JACR: Not-so-hidden teleradiology dangers exposed
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More than half of all radiology practices in the U.S. outsource night and weekend coverage. “When a group does that, what does it say to other physicians in the hospital? We think we’re very important in terms of providing patient care, but only between 8 a.m. and 11 p.m. After that, we can abrogate our responsibility to a teleradiology company that may be 1,000 miles away,” David C. Levin, MD, of the department of radiology at Thomas Jefferson University Hospital in Philadelphia, said in an interview.
In fact, this all-too-common business model threatens the profession and may represent a final nail in the commoditization coffin.
Radiology groups have turned to teleradiology over the past decade for a number of reasons, according to Levin. These include respite from night and weekend call, access to subspecialty expertise, supplemental radiology services and rapid turnaround times.
The real or perceived benefits of teleradiology, however, may be outweighed by the disadvantages, argued Levin, who noted that some teleradiology providers are embarking on a more predatory course characterized by aggressive pursuit of hospital contracts and direct competition with local practices.
Losing a hospital contract may be the final step in a slow march toward extinction. The intermediate steps may be equally devastating. “Radiologists already do a lot to commoditize the field,” explained Levin. “They don’t talk to patients, nor do they talk to referring physicians about the appropriateness of imaging studies.”
Levin contends that abdicating professional responsibilities to a teleradiology group sends referring physicians and hospital administrators the wrong message. “The message would seem to be that radiology is just a commodity and that radiologists are more concerned with their own convenience than with taking care of patients. Moreover, if the radiology group isn’t indispensable at night, why should they feel they are indispensable during the day,” he wrote.
The discrepancy between nighthawk fees and professional reimbursement further endangers conventional radiology practices. “If a nighthawk group reads an MRI for $35 and payors reimburse it at $70 to $80 or more, they are going to begin to ask why they need to pay the higher rate … This is really going to hurt us.”
The reimbursement differential could instigate competition and commoditization in the overcrowded diagnostic imaging market. Independent diagnostic testing facilities or nonradiologist physicians who own advanced imaging equipment could turn to lower-cost teleradiology providers rather than local radiologists for imaging contracts. Finally, relying on teleradiology providers for night and weekend interpretation could further undermine relationships between radiologists and their clinical colleagues, and encourage continued encroachment of imaging by other specialties, noted Levin.
The patient care question
A final, and critical, con to the teleradiology model arises on the patient care front. Levin outlined multiple reasons why teleradiology interpretation may be subpar. These include:
- The push by teleradiology providers to read studies as quickly as possible;
- The lack of contact between referring physicians and teleradiologists;
- The lack of contact between teleradiologists and patients;
- Teleradiologists’ limited access to clinical data;
- The lack of clinical collaboration between teleradiologists and radiology peers;
- The incomplete teleradiology clinical loop that excludes follow-up feedback; and
- Minimal oversight by hospital quality assurance or risk management committees.
In contrast to the service provided by teleradiology companies, Levin noted that on-site radiology practices provide multiple additional professional services including consultations with referring physicians and patients; study protocol and supervision; guidance and education for clinicians, technologists and administration; hospital committee service and day-to-day operational management.
Levin concluded with recommendations for radiologists. “Take back the night,” he asserted, calculating that night coverage amounts to approximately two weeks of nights and two weekends annually for a 25- to 30-radiologist practice. “That’s not a lot,” Levin insisted. He also urged his colleagues to eschew working for teleradiology companies.
Concurrently, Levin acknowledged that teleradiology providers do fill a void for smaller radiology practices and offered several alternatives that might help five- to seven-physician practices better supplement local expertise and availability. These include consolidation into a larger group, cooperative night and weekend call coverage with other local practices or partnerships with academic radiology practices to cover night and weekend call coverage.