· COO Spotlight
· Telemammography Tool Frees Up Rads

COO Spotlight

Mark Stevens, USTeleradiology

During the 2005 meeting of the Radiological Society of North America, USTeleradiology LLC CEO Frank Ferraro and COO Mark Stevens met Maheep Goyal, MD, CEO of University Nighthawk Partners (more commonly known as Nighthawk Pros). A dialogue ensued, and it became apparent that both parties shared a vision of greatness for their respective companies and a commitment to patient care. Last April, USTeleradiology acquired the profitable teleradiology firm, and together the two serve between 500 and 600 patients per day. Medical Imaging recently caught up with Stevens and talked with him about the company’s latest developments.

Mark Stevens, COO

MI: How will the acquisition of Nighthawk Pros improve your service offerings?

Stevens: It adds capacity in terms of volume, adds greater depth in terms of technology, and provides both entities with enhanced disaster recovery capabilities as we leverage Nighthawk Pros’ distributive reading platform against USTeleradiology’s TeleCenters in Atlanta and Palm Springs, Calif.

The acquisition of Nighthawk Pros increases our geographic range as a result of diversification in physician licensure. Additionally, any inefficiency in physician staffing and privileging will be eliminated as our credentialing departments merge and converge upon a single platform. The goal of which is to reduce the amount of days from contract execution to commencement of service.

Nighthawk Pros was once an after-hours, preliminary report-only service. Postacquisition by USTeleradiology, Nighthawk Pros now offers coverage on a 24x7x365 basis providing both preliminary reports and final reads.

MI: Your company recently enjoyed the launch of US TeleMammography, of which you own a majority interest. Can you describe what that business is and what attracted you to it?

Stevens: USTeleMammography LLC (USTM) is a high-quality mammography and women’s imaging reading service founded by the members of USTeleradiology and the USTM CEO, Martha Garrison, MD, a fellowship-trained mammographer who taught at Emory University. It provides reads, reports, lay letters, reminder letters, MQSA tracking, and CAD service (analog films) to both analog and digital facilities taking advantage of technology, the US Postal Service, and overnight carriers to deliver images for interpretation by a team of fellowship-trained mammographers who only read mammograms. At USTM the objective is to deliver service to areas where it is necessary and or nonexistent. Our goal is to enhance the quality of women’s imaging interpretation and to reduce patient wait times for screening mammogram appointments. We do this by using only fellowship-trained women’s imagers and by allowing clients to increase throughput. Reports are turned around within 24 hours of our receipt of images and prior exams.

USTeleMammography also provides its client radiologists with the opportunity to better utilize their time by reading the higher reimbursed, more complex, and less litigated modalities such as CT, MR, PET, etc.

MI: What is your acquisition strategy?

Stevens: USTeleradiology’s acquisition strategy is a simple and straightforward manifestation of our overall business strategy. We look for the win-win scenarios where we can partner with other like-minded radiologists in 100% physician-owned practices or companies who share the same high standard of care that we do. We are interested in smaller groups or solo practitioners who have assembled contracts and are looking to partner with a large organization that will value their input. Emphasis will be placed on markets that are under-represented in our client base. Our current plan is to continue in the direction of playing a more dominant role in the marketplace while increasing revenue and market share through organic growth and the pursuit of limited strategic acquisitions. We love what we do, we do it well, and we are making a difference in people’s lives. We have no intent of positioning ourselves as an acquisition target or IPO candidate at this time. But who knows what the future holds?

MI: Why did you decide to have the three entities operate separately? What are the advantages of this setup?

Stevens: USTeleradiology and Nighthawk Pros will continue to function as separate entities with integrated back office functions including management, credentialing, and accounting. We are in the process of cross credentialing our physicians and integrating our IT platforms at this time, but we are in no real rush as our clients are happy. Our goal is to move onto a common proprietary RIS platform while taking advantage of the differences and redundancies offered by the diversity in our respective viewing platforms. Once the RIS integration is complete and we are working from a common worklist, we will re-evaluate absorbing Nighthawk Pros more fully into USTeleradiology.

USTeleradiology has a majority interest in USTeleMammography LLC, but this entity will remain on its own. It has a strong CEO in Dr Garrison, a nice trajectory of growth, and is providing an essential service to its clients. While similar in name, there are distinct differences between teleradiology and telemammography. Telemammography is still in its infancy, and while we have a firm grasp on mammography image distribution, the technology varies greatly from that used for teleradiology image distribution. Analog films are still quite prevalent, and we are well equipped to deal with both mediums. Reporting requirements, MQSA compliance, and patient tracking also require a separate mammography workflow.

