The rise of teleradiology has led to the displacement of many radiology groups from long-standing relationships with hospitals. But it doesn't have to be that way if radiology groups can retool to become more competitive with teleradiology firms, according to Dr. David C. Levin.
In a talk at the 2013 RSNA meeting, Levin of Thomas Jefferson University explained his take on teleradiology and outsourcing, which he sees as one of the most fundamental and dangerous threats to radiologists in recent years. Levin believes that onsite radiology is better for a hospital than coverage by a remote teleradiology company, and for the past several years he has advocated that radiology groups take a more aggressive stance against teleradiology providers.
"Local radiology groups provide real value to a hospital in many ways -- from being available for interventional procedures to helping the hospital attract referrals and build its imaging department," he said.
From friend to foe?
Levin began his RSNA presentation with a brief outline of the history of teleradiology.
| Year | Trend |
| 2000 | Teleradiology firms appear on the scene, initially offering to cover night reads for small radiology groups. |
| 2005 | Many large radiology groups start outsourcing to teleradiology companies. |
| 2008 | Hospitals and their radiology groups generally have good relationships. There is a shortage of radiologists, and hospitals are happy to have their groups on board. |
| 2010 | The radiology job market turns. Now there's a surplus of radiologists, and hospitals become more demanding. Teleradiology firms start to expand their services to satisfy their investors. |
| 2012 | Teleradiology companies begin to actively pursue hospital contracts, replacing incumbent radiology groups. |
There are good reasons why a hospital might want to cut off its local radiology group and hire a teleradiology firm, Levin said.
"Perhaps because the group competes with the hospital, doesn't provide necessary subspecialty expertise, or isn't responsive to other service needs or complaints from referring physicians," he said. "Or the hospital resents being asked to pay for night coverage, transcription, or RIS/PACS. Or hospitals may want to increase profits from imaging by billing globally and profiting on professional fees."
But local radiologists can provide lots of services that teleradiology companies can't, according to Levin.
Dr. David C. Levin from Thomas Jefferson University."Local radiologists are available for interventional procedures and can oversee imaging protocols and performance of exams by technologists," he said. "It's easier to attract referrals and build the practice with local radiologists. And local radiologists can evaluate the appropriateness of imaging requests and answer patient questions."
Local radiologists are available to supervise patient safety efforts, treat contrast reactions, oversee equipment accreditation, and provide techs with in-service training, Levin said. In addition, they can help triage patients, work with hospital administration to evaluate equipment purchases, and serve on hospital committees.
"And local radiologists aren't beholden to a company whose primary goal is profit, rather than good patient care," he said.
Besides, it's unclear whether teleradiologists practice high-quality radiology, according to Levin.
"Teleradiologists are forced to read quickly, which can lead to more mistakes," he said. "They have little or no contact with referring physicians or patients, and little or no opportunity to consult with colleagues on tough cases, access patient charts, and follow up on their interpretations. And they don't protocol their exams."
Click here to watch a video from RSNA 2013 in which Levin discusses his thoughts on teleradiology.
Levin offered a number of dos and don'ts for radiologist groups:
- Don't try to set up an office across the street to compete with the hospital -- or at least do it as a joint venture.
- Don't give teleradiology companies a foot in the door by outsourcing nights and weekends to them.
- Provide great service and build up loyalty among referring doctors and hospital administration.
- Be visible: Embrace the consultant role.
- Become more subspecialized.
- Be active on hospital committees and boards.
- Develop radiology-specific quality metrics, then use and track them.
- Track utilization, especially for inpatients and emergency department patients.
- Help the hospital get American College of Radiology accreditation for its outpatient imaging facilities, because even though it's not required by law, it's proof of a quality operation.
"Respond quickly to referring physician and patient satisfaction surveys," Levin told RSNA attendees. "And promote the hospital's business interests -- that is, build the practice. Hospital administrators have a right to expect quality, dedication, and hard work from its radiologists."
