Teleradiology in the Crosshairs

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The reading room serves as 24x7 headquarters for Radiology Associates of Fox Valley self-developed teleradiology service

Originally hailed as a practice-extending boon for overworked radiologists, teleradiology has faced increasing fire and fury in the last 12 to 18 months. As the major players grow larger, swallowing other teleradiology providers and building affiliations with local practices, rad practices are concerned that they, too, may be bait for teleradiology companies.

In the February issue of the Journal of the American College of Radiology, David C. Levin, MD, of the department of radiology at Thomas Jefferson University Hospital in Philadelphia, cautioned of "the serious negative consequences [of outsourcing night and weekend call]. These include the likelihood of commoditization of the field, lowering of fees, displacement from hospital contracts, greater encroachment by other specialties and lowering of quality."  

Teleradiology proponents, however, refer to greater access to subspecialized care, expedited turn-around time and improved quality. Plus, the ability to balance radiologist workload extends efficiency and cuts costs, they argue.

Both camps make valid points. The growing size and increasing aggressiveness on the part of some teleradiology companies have sparked fear in radiologists' hearts and wallets. And many clinicians are hesitant about working with unfamiliar teleradiologists. But there are ways to leverage the concept with services tailored to local needs.

Patient-centered service

Gem State Radiology, a 25-radiologist practice in Boise, Idaho, considered the teleradiology route about a decade ago when the local hospital began to acquire hospitals and the volume of night work increased. After meeting with internal and external stakeholders, the practice decided teleradiology didn't fit its business model. "We believe we're integral to patient care in the community. Like emergency physicians and trauma surgeons, we cover nights and weekends. We determined that we would be a can-do department," recalls Radiologist Tim Hall, MD.

Radiology Associates of Fox Valley, a 28-radiologist practice in Neenah, Wis., has embraced a do-it-yourself model that involves some teleradiology.

When a host of commercial teleradiology offerings burst onto the radiology scene a decade ago, the practice analyzed its night-call routines and realized it was suffering from inefficiency and overlap. Film-based radiology required that the practice staff multiple physicians at night, so that they could be available for on-site interpretation and procedures. Teleradiology, the radiologists believed, might provide a more efficient, cost-effective model.

"We presented the idea to physicians at the six hospitals we served at the time and they uniformly told us they would hate it. There was no acceptance for an outside source," recalls Fred Klein, MD, president. The practice solved the dilemma by developing a rudimentary internal nighthawk service.

Other successful teleradiology models driven by local needs needs include Arkansas Children's Hospital in Little Rock. Several years ago, the radiology department faced a critical staffing shortage with several concurrent retirements and multiple overlapping medical leave periods. "We knew if we didn't do something to reduce the weekday and evening shift load, the remaining subspecialist pediatric radiologists would be difficult to retain," recalls Charles James, MD, medical director of pediatric radiology. However, clinicians voiced a fair amount of resistance to the teleradiology model.

James assuaged physicians' hesitations about working with unfamiliar, offsite radiologists by tapping into known resources. Part one of the plan centered on a small pediatric teleradiology provider, which employed a subspecialized pediatric radiologist previously on staff at the hospital. Part two entailed equipping a former trainee with a PACS workstation. She read a subset of neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) studies from home for two days a week for two years. Physicians in those departments had worked with her, which increased their comfort level with teleradiology, says James. To further boost clinicians' confidence, James tasked an onsite pediatric radiology fellow with listening to teleradiologists' voice clip impressions before NICU rounds.

Teleradiology can be a practice builder. Over the last eight years, the teleradiology service