Hospitals never close, but that doesn't mean someone from every specialty is always on call. A growing number of facilities aren't scheduling radiologists for overnight and weekend shifts, and others no longer have them on staff. Instead, they rely on teleradiology companies to fulfill their imaging needs.
Also known as nighthawking, teleradiology steadily has grown in popularity in recent years. A 2009 study by VHA Inc., a nationwide network of community-owned health systems, reported 56 percent of U.S. hospitals use it. Many hail the service for its convenience and instant subspecialty coverage.
"Teleradiology is essential for small, rural practices that want to deliver high-end care, but don't have enough volume to offer fellowships for subspecialty providers or that can't afford to hire more staff to cover nights," says William Bradley Jr., M.D., University of California–San Diego's radiology chair. "Diagnosis quality also goes up because radiologists' reading scans are already awake and alert. Someone who's been awakened in the middle of the night is likely to miss finer details."
Contracting with a teleradiology company also can help hospitals attract and retain talented radiologists, says Michael Modic, M.D., chairman of the Cleveland Clinic's Neurological Institute. "Some radiologists are willing to forgo the additional reimbursement—sometimes as much as 10 to 15 percent of business—if they can avoid the night shift," Modic says. "They want more work-life balance, and hospitals use teleradiology to retain them."
But not everyone agrees teleradiology is financially sound or safe. Relinquishing additional reimbursement could have long-lasting effects, says David Levin, M.D., chairman emeritus of the department of radiology at Jefferson Medical College of Thomas Jefferson University. Having outside companies read scans could cause a permanent dip.
"It's possible that reimbursement could start to drop because teleradiology companies bill less for reading scans," he says. "If they're billing $40 for reading an MRI, but hospitals bill $80, insurance companies will start wondering why they're reimbursing at higher levels."
Hospitals without in-house radiologists also lose an advantage when shopping for new imaging equipment, Levin says. Knowledgeable in-house radiologists can be intermediaries who negotiate with vendors for significant cost concessions on updated imaging equipment.
Levin disagrees that teleradiology improves diagnosis quality. Teleradiologists not only lack access to all patient records with potentially pertinent information that could alter a diagnosis, but neither can they consult with other providers if they have questions.