Leveraging PACS for Growth

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When Rob Smith walked into a rural Kentucky emergency department on a Saturday afternoon in the summer of 2011, he knew nothing of the distributed-reading contract put in place just a week before. This fortuitous timing led to prompt care for his aching wrist—a direct result of services from Radiology Imaging Consultants, Harvey, Illinois.

Without Radiology Imaging Consultants’ help, Smith’s plain-film wrist radiograph would have languished on the PACS virtual shelf until Monday morning. As part of the hospital’s new workflow, Jay A. Bronner, MD, MBA, saw the image on his monitor in Chicago while the patient was in the emergency department, and he recognized a dislocation of the carpal bones.

Bronner, a 26-year veteran radiologist and CEO of Radiology Imaging Consultants for the past decade, heads Radiology Imaging Consultants’ group practice of 75 associates and partners. He called the emergency-department physician to discuss the case just 10 minutes after receiving the image. The emergency-department physician was extremely skilled, but the patient’s injury was not an easy one to catch.

“I told the emergency-department attending physician that I thought it was a perilunate dislocation—a type of injury that required immediate care,” Bronner says. “It’s much better if this type of injury is reduced in short order, as opposed to waiting days to fix it. The physician and patient were pleased, and the patient was sent, that afternoon, to a university facility, where he saw an orthopedist.”

At first glance, the emergency-department wrist radiograph contained little drama, but another pair of eyes uncovered another layer of the mystery. “Nothing about that emergency physician was deficient in any way, but perilunate dislocation is not something you see very often,” Bronner says. “I had not seen it in five years.”

Bronner’s analysis from afar is one benefit of distributed reading, particularly when it comes to faster turnaround times and better access to care in rural areas. Spreading its reach from the southern suburbs of Chicago, Radiology Imaging Consultants now serves 16 hospitals in a region that includes Illinois, Kentucky, and Indiana.

Radiology Imaging Consultants is part of a growing cadre of group practices that are able to distribute in-person talent from headquarters to various points. Advanced Radiology Services, Grand Rapids, Michigan, boasts what might be the largest physician-owned distributed-reading group practice in the country, with 120 radiologists fanning out to many hospitals.

Advanced Radiology Services does not own competing imaging centers, choosing instead to plant its flag at host facilities—an arrangement that pleases all parties. Steven Waslawski, MD, president of the group’s Grand Rapids division (one of four divisions), relies on a solid PACS, but is keen never to lose sight of the personal touch. “We are not a virtual service where there is a lack of physical presence and boots on the ground,” Waslawski, a 21-year radiology practitioner, explains. “We forge partnerships, and we don’t want to compete on a virtual playing field. We feel we can deliver greater value by maintaining and strengthening our on-site presence.”

Effective engagement with medical leaders, as well as the performance of common interventional procedures, requires on-site radiologists. Despite all manner of technology, many hospitals are loath to give up that vital communication and expertise.

If referring physicians doing business with Medford Radiological Group in Oregon have any trouble maintaining that personal connection with radiologists, a call center fosters crucial communication. Roseanne McLaren, CEO of Medford Radiological Group, says, “Physicians are put through to wherever the radiologist is working, and it’s a convenient way to access our physicians. This is a way to connect referring providers to radiologists, if the radiologists are not available in the hospital to speak in person. The central call center is open from 8 am to midnight, Monday through Friday, and physicians can call directly to get a radiologist. We extended the hours because providers liked the service.”

Justifying a PACS

There will always be small facilities where critical volume makes it difficult to justify a 24/7 on-site presence. In these cases, coverage five days a week—or even one day a week, for small facilities—might be appropriate.

When radiologists can’t be on-site, an excellent Web-based PACS that