Keeping Country Radiology Cool

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A rising tide lifts all boats, as the saying goes, and thanks to the hastening deployment of subspecialty teleradiology, some of the smallest imaging-department boats are riding high. This is good news for patients in rural areas, who can now stick with their local hospitals for their imaging needs. It’s good news for those hospitals, too, because the subspecialty imaging they can now offer helps them run in the black.
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Jane Wheatley, CEO
Extending subspecialty service to rural areas is no trivial matter. According to the American Hospital Association (AHA), of the more than 5,700 hospitals in the United States in 2007, about 2,000 of them (35%) were classified as rural community hospitals. According to 2006 AHA data, approximately 54 million patients were served in these rural settings, including 9 million Medicare beneficiaries. Rural hospitals provide a critical component of US health care. Syringa General Hospital Grangeville, Idaho, is a town of about 4,000 people situated roughly 200 miles north of Boise. Syringa General Hospital is Grangeville’s only hospital and, according to radiology manager Kyle Kellum, RT(R), serves an area within a radius of about 40 miles beyond the town.
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Kyle Kellum, RT(R)
By any measure, Syringa General Hospital is modest. In 2008, the hospital had total operating revenues of $9.5 million. It is licensed for 16 beds and has four physicians on staff. The hospital treated about 26,000 outpatients and about 1,800 inpatients in 2008, and more than 2,700 were treated in its emergency department. Syringa General Hospital has no radiologist on-site. Kellum, in addition to managing the radiology department, is one of four technologists. The hospital does about 6,000 imaging exams per year, and all of them are now interpreted by subspecialists from Franklin & Seidelmann Subspecialty Radiology, Beachwood, Ohio—including stat readings for the emergency department. Because of a hospital contract, Franklin & Seidelmann does not interpret mammography; a mobile mammography unit services the hospital, and the mobile service does its own imaging, interpretation, and billing, Kellum says. Kellum came to Syringa General Hospital as radiology manager in 2007; shortly thereafter, he says, he began searching for a new teleradiology provider. “We switched to Franklin & Seidelmann for quality reasons,” he says. “The physicians here had a real quality issue with the ultrasound reports not being adequate. They were misinterpreted, or not all the information was included in the report. When I fought for a different radiology group, I wanted a subspecialty provider. If I had a patient with a brain injury, I wanted a subspecialist to read that patient’s study.” Kellum contacted Franklin & Seidelmann; after going through a credentialing process, the group began reading Syringa General Hospital’s images. That was just under a year ago, Kellum says. Since then, the obstetrician who had been the most vocal about poor ultrasound interpretations has more than doubled Syringa General Hospital’s ultrasound volume. “The quality from Franklin & Seidelmann has been exceptional,” Kellum says. “The customer service is by far the best I’ve ever dealt with. I have one contact. If I have a problem, I contact her. She takes it from there.” If technologists have protocol queries or other questions, they can quickly contact Franklin & Seidelmann and get guidance, Kellum adds. “Since they have come on, our MRI has gone up by 48%,” he says. “I can’t attribute all that to them, but just last month, our MRI doubled again. They’ve been extremely good for us. We’re bringing the MRI mobile unit in every week now, instead of twice a month.” Another huge difference is that Franklin & Seidelmann subspecialists do final interpretations for every exam. “We have 24-hour turnaround (by contract) on finals, but we are averaging just over two hours. Less than two years ago, we were digitizing images, sending them to Boise, and waiting for reports in the mail,” Kellum notes. For stat interpretations, the turnaround time with Franklin & Seidelmann is about 33 minutes, and in critical cases, it’s about 13 minutes, he says. Patients with subspecialty clinical needs must go out of town, but their clinicians can now refer imaging to Syringa General Hospital, knowing that the reports will be done quickly and with expertise. “We get a lot of referrals from Lewiston, Idaho, and from Clarkston and Spokane, Washington, and all our feedback has been positive,” Kellum says. “One of the Franklin & Seidelmann physicians spotted a dissection that was almost impossible to see.” A helicopter was called for that patient, who was taken to a larger hospital for life-saving care. “I went back and looked for the dissection, and I couldn’t see it,” Kellum says. He says that the Franklin & Seidelmann portable reporting and image-transmission system has also improved access for referrers. “We were having all kinds of problems with our online PACS dealer; the computer was freezing up and everything. We actually stopped using our online PACS dealer and are just using the Franklin & Seidelmann portable because it’s much easier—three clicks, and the final report is faxed,” Kellum says. He also notes that for some Franklin & Seidelmann physicians, dictated reports will appear on the Internet in audio form. If time is critical, the dictation can be listened to before it’s transcribed. “Most of the Franklin & Seidelmann radiologists have that, and it’s handy,” Kellum says. When the contract with the online PACS vendor expires, the hospital will save another $5,000 per year through its use of Franklin & Seidelmann, according to Kellum. “We’re much better off with Franklin & Seidelmann, as far as the financial part of radiology goes,” he says. “We’re paying less per exam, and we’re getting much faster turnaround.” New Horizons Medical Center At New Horizons Medical Center in