When a Hospital Replaces a Private Practice—With a Teleradiology Company

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When hospital executives express dissatisfaction with professional radiology services, local radiology practices should put on their nimble-response shoes and communicate. If they don’t, national teleradiology companies will, and the experience at Stamford Hospital in Connecticut is a case in point. Today’s cost-oriented, results-focused health-care environment is forcing hospitals to rethink how they operate, and no relationship in the care continuum is immune from scrutiny. When a local radiology practice lost a decades-long contract with a midsized community hospital, the hospital issued a request for proposal (RFP); ultimately, it entered into an agreement with a national teleradiology company. Sharon C. Kiely, MD, MPM, CMO of Stamford Hospital, presented her hospital’s reasoning in “Nationwide Radiology: Coming to Your City Soon,” presented at the RBMA’s 2013 Radiology Summit in Colorado Springs, Colorado, on May 22. The session was moderated by Joseph White, CPA, MBA, CMPE, of CliftonLarsonAllen. The key factor in replacing the radiology practice was aligning with a communicative partner, Kiely says. More specifically, what sealed the deal with the new provider was its willingness to specify report-turnaround times and stand behind them. Kiely explains that Stamford Hospital was in a financial turnaround mode when she joined the organization in 2012. Located in an affluent (but highly competitive) market, Stamford Hospital had broken ground on a new hospital facility that would double its bed size, double the capacity of its emergency department, and more than double the number of its operating rooms. A campaign to recruit world-class physicians was also underway, and Kiely and her colleagues were concerned that the radiology department would not meet the challenge when the hospital opened in 2016. A Familiar Story The litany of complaints might sound familiar. Emergency-department physicians were not happy with turnaround times on stat exams; some types of exams had as much as a seven-day wait; and the hospital wanted tighter alignment with the practice on outpatient facilities. “We needed to look under the hood,” Kiely says. “We didn’t take anything we were told at face value. We looked at statistics and at benchmarks, we did our research, and we asked a lot of questions.” Every medical-staff leader was invited to be part of the evaluation committee, but only two people came forward to participate actively. “Chairs of various services all were in agreement that they couldn’t figure out why the radiology practice was performing so badly,” she says. The evaluation team tried to work with the practice to improve service, suggesting new performance models that included setting standards for turnaround times, call coverage, use of speech-recognition software, and ongoing peer review—and measuring results. Junior radiologists in the practice seemed more interested than senior members, Kiely notes, but nobody felt comfortable critiquing other radiologists’ reports and interpretations. With the assistance of CliftonLarsonAllen, an RFP was developed. It was heavily weighted in the favor of radiology practices in the region, but the RFP was also sent to several national teleradiology groups, Kiely explains. The Winner The finalists included two teleradiology groups, and one of them won the contract. The implementation started in October 2012, with all services provided by the teleradiology company except breast-imaging interpretation. A separate contract was awarded to local employed radiologists. “We wanted to develop a sound, flexible relationship with a group that would communicate and work through problems with the hospital as a partner, not an adversary,” Kiely explains. Kiely reports that the transition has not been 100% smooth, but hospital physicians are happy with turnaround times of less than 20 minutes for stat exams and four hours for all other exams. The on-site radiologists participate in tumor boards and administrative meetings, and they are active in the teaching program. Teleradiology exams—about 20% of the total—are provided in final form, eliminating workload pressure that previously existed when next-day overreading of preliminary reports was the norm. Problems are being worked out, and hospital leaders are happy with their decision, Kiely says. White advises radiology practices not to underestimate the quality of services available from (and the savvy marketing of those services by) national