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  • Hospitals' Ties Increasingly Risky for Radiology Groups

    February 01, 2011

    It was one of the most enduring partnerships in radiology—for more than 80 years, Radiological Associates of Sacramento (RAS) provided radiology services to Sutter Health, a large network of hospitals and physicians in northern California.

    But the partnership ended abruptly on April 1, 2010, when Sutter officials chose to let their contract with RAS expire. Despite a unanimous vote of confidence from the medical staff at Sutter Roseville Medical Center, RAS was replaced by the hospital's newly formed radiology group along with a teleradiology firm hired to pick up the slack.

    "This was an issue of control," said Fred Gaschen, M.B.A., executive vice-president of RAS. "The physicians were very happy with our work, but the administration was trying to tell us how to staff a clinic. Eventually, they got tired of negotiating with us."

    The decision was based not on control but on improved integration of medical care, according to Patrick D. Browning, M.D., chief of the division of medical imaging for the Sutter Medical Group.

    "RAS and Sutter had different PACS, and transferring images either way could be very problematic," said Dr. Browning, who was not involved in Sutter's decision to end its contract with RAS. "I don't feel controlled at all by Sutter. The idea here is to take imaging into the next millennium by integrating care for patients."

    The breakup is just one notable example of the changing dynamic between community-based radiology groups and hospitals. Other groups, including Florida Radiology Associates and Consulting Radiologists Corporation, have also seen longstanding relationships come to an end as hospitals opt to form their own radiology groups and/or contract with teleradiology companies.

    "Radiologists don't have the same security and stability that they had in the past," said Cynthia S. Sherry, M.D., chair of the Radiology Department at Presbyterian Hospital in Dallas, who also served on the American College of Radiology's (ACR) Task Force on Relationships Between Radiology Groups and Hospitals and Other Healthcare Organizations. "Some radiology groups are finding out the hard way that it's easier than ever before for a hospital to replace them." 

    Teleradiology "Snuck in the Back Door"

    Community-based radiology groups sprang up within a decade of the 1895 discovery of X-rays and became fixtures in hospitals across the U.S. and Canada during the 20th century.

    The new millennium ushered in a teleradiology boom that, along with increased imaging volume and lower reimbursements, dramatically changed the practice of radiology. In 2001, Nighthawk Radiology began offering teleradiology services from Australia to cover night shifts at U.S. facilities. New companies like Radisphere and Imaging Advantage added onsite radiologists to their teleradiology services, and hospitals began taking them up on their offers of lower costs and around-the-clock access to subspecialists.

    "At times, radiologists were their own worst enemies," said Steven R. Renard, president and CEO of Diagnostic Radiology and Oncology Services, a consulting firm based in Roseville, Calif. "When older members of the group didn't want to handle night calls or emergency room cases, teleradiology snuck in the back door. Some hospitals liked the change. Fast-forward five to 10 years later and you see hospitals looking at teleradiology as a way to pare down expenses." 

    Proactivity Equals Protection

    This trend has hardly gone unnoticed among leaders in the radiology community. Based on her work with the ACR task force, Dr. Sherry recommends that radiology groups be proactive in order to protect their position in the hospital. (See sidebar)

    "The most important thing we must do is increase our understanding of the situation," she said. "Radiology education poorly equips radiologists to run a practice. We need more leadership training to interact with hospitals and administrators and weave ourselves into the social and political environments of a hospital."

    This process will require a concerted effort from radiologists who have a tendency to spend their workdays reading reports and interpreting images in their offices, according to Dr. Sherry.

    "Radiologists do a good job of spreading work out evenly within their groups, but they need to make time to allow group members to go to meetings, be on medical staff committees and just mingle and build rapport with the other hospital staff," she advised.

    Besides making an effort to interact, Dr. Sherry said that radiology groups should strive to improve their level of service wherever possible, including report turnaround time and the number of hours onsite in a department.

    Renard suggests that radiology groups make themselves more indispensable by ending their contracts with teleradiology groups and enabling their own teleradiology capabilities. He also recommends that groups make exclusive arrangements with hospitals for night calls and generate extra money for the hospital through outpatient services and women's imaging.

    "Radiology groups are going to have to think outside the box," he said. "The ones that have been successful acknowledge that they are a commodity and can be sold down the river at any time. They have to constantly prove themselves. The days of sitting back and letting hospitals develop ideas are over." 

    Personal Interaction Still Unbeatable

    While there are anecdotal reports of substandard care from radiology services companies, the long-term effects on patient care remain to be seen. But as Dr. Sherry points out, teleradiology services and locum tenens radiologists are no substitute for the interaction between radiologists and referring physicians for the benefit of patients in a hospital setting.

    "Say a person shows up at the hospital with right lower quadrant pain and we need to know if this is appendicitis or not, or if it's a perforation or an abscess," she said. "In this situation, it is really valuable when the surgeon can talk with the radiologist he or she is used to working with and has confidence in."

    Patient care, along with all the other services onsite radiologists provide—from tailoring exams for specific patients to providing input on expensive equipment purchases—make Dr. Sherry and others in the field confident that reports on the demise of community-based radiology groups are greatly exaggerated.

    "I'm an optimist and I think the pendulum is swinging back toward radiology groups," she said. "Radiologists have gotten wiser and are improving the level of service they provide and hospitals have a growing appreciation of the value added by radiologists."

    Learn More

    The American College of Radiology's (ACR) Task Force on Relationships between Radiology Groups and Hospitals and Other Healthcare Organizations has proposed several steps that can help improve relationships between radiologists and the healthcare systems they service. Among the initiatives radiologists should consider:

    • Being responsive to the legitimate service needs of referring physicians and their patients.
    • Striving to see hospitals' perspectives and to deeply understand the needs of hospitals and clinicians.
    • Integrating themselves into the medical, political and social structures of their hospitals and communities

    To read an abstract of the article by Cynthia S. Sherry, M.D., and colleagues, in the June issue of the Journal of the American College of Radiology, click here.

    Cynthia S. Sherry, M.D.
    Community-based radiology groups have seen longstanding relationships come to an end as hospitals opt to form their own radiology groups and/or contract with teleradiology companies.
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