The Challenges of Expanding Teleradiology During COVID-19
Segment Description: Dhruv Chopra, chief executive officer of Collaborative Imaging, talks with Whitney Palmer, Diagnostic Imaging senior edtior, about the expanding role of teleradiology during the COVID-19 pandemic, as well as the staffing, financial, and logistical challenges associated with having more radiologists moving into the realm of telehealth.
*Interview transcript modified slightly for readability.*
Diagnostic Imaging: Thank you for joining me today to talk about COVID-19 and the expansion of teleradiology. I appreciate your taking the time to talk with us about this important topic for providers. To jump right in, given that we are talking about this need for expanding teleradiology, with a background of CMS recently relaxing the rules and regulations around telehealth, is this something that you feel like is going to facilitate the expansion of teleradiology in a significant way?
Dhruv Chopra: I think it's kind of interesting, because I was probably the most excited when I saw that. For any groups to get licensed in a different state, it takes forever. We were trying to get physicians licensed in Pennsylvania today, and they require you to go through all sorts of tests, all sorts of exams. It's a very long drawn out process. The same is true in Texas. The issue that I think we're going to run into is just because you have physicians licensed now in different states that doesn't mean they're going to get reimbursed for what they do. Reimbursement is a completely separate phenomenon. So, you have the commercial carriers that are going to say these are out-of-network docs or these docs don't have contracts with us.
And, there's an economic side to it, as well, which means physicians, when they start reading across state lines, they'll be able to do that. But, they're not going to get reimbursed for that from the commercial carriers. Medicare will, of course, reimburse them, but Medicare is one portion of the population, right? You have a lot of patients who are getting sick, who are not Medicare patients, as well. I mean, the majority of them are younger patients who are getting sick, so they're going to have other insurance. So, how do you collect on that? And, while that's not the primary focus by any means, it is something that one needs to be cognizant off because these practices have to exist, as well.
And today, what we're seeing happen right now in radiology is the volumes have just plummeted because elective procedures have been canceled or postponed. So, you have groups that have hundreds of physicians -- 40-to-50 physicians. But, their volume has dropped by about 40 percent to 50 percent. And, the revenue is going to drop by a much greater percentage because the large amount of revenue that they get is from the outpatient setting. And, what's happening is the outpatient setting has just disappeared. So, how are these practices going to exist going forward? It's very real. Even though we shouldn't be thinking about the economic aspect of it right now, it's something that we do have to consider because these practices are having to make tough decisions. Which physicians will they let go of? Will they put older physicians on furlough or let go of the younger physicians? What is the approach?
Physicians are not good businessmen, by nature, they're good doctors. And, they're having to make these business decisions right now. And, so we're trying to help them through that, as well.
Diagnostic Imaging: What guidance or advice can we provide to physicians who are facing these decisions?
Chopra: So, I think the key is we need to identify where we can get the most volume from. All of a sudden, what's happened is you have the same number of doctors, but the volume’s gone down because your outpatient centers are not doing any work anymore. So, how do we get more volume to these doctors? That's where teleradiology can play a big part, right? We have doctors today who specialize in every aspect of radiology. Do we want the doctors with chest sub-specialties reading all the coronavirus cases? Should we create a Center of Excellence where all those cases go to these doctors who have subspecialty in chest CTs and let them read the studies? Do we go and look for opportunities? The Army Corps of Engineers is going to be setting up hospitals all over the place. They're going to need radiology services. Can we get these doctors on the front lines of that, as well, to help them cover those reads. These are cases that were not originally there.
The other thing that's also happening right now in teleradiology is a change in cases because most people are working from home. We're seeing a lot more cases where patients are falling in the house, or they tripping on something or they're getting electrocuted because they're doing some electrical work. Or they cutting their fingers. Those are the kind of cases we're seeing now. I mean, that's the bread and butter, it's completely changed. It's no longer what we used to see. Vehicular accidents are now a rarity, whereas before, there used to be a lot more because people aren’t go out on the road anymore, right? So, it's very interesting, the dynamic has changed. And, I think there's a role for teleradiology over there, as well, that you can have your sub-specialty centers that are just focusing on different areas of medicine, if you will, to deliver the best patient care.
