at night and on weekends has increased, the supply of radiologists, and especially specialists, has not gone up to keep pace. In areas that are understaffed, a remote reading service can stretch manpower. “I don’t see either of these trends turning around so there’s a good, healthy future for teleradiology,” says Brunner.