Keeping patients and primary care providers happy is a priority for Prairie Cardiovascular Consultants, a radiology group that services the south and central regions of Illinois. In fact, the simple mantra is the business’ key to exclusivity in today’s troubled economy, according to Maria Falcone, MD, a nuclear and echocardiologist who works for the practice.

Once upon a time, the physicians burned images and reports onto CDs and mailed them, averaging a 3-week turnaround. “It was a pain,” recalled Falcone, who has a contract with 25-bed Marshall Browning Hospital in Du Quoin, Ill. “The primary care doctors had to burn hard copies, and we could not manipulate anything because they were hard copies with fixed images.”

Through an advanced teleradiology solution from Numed and BRIT Systems, studies are completed in a timely fashion, now taking less than 48 hours. Additionally, Falcone and team can open pages, make a variety of combinations, and do different attenuations.

“We can give the same services as those of a big institution,” Falcone said. “Patients can get results the same day and call their primary doctors. Patients also can stay locally and enjoy technologies that in the past they needed to travel to get to. Because of teleradiology, we can connect little hospitals to a provider that can give you the same report and expertise as a big institution.”

A System for Nuclear Cardiac Images

Prairie Cardiovascular Consultants uses a solution created by a partnership between Dallas-based BRIT Systems and Numed Inc, of Denton, Tex. Prior to the joint project, conventional PACS did not have the functionality for nuclear cardiac studies. Physicians reported to a specific workstation or mailed or couriered images on CDs.

Searching for a system that could manage nuclear cardiac images in a telemedicine environment, Numed linked up with BRIT Systems. The collaboration produced a custom cardiac PACS called “Portal,” which was announced during last year’s meeting of the Radiological Society of North America. Specifically, BRIT made the solution Web-based through use of a Citrix Presentation server.

Additionally, the companies connected with Invia Solutions and its INVIA Corridor4DM software. Giving cardiac PACS the capability to read nuclear medicine studies, Invia’s Corridor4DM offers clinically validated algorithms, supported data, quality assurance and processing, 2D and 3D polar maps, normal databases, myocardial function and perfusion, and wall motion.

“These new partnerships are the cornerstone of our expansion into new markets and niche imaging services and will help continue to pave our success for the next 15 years,” said Shelly Fisher, president, BRIT systems, upon celebrating her company’s 15-year anniversary.

Serving the Mammography Market

With the popularity of teleradiology, a growing trend is the movement beyond nighttime preliminary reports toward specialty services, like nuclear cardiology. Jesse Salen, vice president of sales and technology for telerad company Online Radiology, discussed how more and more teleradiology providers are looking at the daytime and specialty markets to satiate untapped demand.

“What has happened is that there are so many nighthawk groups now for the preliminary report nighttime business that the market has become saturated,” Salen explained. “For the most part, hospitals or radiology groups that are buying nighthawk services are looking at price. It has become an overcompetitive price game. What’s happened now is that the industry has moved toward more complete solutions.”

Salen said his company has been approached by an increasing number of people looking for subspecialty services like mammography. It’s a unique little niche, Salen says, and there is a shortage of breast imagers, especially in rural areas. Not many teleradiology providers offer it because it is difficult to keep up with the specialty’s standards, such as studies read per year and CME course requirements. Furthermore, telerad companies must make sure they have mammography privileges on their medical staff.

“All of these things are challenges that get taken into consideration for adding mammo as a subspecialty,” Salen continued. “It makes it very difficult to do, but at the end of the day, there are a lot of facilities out there that are focused on women’s health. There’s a huge demand for mammograms, and many of these facilities are backlogged for weeks, if not months. By using a service like ours, you can bring those skills into your facility, no matter where you are located.”

Established in April 1998 alongside other pioneer teleradiology companies, Online Radiology started its business by covering nighttime calls for radiology groups. “There were so few of us and so much demand for that service,” Salen said. “There was a lot of volume going through these groups and radiologists were overworked. We were turning people away.”

For the first 6 to 8 years, the company grew by word of mouth, and it continued to thrive by handling preliminary, nonbillable reports done at night. But as more businesses entered the market, Online Radiology expanded its focus. Instead of providing quality of life, it sought to sell efficiency.

Radiology groups who are shorthanded or are in rural locations are a big target for the company these days. “They might have one or two radiologists or a part-time guy, and it might be too hard or expensive to get a radiologist to work in the area. It’s more efficient to move the images to the radiologist than the radiologist to the image,” Salen said.

Technology has also significantly evolved, Salen pointed out. The company’s RIS system, from ThinAir Data Corporation, now understands where studies are coming from, which of Online Radiology’s 40 radiologists are logged into the system at any given time, and who is allowed to read specific studies, depending on their licenses. The system can also identify who is least busy and how to best send reports back to the facility.

A Driving Factor: Economics

“At the end of the day, economics is really going to drive everything,” Salen said. “We’re seeing price pressure for sure in the nighttime market. For every telerad, that’s their core business.”

Nevertheless, Online Radiology’s general business philosophy, trying to distinguish itself from its competitors, is not necessarily to offer the lowest price. Rather, it wants to be known as a flexible solution that can solve the particular problems of any radiology department. Like Falcone’s Prairie Cardiovascular Consultants, “keeping them happy” is key. “We want you to use us because you are happy with us, not because you have a contract that says you can’t be with anyone else,” Salen said.

Pricing trends that Salen has observed include pushes to have standard teleradiology contracts lessened from 3 years to 1 year, with five option years. Previously, providers held contracts with clients for 3 years and autorenewed each year. Many companies add clauses for minimum amounts clients must pay each day and 90-day written notices to get out of contracts.

“We’ve always avoided having contracts like that,” Salen said. “There’s no exclusivity clause, there’s no minimum, there’s no standby fee. It’s basically you pay for the service as you use it. If you don’t use it, you don’t pay. If you want to use someone else, you go use someone else. And that’s okay with us because we feel that it’s the quality of customer service, the technology platform we offer, that are the important drivers in the industry. We’re here to solve people’s problems, not lock them into a contract.”

The Hybridization of Radiology Groups

With improvements in technology, images are becoming easier than ever to move around. This fact, along with the shortage of radiologists and the costliness of quality health care, has fueled another trend?the hybridization of radiology groups. Salen believes that radiology’s forecast is for the efficient movement of images and lighter staffing in hospitals, with interventional work being done in the hospitals and the rest of the load done with teleradiology.

“It’d be easier for standard radiology groups to grow,” Salen said. “If you want to take on an extra hospital, but you don’t have the staffing, you don’t necessarily need to add the staff. What you can do is actually move the images around among your network of doctors. That’s happening more and more. You see these standard radiology groups branching out to teleradiology and becoming hybrid.”

On the flip side, the reverse is also occurring. “Some teleradiology groups are understanding that we’re getting cut out of the loop. But we’ve built these networks of really competent radiologists, and we have some great skill sets, offering high-quality health care in multiple locations. These teleradiology groups are now starting to develop closer relationships with the hospitals.”

While the future of teleradiology is unclear, it’s safe to say that health care reform and the billions of dollars being spent on health care IT will affect?and change?the field. “I don’t know at the end of the day what the outcome is going to be,” Salen said. “We’re all waiting for it. The easier it is to move images around for these hospitals, the more likely it is that they’ll pick a business like ours to help them be more efficient.”

Elaine Sanchez is an contributing writer for Axis Imaging News.