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