Starting evening shift later helps control teleradiology costs

Until we broke down the numbers, we didn’t realize that our practice’s overnight call coverage cost had increased by 200% in just three years. We had to take a close look at the root causes before we could agree on the solution.

The first suggestion was to attempt to decrease utilization by reeducating our referring ER physicians. However, we quickly realized that decreasing referrals would be problematic for several reasons: it might injure our relationship with the hospital’s administration, it would reduce referrals, it was unlikely to succeed because the general trend in emergency medicine, and among the newer generation of ER physicians, is to make heavy use of imaging for triage.

The next solution we considered was to cover our own call. Most of our practice’s radiologists felt that this solution would take too high a toll on the lifestyle they valued. It also would have meant fewer of us here during the daytime.

With no realistic countermeasures in sight, we decided to take a closer look at the problem to see what was causing it. First, we asked if we were getting a competitive rate from our overnight teleradiology company. It turned out we had not renegotiated our contract with them in two years. By leveraging the ultracompetitiveness of the teleradiology world, we were able to reduce our per-exam cost by 20%. Next, we asked when our highest overnight volume was occurring and found that a massive amount (50%) was between 11 p.m. and 1 a.m., the first two hours after we turn over call to our teleradiology service.

We then had to think creatively and flexibly. We could create a work rotation that extended until 1 a.m.; that evening’s radiologist could still work the next day but on a shorter shift. We also considered scheduling our late coverage rotation to start later and continue to 1 a.m. Although some members of the group protested that this second option might reduce the daytime workforce, we decided we could reduce some of the pressure on the daytime radiologists by leaving the routine, nonurgent studies from the day for the late person to read. Those two steps, starting the evening shift a little later and handing off nonurgent studies to that physician, has alleviated daytime stress for everyone and reduced evening and overnight costs.

Next, we asked if any members of the group wanted to work nights. Just because not everyone works an occasional night shift doesn't mean some couldn't. Fortunately, we found that enough of our radiologists agreed to take a later shift now and then that we could cut back the number of days per month we needed to use the teleradiology service.

This option doesn’t cut a huge amount of the costs, but at least it keeps the money in the family, and our own group members can be the ones reading nonemergent overnight or daytime studies, not an expensive contracted service. If this system doesn’t prove workable, we can still hire a radiologist so that the overnight (or at least part of it) is covered internally and more affordably.


Dr. Woodcock is medical director for MRI at St. Joseph's Hospital in Atlanta. He is also a member of executive board of Atlanta Radiology Consultants and is the practice’s executive officer for finance. He may be reached at rjwatlrad@gmail.com.