By Aine Cryts
Teleradiology and the corporatization of radiology are two topics on the mind of Ezequiel Silva, MD, FACR, interventional radiologist at San Antonio-based South Texas Radiology Imaging Centers and chair of the American College of Radiology’s (ACR’s) commission on economics.
In 2013, Silva was lead author of a 2013 ACR white paper that provided guidance on the practice of teleradiology. Currently a member of the ACR corporatization task force, Silva served as chair of the organization’s task force on teleradiology practice from 2012 to 2014.
Looking back more than six years later, he’s “most proud that the [white paper] brought that evolving model up to the standard that the entire profession should expect of itself,” he tells AXIS Imaging News. AXIS recently discussed the impact of the ACR white paper on teleradiology with Silva. Here’s what he had to say.
AXIS Imaging News: What prompted the decision to develop the ACR white paper in 2013?
Ezequiel Silva: Back in 2009 or 2010, we were seeing an evolution of teleradiology from being a practice model that was international in focus to one that was potentially disruptive for traditional, local, facility-based radiology practices. For a quick retrospective, before 2010, imagine that my practice allowed a radiology service based in Australia to read radiology images at night while our radiologists are sleeping or, at least, not working. When it’s nighttime in Texas, it’s daytime in Australia, so this was a naturally evolving relationship.
What happened around the 2010 timeframe was we started to see teleradiology entities moving into reading radiology exams during the day. Because of the potentially disruptive nature of this move, ACR leadership decided that we needed to look at this industry development from multiple perspectives. It wasn’t just a look at potential predatory business practices; rather, it was an attempt to develop ACR’s position on this growing, evolving model.
AXIS: Please discuss the white paper and how it was received at the time.
Silva: We certainly talked about the business and contracting aspects of the new model. But I think we caught a lot of people by surprise, and I say that in the most favorable of ways. We really constructed it as a standards- and practice guidelines-type document. For example, the white paper covered a teleradiologist’s qualifications, [his/her] workspace, and the availability of prior studies and other clinical information about the patient’s care.
I think the expectation from the teleradiology community was that the white paper was going to be overly critical about the business practice. But we found it was very well received in that subset of our industry. That’s because it presented standards in the best interests of all parties, involving, in particular, patients.
On patients, specifically, we wrote that any financial relationship undertaken by a teleradiology practice had to be done with patient primacy in mind. If patient primacy isn’t considered, then the teleradiology practice should [scrutinize] that relationship.
AXIS: What value do you want radiologists to get from the white paper?
Silva: Radiologists practicing in teleradiology environments want their value, qualifications, and credibility to be recognized. Instead of saying, for example, that all radiologists who are reading brain MRIs need to have read 1,000 brain MRIs in the last year, we tied those modalities to the practice guidelines and technical standards. That would mean that a radiologist reading this particular modality should satisfy the qualifications laid out in the practice guidelines for that modality. We created this as a living document. We recognized that the practice guidelines, by definition, will evolve.
If I’m a teleradiologist, I want my value to be recognized. I want there to be confidence among my referring physicians in my ability to do what I do. A corollary to that is that I want my professional skills to be recognized from a reimbursement perspective. I went to school for 14 years to be able to do what I do currently. I want that to be recognized from an economic perspective. That’s not the metric that we would ever advocate for—and it’s not even No.1, but it’s relevant.
AXIS: What’s happened to the teleradiology market since the paper was published in 2013?
Silva: There have been some interesting trends. But I think what’s potentially the most relevant is we’re seeing a move toward more corporatization in radiology. We’re seeing more private equity and venture capital money coming into medicine—and that includes radiology.
A white paper on corporatization in radiology was published in the Journal of the American College of Radiology in October 2019. It was written by Howard Fleishon, MD, FACR, vice chair of the ACR board of chancellors and chief of radiology services at Emory Johns Creek Hospital in Johns Creek, Ga. The paper was built on the concepts that we talked about with the teleradiology task force [regarding] what qualifications and responsibilities those entities could have toward radiologists and patient care.
By definition, you’re talking about non-physicians and even potentially non-medically trained people, such as those in finance, coming into our profession. That creates a dynamic where we, as radiology professionals, need to maintain responsibility and accountability for the quality of what we do. We do that while recognizing that we have a potentially different obligation to a third-party entity that’s funding our operations and paying our salaries. There are business dynamics there that are relevant. But it gets to a concept where we came right out in the task force paper and said patient primacy is key.
Aine Cryts is a contributing writer for AXIS Imaging News.