Radiology needs to be cautious as teleradiology business expands

Not too long ago, the only way to really squeeze a hospital-based radiology group was to threaten to throw it out and hire another local radiology group. Understandably, that didn't happen often.

That option still exists, but it's been joined by another option made available courtesy of the digital transformation of radiology-farming out work to outside groups via teleradiology.

So far, there are no indications that this is happening in any big way. Teleradiologists we interviewed for this month's cover story insist they are working only through established radiology practices or in concert with them to supply services that wouldn't otherwise be available.

But you don't have to look too hard to see how teleradiology adds a new set of factors that will put pressure on the local character of radiology practice.

Leading that list is the entry of investment capital into the financing of teleradiology practices. We've cautioned before in this space about the difference between business and medical ethics, that is, the need for profits versus the needs of patients and referring clinicians. Some will have no trouble reconciling these competing sets of values, but others, inevitably, will.

A related concern is the pressure on prices that teleradiology brings to the marketplace, particularly as the night-reading companies expand into the day-reading field. For now, it appears that service and quality remain the dominant means of competition among teleradiology firms, but some big outside forces are at play here. As the government and private insurers rachet down payments, imaging centers and hospitals may be forced to shop prices more aggressively. The widespread availability of teleradiology options makes price competition much more feasible.

Besides allowing the aggregation of night reads, teleradiology is also making possible the aggregation of specialty radiology services, either as a dedicated style of practice or as an adjunct to night-reading services. All radiologists recognize the importance and value of continuous exposure to particular modalities and pathologies. To the extent that a particular modality or pathology is sent off to specialty practices via teleradiology, opportunities for a practice to develop broader expertise can become limited. The tendency to specialize is well established in all of medicine, but teleradiology will accelerate this process in imaging practice.

Finally, when you begin to sever the link between local radiologists and some segment of the interpretation business, whether it be via night, day, or subspecialty reads, you create some new internal stresses. Hospital and radiology administrators may wonder why they should pay for both a preliminary night and a final day read. Referring clinicians may wonder why they need a local radiologist when the teleradiologist seems to be just as good or better and, perhaps, cheaper.

Of course, teleradiology has brought advantages to the practice of radiology that extend far beyond a more efficient and humane answer to the dreaded night call. Rural areas, in particular, have benefited from better access to image interpretations. In some instances, the ability to supplement local resources with outside night or day reads via teleradiology has allowed local radiology practices to keep hospital or imaging center contracts they might otherwise have had to let go. Wider access to subspecialty interpretations will probably improve the quality of specialty care.

But these gains are not without their costs. It's clear that the scope and economic significance of teleradiology have reached a point where it could begin to have significant impacts on practice. Teleradiologists and their facility-based counterparts need to consider these impacts and proceed carefully to assure that the growth of teleradiology does not undermine the quality of patient care or the strength of local radiology practice.