To your point as far as the business side goes, I think we need to just keep physicians aware of all the laws and legislations and bills that have been passed, so that they're also not making decisions that will hurt them in the future. For example, there's a bill now that says that the government will provide two months of payroll relief for small businesses. They don't want the businesses laying off these people. Well, so let's have our radiology groups, let's have our practices, just be aware of what's coming in their direction before they make any hasty decisions. Because once you lose these employees, you're not going to get them back. I mean, that's just the reality, right? It’s not going to sit well, especially with the outpatient setting. So, if you can delay that, and you can absorb some of the hit amongst yourselves, I think that's the right thing to do.
Diagnostic Imaging: Circling back around to the idea of spreading teleradiology more across state lines. What else can be done to facilitate this and to try to make this as sustainable as possible for the long term as we go forward?
Chopra: So, I think one of the concerns that I have right now that's coming up is just the Internet's going break. We're seeing that today. Everybody's pushing telehealth, everybody's pushing teleradiology. But, you have people on Netflix, you have people streaming live video, the Internet's not able to handle that. And, what we're seeing is situations where you can try sending an image from a hospital to a radiologist. They're just not going through because the bandwidth isn't there. It's been drained.
So, I think it's important just to throw that out there as a cautionary tip, if you will. You have to have a backup plan. You have to have boots on the ground somewhere. So, if there is a connection that goes down, your doctors can get in there. Similarly, you have to have backups as far as different Internet connections, right? Let's use different lines. Let's use fiber optics. In some cases, let's use cable in others. In case one gets clogged, you have another solution, as well.
But, teleradiology is growing. It's been growing quite a bit. I think what we can do even without state lines is there's just ample opportunity in the rural hospital setting, as well. A lot of the rural hospitals don't get the care that they need because they are rural hospitals. So, we can focus on providing them with teleradiology solutions within the state itself. We're crossing borders, and I think the key is going to be once you get past the read, how do you deal with the patients? Now all of a sudden, the patient's going to get a bill from a group in Texas, and they're in Florida. They're going to be like, “I never went to Florida,” and you have to explain that to the patient. It's going to create another set of concerns from the patients. They're going be like, “Have I been a victim of fraud, has someone stolen my identity? I was never there.”
They don't understand teleradiology. They don't understand the radiologist might not be there. In many cases, they don't even understand they're having a radiology procedure that's going to require a radiologist to interpret this study. All they know is they're getting an X-ray done. And, guess what, they paid for that X-ray when they went into the center, or they went into the hospital. Now, all of a sudden, they're getting your bill, and they're like, “Why am I getting this bill?” But, now they're going to get a bill from a completely different state. And, they're going to be like, “Why?” So, there's going to be an educational curve that needs to be handled with that, as well.
But, I think we need to also lessen the burden on the physicians as far as credentialing goes. So, today, to credential in a hospital, it's a process. The hospitals don't have these resources. Just sitting around doing nothing, they have the medical executive staff, if you will, the medical record staff that's doing all the credentialing. You only have a few people doing that. And, now all of a sudden, my group is going to come in, and we have 100 radiologists. I'm going to say, “Credential these hundred radiologists.” And, they're going to say there’s no way they can credential them. How am I supposed to credential? So, there’s much more to it. It sounds great that CMS is relaxing these state guidelines and state laws, but they haven't really thought it through all the way. And, then, on top of that you have the reimbursement changes and considerations coming, as well, for the radiologist. That's a big whammy, as well.
So, there's just a lot that one needs to think about on this side of the equation. And, while teleradiology is a solution, one has to look at the economic side of it, as well. Of course, we need to deliver the care, and our doctors will gladly be on the front line, regardless of the economy, regardless of the economics. However, at the end of the day for a long-term solution, you have to make sure that you know they can actually survive.