Demands of volume coverage drive use of teleradiology

Joe and Jane Radiologist seem reasonably happy. Volumes at their practice are way up. Reading an average of 15,000 to 20,000 studies per year, they occasionally feel overworked, but they manage by putting in longer hours. They do wish they had a little more help.

Their practice, with the aid of teleradiology, provides 24-hour coverage. Profits remain strong, but Joe and Jane worry about reimbursement pressures and the need for systems upgrades to meet the demands of the digital age. Still, they consider their working lives good. Asked if they would retire tomorrow if they could, they may hesitate just a moment, but eventually they answer no.

If this sounds like you, don't be surprised. Joe and Jane Radiologist are composites of what The Radlinx Group and U.S. Radiology Partners found in a 48-state survey of 2,000 radiologists, conducted between November and December 2003. The survey garnered a response rate of 13.8%.

Beyond the numbers, rising volumes and the increasing use of teleradiology seem to define a pivotal moment. A labor shortage in the face of increasing demand for imaging is forcing radiologists to reassess needs, resources, and even policies.

The increasing volume of imaging studies was among the survey's top findings. Of those responding, 83% said their imaging volumes increased in the last year. In addition, 89% said their practice provides 24-hour coverage, a noticeable increase from 71% in 2002.

"The good news is there's plenty of work for everybody. But it's gone to such an extent that it has become a problem," said Mark Bakken, president of The Radlinx Group and U.S. Radiology Partners.

Reasons vary, but the bottom line is that imaging volumes continue to expand.

"First, we have known for years that older patients require more imaging services. Second, the march of technology has provided many new modalities and expanded applications. Finally, much of what we do as radiologists offers a less invasive and usually less expensive alternative to competing options," said Dr. Lawrence Muroff, president and CEO of Imaging Consultants and an expert in radiology practice issues.

But the increasing number of imaging studies is putting a strain on resources, mostly on the human side. According to the survey, 57% of the radiologists responding said their groups are overburdened, due to both the increasing volume of work and understaffing. Forty-seven percent said they are compensating by working longer hours; 46% said they are recruiting more radiologists.

"Rising volumes have compromised the quality of life for our radiologists," said Fred Gaschen, executive vice president of Radiological Associates of Sacramento, CA.

Every RAS physician had to give up several weeks of vacation this year to cover the increased work load, he said. As a result, RAS plans to hire nine additional radiologists.

Forty-six percent of survey respondents said their revenues increased, down slightly from the 48% who gave the same answer in a 2002 survey conducted by the same companies. Twenty-eight per cent said their revenues decreased, up from 23% in the 2002 survey, and 61% said dealing with declining reimbursement is a top priority in the months ahead.

Most radiology groups are making efforts to become more efficient. Of the survey respondents, 54% said upgrading or transitioning to digital imaging was a top priority. Hiring more staff was right behind, at 52%.

TELERADIOLOGY BOOM

One of the survey's most striking findings is that teleradiology has become a dominant feature of modern radiology practice. Of the radiologists who participated in the poll, 87% indicated that they use offsite readers, compared with 70% in 2002. Most teleradiology use, however, appears to be in-house, as 68% said they do not use a nighthawk service.

"I am surprised the (teleradiology) number is not 100%," said Dr. Michael Maresca, president and founder of St. Lawrence Radiology, a nighthawk service based in Potsdam, NY. "I don't know why any group would not be using teleradiology unless they are afraid of technology. Once people start doing it, they realize how convenient and cost-effective it is."

Sending a study to an offsite location in the U.S. is one thing; sending it to another country, such as Australia or India, is another. Sixty-four percent of the radiologists in the survey said they do not approve of sending studies overseas for interpretation.

Maresca's group does send studies overseas, specifically to India. But before any studies are transmitted, the practice reviews credentialing requirements from the hospitals it serves and makes sure the doctors reading the studies are U.S.-trained and licensed. These specialists are carefully overseen, and a quality assurance file is kept for each of them, he said.

"We are only seeing the tip of it. We have too much in our hands now, and that's why people are trying to take imaging from us," Maresca said.

Despite these challenges, radiologists do not seem strongly motivated to leave their practices. Asked if they would retire tomorrow if they could, 50% said no, 39% said yes, and the remaining 11% were unsure.

Editor's note: Additional statistics from the survey are available at www.radlinxgroup