26 March 2009


Vijay links to an interesting point on the growth of teleradiology:
The dayhawk phenomenon has grown out of hospital satisfaction with the rapid service hospitals receive on outsourced off-hour interpretations by nighthawk teleradiology groups. Hospital administrators and referring physicians have begun to wonder why their local radiology groups cannot deliver the same level of service for daytime radiology reads that they are receiving from nighthawk groups.
I agree with Vijay that smaller radiology groups will probably lose out, but not because of defensive medicine, as he posits.  I think it is just the economy of scale -- that larger groups with centralized reading facilities are better able to staff nights, weekends, and specialty reads.  As radiology interpretive services becomes more and more a commodity, that trend will accelerate.   We're lucky, in that our tele-radiologists are the same local docs we have always had, just grown up a bit and providing services to a dozen local hospitals.  They came close, though, a few years ago, to losing their contract at our large hospital because of terrible customer service.   It was that threat that forced them to re-engineer their processes and become an absolute paragon of superior service.   Now, they are so good that I often have a dictated report on the chart before the patient is physically back from the scanner.

I wonder, though, how hospitals that outsource to regional or international vendors manage the services that require an on-site radiologist -- fluoro, ultrasound, and other radiologic procedures.   Some could be performed by IR, but a lot of smaller hospitals don't have full-fledged IR services.   It's a big risk, I think, for a hospital to completely demolish its local radiology capacity.


Vijay said...

I agree with the economy of scale explanation. What I meant was that defensive medicine is at the root of the problem.
Though my language sounded disparaging, I did not mean to poke at the way doctors practice in the US. That'd be fishing way out of my waters ;)
"I often have a dictated report on the chart before the patient is physically back from the scanner."
That's the kind of efficiency that I dream about, or rather my manager dreams about, but it isn't likely to happen with the current manpower (radiologist =1).

Anonymous said...

I'm a member of a very large subspecialized radiology. We offer 24-7 coverage to a large healthcare system including 5 hospitals as well as many group owned imaging centers and other multiphysician imaging centers. Several years ago, there was some debate as to whether we should outsource our overnight reads. This was quickly quashed as most of the younger members were well aware and concerned about commoditization of radiology.

I don't mean to disparage "nighthawks", but during our analysis of their services, their miss rate was quite a bit higher than ours. These "nighthawks" are simply reading too quickly. We felt our referrers would not tolerate their suboptimal interpretations and would ultimately hurt our credibility. Currently we offer nearly 100% subspecialized interpretations and approach the level of service of Shadowfax's radiologists where our final reads routinely approach 5-15 minutes for ER and stat studies. We have also built a strong rapport with referrers and administrators alike which is vital in today's day and age of commoditization.

Outsourcing radiology is often not for quality issues, rather fiscal choices. Smaller groups have unfortunately let the wolf into the henhouse by outsourcing their overnight and weekend studies. We have made a commitment not to do that.

Ultimately, I do believe that radiology will continue subspecialized interpretations as that is quickly approaching community standard of care, particularly in larger markets. Our group (due to our large size and commitment to subspecialization) is poised to meet this new paradigm. The day of the small general group may be numbered.