Owenton, Kentucky, Bernie Poe, president, is hoping for a positive financial impact from his hospital’s contract with Franklin & Seidelmann. Anything will help. Three times in the past 20 years, the hospital (which is licensed for 25 beds and conducts about 6,000 radiology exams per year) has come close to closing its doors. At one point, the hospital’s original owner, Owen County, was ready to walk away from the red ink and let the hospital fail, Poe says. Poe, who operated a pharmacy in Owenton (population 1,400) for years, in addition to a nursing home, led a community effort to save the hospital. He has been president of New Horizons Medical Center since 2001. On assigned days, he still works in the hospital’s pharmacy. “We are the only provider of health services in the county,” he says—one reason that the community fought to hang on to New Horizons Medical Center, he adds. Through a community foundation, Poe has been able to borrow money to put in a new nursing call system, and the hospital is on the verge of completing a dialysis center. It has already opened an outpatient family-practice clinic. Poe says that when he took over, a single radiologist was coming to the hospital two days a week and reading from ancient equipment. “We had a CT scanner that took 45 minutes,” he says. Through an equipment vendor, Poe was able to lease what was essentially an upgrade of the whole radiology department. This included a PACS, new radiography equipment, a CT scanner, ultrasound units, a radiography room, and portable radiography for the hospital’s 24/7 emergency department. With the PACS, the hospital was able to contract with a retired radiologist for teleradiology interpretation, Poe says, but that physician’s health began to fail. Poe talked to some of the large teleradiology providers, but came away dissatisfied. “A lot would want us to do the billing and pay them a global fee. I was too insecure to do that,” Poe says. In 2008, sales representation for Franklin & Seidelmann approached New Horizons Medical Center. “They took a different approach,” Poe says. “They said, ‘We want to work with you.’ I said, ‘Show me where the money is,’ and they were able to do that. They seemed to understand the rural community’s problems more than the other groups.” In the end, Poe says, Franklin & Seidelmann agreed to bill for the professional fees for the exams that it interpreted for New Horizons Medical Center and to let the hospital bill for the technical fees. This was just what Poe had asked for, but there was one little glitch. Before anybody could bill, the Franklin & Seidelmann radiologists had to be credentialed at the hospital, which turned out to be a lengthy process. In March 2009, Franklin & Seidelmann began reading for New Horizons Medical Center. The hospital also pays Franklin & Seidelmann to provide one of its physicians to act as medical director of radiology. So far, Poe says, everything is going well. “A lot of our interpretations are for the emergency department,” he notes, adding that a number of patients with intracranial hemorrhages have been sent out by helicopter. “In 30 minutes we can have a helicopter on its way to the University of Kentucky,” he says. The hospital’s referring physicians have also been pleased with Franklin & Seidelmann’s service, Poe adds: “We can transmit the images and send them the reports before the patients get back to their offices, in many cases.” The growth in imaging services over the years has helped New Horizons Medical Center “get through the slack times,” Poe says. He adds that he’s confident that, with Franklin & Seidelmann subspecialty service, the hospital will build more outpatient volume. “We will find more interest coming from this community,” he says. “I’ve already seen that.” Taylor Regional Hospital Taylor Regional Hospital in Campbellsville, Kentucky, is not quite as rural a provider—with 90 beds, it’s larger, for one thing. According to CEO Jane Wheatley, Taylor Regional Hospital serves a population of about 110,000. Its radiology department completes about 60,000 exams per year, including CT, MRI, and ultrasound studies. The department also handles nuclear medicine, fluoroscopy, and cardiac diagnostic catheterization, Wheatley says. To handle interventional radiology, the hospital has contracted with Franklin & Seidelmann to provide a physician on staff during daytime hours. If the interventional demand lessens, that physician reads other cases. The physician also acts as medical director of radiology and attends staff meetings. All routine imaging is transmitted to Franklin & Seidelmann for interpretation, Wheatley says. The hospital contacted Franklin & Seidelmann in 2008, when its former staff radiologists and local teleradiology providers couldn’t keep up with demand. Franklin & Seidelmann has been interpreting for the hospital since February. “We are very, very pleased,” Wheatley says. “They’ve been very attentive. The first couple of weeks, there were daily calls on our formatting, and now there are weekly check-in calls.” A big plus for Wheatley has been the Franklin & Seidelmann quality-assurance (QA) program. Random overreading is done, and any case where a referrer thinks something might have been missed is put through the QA program for a second opinion as well. “We think it’s very important to have that QA process,” Wheatley says. Emergency-department turnaround is about 30 minutes, while reports for hyperacute cases are ready in 20 minutes. For PET/CT mobile studies, the turnaround is longer (48 hours). Wheatley says that the medical staff at the hospital is pleased with the turnaround times and “the higher level of expertise” of the interpretations. Franklin & Seidelmann bills for professional fees and charges for providing the interventional radiologist, but overall, Wheatley notes, the coverage from Franklin & Seidelmann costs less than the hospital was paying previously. “This is a much better financial decision for our hospital,” Wheatley says, “and now, we have the luxury of the case specialist. It’s amazing what teleradiology has done for us.”