USTeleMammography is a strong, independent force in the marketplace, and it will remain that way.

MI: Lastly, why is teleradiology becoming so popular in today’s health care structure?

Stevens: Teleradiology provides immeasurable flexibility to radiology practice managers, hospital CEOs, radiology directors, imaging center operators, and others.

It allows practices to remote staff their own facilities and outsource reads from the lower-volume after-hours periods. It provides the opportunity for smaller facilities to receive subspecialty radiology service that was once only found in larger hospitals and academic institutions. Another of our companies, a traditional radiology practice with contracts in Georgia and California called Quantum Medical Radiology PC, leverages teleradiology against multiple facilities to facilitate subspecialty consults, vacation coverage, and to virtually staff smaller, low-volume hospitals.

Hospital CEOs, COOs, and radiology directors can use teleradiology to bolster and support a good relationship on the ground, or in conjunction with practice transition coverage. Our platform allows us to rapidly deploy teleradiologists to help eliminate backlogs while providing support to on-site radiologists during practice transitions, vacations, and unplanned absences.

Imaging center operators can use teleradiology to meet turnaround commitments during holidays, vacations, or when volume increases to that 1.25 to 1.75 FTE range where putting another radiologist on the ground is not economically viable.

The key to these relationships is trust. Our clients know that we will not displace their practices with an eye toward taking over their accounts. We back this promise with contractual noncompete language to ensure that everyone involved has a feeling of comfort and trust with the relationship.

—Elaine Sanchez

Telemammography Tool Frees Up Rads

With the aid of a Web-based system for viewing mammography studies, a radiologist can save time and effort by working from home instead of going to the office.

Candelis Inc, a medical informatics company based in Irvine, Calif, has developed a system that allows users to receive mammography reports over a virtual private network connected to a central server. The company’s ImageGrid Mammography Web Viewer also can be used to view CT, MRI, and ultrasound studies.

“Now that everything is digital, having a Web-based mammography viewer allows the radiologist to essentially do diagnostic reads from anywhere, so they don’t have to be tied to their office,” said Hossein Pourmand, vice president of business development for Candelis. One of the early clients of the ImageGrid Mammography Web Viewer is a radiologist based in Newport Beach, Calif, who uses the system to work from home, according to Candelis.

But the system has other applications aside from the ability to work from home, Pourmand said.

“In a hospital environment, instead of the doctors having to go to only a particular room or one particular station, this gives them more flexibility in terms of doing diagnostic reads from anywhere,” he said.

The system received FDA approval in February. Candelis developed the system after its ImageGrid PACS appliance started being used in mammography labs. Customers told the company that they liked its ImageGrid PACS system, but they had to use other applications to view reports, Pourmand said. In response, Candelis developed the ImageGrid Mammography Web Viewer, which uses the Digital Imaging and Communications in Medicine (DICOM) standard.

Since radiologists working with mammography reports need to have access to many prior relevant studies, the system allows for customizable prefetching of relevant priors, according to Candelis. The system does not require a radiologist to install special software on the computer being used as the viewer. Instead, the software is installed on a server, and the user can access that server from a remote location via a secure connection over the Internet—a system that is called the “thin client” approach, Pourmand said.

By comparison, other systems use a “thick client” approach, so the software has to be located on the computer being used as a viewing station, which makes those systems more expensive, he said.

“Most of the mammography viewers are thick client, and they don’t have the easy-access that ImageGrid has as a thin client, Web-based mammography solution,” Pourmand said.

The ImageGrid Mammography Web Viewer also has many of the standard features that come with a PACS viewer, Pourmand said. Those include integration with mammography Computer Aided Detection (CAD), Breast Imaging Reporting and Data System (BIRADS) capabilities, the ability to view multiple studies side-by-side, image processing, measurement and viewing tools, quick retrieval of large studies, and the ability to export studies and perform DICOM printing, according to Candelis. The system also has Cine Tool, a feature that allows users to view successive images in loop or shuffle mode.

While the ImageGrid Mammography Web Viewer is mainly intended for radiologists, it is also being used in OB/GYN offices, especially as those environments are beginning to evolve into more wide-ranging women’s health practices, Pourmand said.

“We have OB/GYN customers who are augmenting their practice by doing digital mammography as well,” he said. With the ImageGrid Mammography Web Viewer, an OB/GYN doctor can send a mammography study to a qualified radiologist and get a response back through the system, Pourmand said.

“The OB/GYN doesn’t necessarily need to be conversant and fluent” in how to interpret a mammography study, Pourmand said.

—Alex Dobuzinskis