How to Cope with Limited Resources in Rural Practices

February 18, 2019
Whitney J. Palmer

It can be easy to feel small in the middle of big healthcare problems when you lack resources. Here's how rural practices are coping with shortages.

When most patients think of high-quality medical care, their thoughts frequently turn to hospitals located in large urban areas. But, in reality, a significant portion of patients still receive their healthcare in rural-sometimes remote-environments. This includes any diagnostic imaging they might need.

It’s no secret, though, that rural practices frequently lack the same access to funds and other resources that their more urban counterparts enjoy. So, what does this mean for you if you’re a diagnostic radiologist in small town America?

Even though your practice or associated hospitals might be smaller and your operating budget might be tighter, there are still strategies you can implement and decisions you can make to maximize the resources that are at your disposal. And, it’s critical for your area patients that you succeed.

“The key issue to understand is that there is still a lot of value in having the radiologist as part of the medical community in the smaller communities across the country,” says Lawrence Liebscher, MD, radiologist with Cedar Valley Medical Specialists in Iowa. “They’re all different and have their own challenges, but there’s an understanding that people, hospitals, and practices are very valuable. And, there’s a need for that.”

The state of rural healthcare

According to the American Hospital Association, there are currently 6,210 hospitals serving patients nationwide. Of that, 5,262 are community hospitals, and only 1,875 hospitals operate in rural locations.

That number is shrinking. Since 2010, nearly 90 rural hospitals have shuttered their doors, eliminating the access that thousands of patients have to imaging services needed for quality medical care.

Consequently, safeguarding your abilities to offer the widest variety of imaging services you can is vital.

Hire the right radiologists

Although the trend in radiology today continues to swing toward greater sub-specialization, that’s not what rural radiology needs, says Liebscher, former chair of the American College of Radiology (ACR) Commission on General, Small, and/or Rural Practice. Smaller markets can’t generate the volume needed to support hiring an on-the-ground neuroradiologist or musculoskeletal radiologist. Instead, bring more general radiologists on board.

Related article: Questions To Ask Potential Radiology Hires

“The biggest issue for rural groups right now is having radiologists with a broad enough skill set so that when they’re out in the community in clinics, they can handle the breadth of exams that need to be done,” he says. “The individual volume of exams might be manageable, but they could be called to go from reading a lumbar myelogram to a breast biopsy to an obstetric ultrasound.”

Rural practices that are most successful still require their providers to spend a substantial amount of their practice time devoted to general radiology, he says.

Manage your FTEs

Teleradiology has been an exceptional tool that helps you provide reads to a large number of clients. But, you can also maximize your manpower by determining how much FTE time the facilities you partner with can support, says Gary Dent, MD, chief medical officer of cloud-based radiology services company Radius and founder of South Georgia Radiology Associates.

“If you’re able and willing, leverage a fraction of FTEs,” he says. “If you’re covering a hospital that produces enough volume for 1.25 FTEs, and you’re the only one reading, you’re going to get burned out.”

Instead, he says, devise a system to share the workload so everyone in your practice works together and reads more efficiently.

Create a solid workflow

In many ways, maximizing your resources means streamlining your operations, says Ken Symington, MD, a recently-retired interventional radiologist with Inland Imaging in Spokane, Washington.

First, he says, analyze your strengths and weaknesses. These will vary from site to site. If necessary, collaborate with a larger practice to see where you could make the most significant improvements.

Second, create customized protocols for all your imaging services. If you are partnering with a larger group or facility, make sure your protocols align. This can help reduce the need to repeat exams as you work toward a diagnosis.

“After a study has been completed and anonymized, you shouldn’t be able to tell if it were completed at an urban or rural center,” he says. “The quality should be virtually the same.”

Take advantage of mobile rural programs

Depending on your location, you could take advantage of mobile radiology programs operated by larger practices or academic medical centers. In many cases, they can bring life-saving services to your patients without your having to absorb the full cost.

The University of Virginia School of Medicine launched a mobile mammography van 20 years ago to meet rural needs, says Jennifer Harvey, MD, head of breast imaging. Providers visit rural clinics in the Appalachia and tobacco regions one week a month. They partner with local health departments to find patients who need a mammogram, and they read the studies before the van leaves the area. Last year alone, she says, the mobile van completed approximately 1,600 studies.

“Mammograms are like getting your teeth cleaned. Most people want to do it, but sometimes it’s not so easy to do,” she says. “But, if you go to them-take the service to them-more women are more likely to get screened and get any follow-up services they might need.”

Apply for funding

Alongside staying current with all the reimbursement changes to secure your highest level of payments possible, there are other options that can help you afford more updated equipment or launch screening programs, Dent says.

“If you can’t afford equipment, you can’t afford equipment,” he says. “In these instances, consider seeking out grants.”

In addition to county grants, such as one Dent received from Macon County, Georgia, for a CT program, practices can also find funding opportunities in national organizations. For example, the Helmsley Charitable Trust Rural Healthcare Program Radiology Equipment Initiative offers grants for practices in the MidWest, and the Rural Health Information Hub provides a list of grant opportunities for various states.

ACR Engage

As rural practices, you often find yourself in the unique position of encountering uncommon challenges, Liebscher says. To help you overcome these hurdles, the ACR developed the Engage forum. This initiative gives you access to input and information from 37,000 peers who share your interests and obstacles.

“Only a handful of people are really ever in your situation as a rural radiologist. Through this forum, you’re able to pose questions or voice concerns to more than 30,000 providers across the United States,” he says. “You can ask how they confront the same problems, learn how they handled it, and gather suggestions for the future.”

Through Engage, you can browse discussions, search a resource library, peruse presentations, and read articles relevant to your situation.

Related article: The State of Teleradiology

Ultimately, Dent says, even in rural environments, radiologists are doctors’ doctors. Not only does your skill set support your referring physicians, but it also ensures your patients will receive the highest level of care possible.

Harvey agrees, saying the success and health of rural radiology practices is critical to overall healthcare delivery.

“So much of medicine these days relies on imaging for diagnosis and to assess how a patient is doing, how they’re responding to treatment, or if an issue has been resolved,” she says. “Without that, it’s not modern medicine. So having imaging available in a rural population is really important.”

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