Technology, HR issues crop up when hospital shifts radiology services

When hospitals transition from a contract with an independent radiology practice to an in-house model or a multispecialty group, they can expect some growing pains in the form of technological issues and human resources quandaries, as well as general headaches while trying to get the new practice up to speed.

A recent example of the move is Sutter Health in Sacramento. On April 1, Sutter Health severed its contract with Radiological Associates of Sacramento. Instead of contracting with another radiology group, Sutter hired radiologists to work for its own multispecialty group, Sutter Medical Group.

On July 2, Sutter’s CEO Tom Gagen sent out a letter citing delays with their teleradiology partner at the time, Radisphere, formerly known as Franklin & Seidelmann. The delays related to the time it took to transit images via the Internet to Radisphere.

“I want to let you know that the Radisphere teleradiology report interface has been completed and all of these reports are now automatically populated into our electronic records,” Gagen said. “As a reminder, all reports from teleradiology are final reports. This will eliminate a manual process to import the reports, which had been problematic.”

As a solution, Sutter installed a new server within their network that can compress the imaging files differently prior to transmitting them to Radisphere.

On Aug. 9, Gagen sent out another letter citing further problems.

“Our antiquated transcription system has failed several times, which has caused delays,” he said. “We saw average turnaround times of 26 hours in May drop to 10 hours in June, and we finished July at six hours. We have a target of four hours and intend to achieve this. Our transcription system is slated to be replaced later this year.”

The nighttime teleradiology image transmission issues were resolved, which improved overall turnaround time for teleradiology-generated reports, but Sutter aimed for still shorter transmission times.

Further developments with Radisphere included quality assurance issues. Sutter Medical Group started performing in-depth day-to-day audits of Radisphere’s overnight emergency department and trauma teleradiology interpretations. According to Gagen’s letter, Dr. Patrick Browning, chief of Sutter Medical Group’s medical imaging division, indicated Sutter’s radiologists would reread 95% or more of the after-hours studies, including all CT scans, MRIs, and ultrasounds for the next three to four weeks.

Sutter Health announced on Oct. 7 it decided to switch teleradiology services to StatRad Teleradiology within the next 60 days. StatRad will provide preliminary reads between 11 p.m. and 7 a.m. while Sutter radiologists will provide final reads the next morning.

“Radisphere has expended significant technical and personnel resources to help us during this transition and we appreciate their assistance and professionalism,” said Nancy Turner, Sutter Health’s communications director. “Now that our radiology group is fully functional and our needs are exclusively for after-hours teleradiology services, we are moving forward in contracting with a group that specializes in preliminary after-hours reading, with Sutter Medical Group radiologists providing final reads the next morning.”

Radisphere’s senior vice president of client and network development Clay Larsen said the company was invited to collaborate with Sutter to assist with their transition.

“Even though these services were somewhat atypical for us, we agreed to provide them for an interim period for Sutter while they recruited and deployed their own team of staff radiologists,” he said.

The request from Sutter was twofold: to provide daytime subspecialty interpretations as needed during their staffing-up period and provide nighttime reads using Radisphere’s final interpretations model so their new radiologist staff would not have to over-read the previous night’s preliminary reports.

“These are both core competencies for our organization even though we typically do not split them out for individual clients,” Larsen said. “We’ve been working together with Sutter for some time in a transition to a preliminary-read nighttime vendor and will be participating in that handoff in the near future.”

Of course, a part of transitioning to an in-house or multispecialty group model is the repopulation of radiologists. Therefore, hospitals can expect human resources issues to crop up, according to Dr. Lawrence Muroff, president and CEO of Imaging Consultants in Tampa, FL, and a longtime follower of radiology business.

When the hospital brings the radiology contract in house or under a multispecialty group, they have to play recruiter, he said.

“The hospital has to play HR expert in a field where it has little experience,” he said. “They are getting into an area of physician management that they are not familiar with and become responsible for complaints, issues, and recruiting problems they might not have anticipated.”

Sutter Health started posting pictures of their radiologists in the medical staff lounges, nursing units, and the radiology department to facilitate recognition of their radiologists.

“I recognize that working with radiologists you are not familiar with is challenging,” Gagen said. “We will also begin posting the name and picture of the radiologist currently on shift in the radiology department in the event you want to stop by and consult with them.”

One final issue hospitals might not expect when they transition to an in-house or multispecialty model is that people act differently if they’re an owner as opposed to an employee, according to Muroff.

“If you own the business, you are more liable to work harder, longer, and do things that you might not be willing to do as just an employee,” he said. “It’s that whole, ‘You don’t wash a rental car’ thing.”