The raiding party from Boston that sacked Warwick, RI, could represent the end of an era for radiology practices

Some might have anticipated the news from Rhode Island that Massachusetts General Hospital (MGH), Boston, was in talks with Warwick, RI-based Kent Hospital to take over 70% of its imaging volume via teleradiology; however, it took the state’s radiology groups by complete surprise.

For the second time, MGH has found itself at the center of controversy involving its teleradiology designs. In the first instance, MGH set off a firestorm of public protest when an article appeared in The New York Times exposing the hospital’s plans to send studies abroad to radiologists in India.1 The department of radiology backpedaled on that plan, and as far as I know, the only studies going to India are being read as part of national research projects funded by the government.

On this latest occasion, Kent has signed a letter of intent to contract with MGH for teleradiology services, circumventing Kent’s small local practice, Toll Gate Radiology, also in Warwick, as reported by Toll Gate’s three radiologists were offered salaried positions, which the radiologists reportedly declined as less than adequate.

Just what sort of hospital is Kent? It most likely has a lot in common with many community hospitals across America, struggling for profitability and striving to serve its community. With 359 beds, Kent reported 17,274 inpatient admissions in its last fiscal year, 93,836 inpatient days, 60,479 emergency department visits, and 140,116 inpatient and outpatient diagnostic imaging studies. It just filed a certificate-of-need application to provide emergency coronary angioplasty services. According to its 2006 Annual Report, the hospital lost $1,990,272 on net patient revenue of $227,157,641. If it were a hotel, it would have had a 26% vacancy rate. But it is a hospital operating at a loss on tight margins.

And what about Toll Gate Radiology? Presumably, the practice is like many others across America. With just three full-time members, Toll Gate outsourced a percentage of Kent’s 140,000 annual studies—specifically, all of those examinations that occurred at night and on weekends—to NightHawk Radiology, Couer D’Alene, Idaho.

One would think that practices the size of Toll Gate would be the bedrock of teleradiology companies, because, realistically, it is impossible for a three-person practice to provide a hospital with 24/7 coverage. To be fair, no one could fault Toll Gate’s hard-working radiologists for outsourcing its night and weekend load. However, when Toll Gate outsourced its nights and weekends, it also outsourced service during those hours, thereby placing itself in a vulnerable position. If the hospital received bad service during those off-hours, then Toll Gate would be guilty by association. And if the hospital received good service during those off-hours, well, then, who needs Toll Gate?

The most recent data from the American College of Radiology (ACR), just published in the American Journal of Roentgenology,3 showed that 73% of all radiology practices used teleradiology or PACS in 2003. Unfortunately, that data is 4 years old, and it is unclear how much of that teleradiology was outsourced. Although trailblazer Paul Berger, MD, already had hatched NightHawk Radiology in 2003, Virtual Radiologic Corp, Minnetonka, Minn, was still a gleam in the eye of Sean Casey, MD. Much activity has occurred since then.

When Kent elected to outsource 70% of its reads, it was not to a Rhode Island radiology group, but to MGH, 61 miles away. Two questions immediately occur: What happened to end the gentleman’s agreement among radiology groups to respect local terrain? And if this was inevitable, why did the progressive and entrepreneurial academic group, Rhode Island Medical Imaging, at Rhode Island Hospital and Brown University, allow this to happen in its own backyard?

The Rhode Island Radiological Society (RIRS) plans to take the issue to the ACR annual meeting this May 19–23 in Washington, DC, as reported in the article. However, a quick review of the ACR 2006 bylaws turned up no parameters on business dealings among practices, and a spokesperson for the ACR stated that the organization does not get involved in disputes among members. With all due respects to the RIRS, by May 19, MGH very well may have carved up the state and moved on to Poughkeepsie. Apparently, the only obstacle to prevent one practice from jumping into anyone else’s backyard is the gentleman’s agreement that has prevailed to now. That, and a practice’s best defense: great service to the hospital.

Of course, Kent also has left itself vulnerable. There are some places in radiology that teleradiology cannot go. Who is going to do the chemoembolizations and radiofrequency ablations for cancer patients? Not Kent. Who will perform the biopsies and drainages that the cardiologists couldn’t care less about? Not Kent. And, needless to say, Kent will not be on speed dial for savvy locals who want state-of-the-art care in the event of a stroke. A strong and healthy local radiology group is an invaluable resource for a hospital.

This is a cautionary tale for all of those practices that are enjoying the good life—the one without call. If the gloves come off in this gentleman’s game, radiology could turn into a real slugfest.

Cheryl Proval is business editor of  Axis Imaging News. For more information, contact .


  1. Pollack A. Who’s reading your x-ray? November 16, 2003. The New York Times. Available at: Accessed April 16, 2007.
  2. Forrest W. MGH teleradiology plan rankles Rhode Island radiologists. April 3, 2007. Available at: Accessed April 16, 2007.
  3. Ebbert TL, Meghea C, Iturbe S, Forman HP, Bhargavan M, Sunshine JH. The state of teleradiology in 2003 and changes since 1999. AJR Am J Roentgenol. 2007;188:W103-12. Available at: Accessed April 16, 2007.