Case Study: White Nights

Teleradiology providers can save time, money

In these economic times, healthcare providers are looking for ways to save money and increase efficiency. Teleradiology service providers provide crucial off-hours and overflow coverage, fill staffing gaps, and increase access to subspecialties, yet these services are not necessarily viewed as a cost savings – in fact, they are often viewed as an extra cost. There are ways, however, to optimize the relationship with your provider that will improve your practice’s bottom line and still allow you to enjoy the benefits of outsourcing.

In the current job market, radiologist retention is challenging without the use of an overnight service. Since 2002, Florida Radiology Consultants (FRC), in Fort Myers, Fla., has used a teleradiology provider for after-hour services. The availability of the provider has improved our round-the-clock staffing and, as a result, we have not had to hire any extra staff.

With our 17 radiologists, FRC operates two outpatient facilities and supports three hospitals, one of which is a level II trauma center. Our hospitals are staffed 8 a.m. to 11 p.m., but we have round-the-clock demands. Each morning, there are new cases that require our radiologists’ attention, and in the past, we also have had to over-read the preliminary reports generated by our teleradiology provider.

High Volume Requires Exceptional Productivity

As a high-volume practice reading 425,000 reports per year, we decided to take a close look at the time it was taking to over-read a preliminary interpretation. We discovered that it took our radiologists more time to over-read someone else’s preliminary interpretation than it generally requires us to interpret a study. On average, we over-read at a rate of eight per hour, versus 11 per hour for new studies.

As a result of the analysis, we found that we spent on average 26 hours per week reviewing and dictating final reports. That amounts to approximately 50 percent of a radiologist’s workweek, which could be utilized reading new patient studies.

It became clear that using our teleradiology provider to read our overnight cases as finals made the best sense for our business and radiologists.

In order to make the switch, it was imperative that we felt comfortable with the quality of reports and level of service provided by the teleradiology provider we chose. We were happy with our provider’s overnight preliminary reads, confident in the overall quality they delivered, and trusted them to provide thorough and accurate final reads.

Extension of the Practice

We consider our teleradiology provider, Virtual Radiologic in Minneapolis, to be an extension of our practice. They keep our cases moving and enable us to be as productive as possible when we walk in the door every morning. This productivity gain has led to an increase in studies being read by our radiologists every week.

We are now not only operating more efficiently, but also are serving our patients and community more effectively. We recognize that people depend on us to respond as rapidly, consistently, and accurately as possible – day and night. Without Virtual Radiologic, we would not be able to uphold this responsibility.

Preliminary interpretations can be provided from anywhere in the world because no one is submitting a bill to be paid to either a private or government insurer. Final reads, however, are
reimbursable. Under current rules, radiologists who provide final reads for Medicare and Medicaid patients must be physically located within the United States.

Understanding teleradiology billing rules for outsourced final interpretations can be challenging. Exception criteria and varying billing rules by state and/or payer help fuel confusion about how to properly bill for these services. The teleradiology providers that have invested time and effort to understand these rules can provide considerable help to you in navigating the complex billing hurdles. 

Beyond the added time it takes to over-read a preliminary interpretation, the radiologist also holds the ultimate accountability for the report. Having finals read by a quality teleradiology partner eliminates that risk. We made sure that Virtual Radiologic’s radiologists were all American-trained and board-certified and that they upheld the same rigorous medical standards that we do. We are completely confident in the quality of every report and with their 24/7/365 operations center, and we rest easy knowing that immediate support is just a phone call away.

Virtual Radiologic takes responsibility for the final interpretation and, ultimately, the liability of the read.

Questions to Consider

As you determine whether to outsource your off-hour and overflow cases, ask yourself the following questions:



The Real Deciding Factor: Price Differential

If you are considering teleradiology for a portion of your finals, consider the price differential between the cost of a preliminary interpretation and hours gained by avoiding over-reading a report. Decide what you could be doing with that time in the morning – for example, when you do not have to review the preliminary reports from the night before. Like us, it most likely takes any practice longer to turn a preliminary read into a final report than it takes to read a new study. 

By switching to finals, we have reallocated an estimated 26 hours per week from over-reading our teleradiology provider’s preliminary reports to reading 286 additional studies for new patients. This translates into real dollars for FRC’s bottom line.
 
Overnight teleradiology for finals may not be justifiable for every practice. However, if a radiologist on staff does not have the extra capacity to over-read reports, then a finals interpretation program may be the best option. If your practice is like ours and has a constant stream of work, having finals read overnight will ensure that your radiologists are maximizing their billable time and working as cost effectively as possible.


— Thomas Presbrey, MD, is a board-certified member of Florida Radiology Consultants PA, in Fort Myers, Fla. Direct questions and comments to editorial@rt-image.com.