RT Image January 4, 2010 : Page 25about six months to a year before the collapse of the Bear Stearns financial services company in 2007. “The field may have hit a little bit of a plateau. There’s still some growth, definitely. I don’t think it’s done. There’s definitely still some growth for that, but the growth is limited by the number of providers in the field. X-rays have to be interpreted by radiologists. And so, any growth in those companies that provide teleradiology, including my own, will just be slicing the pie differently, but it won’t necessarily be increasing the number of studies done.” Lampron says there have been many changes in the field over the past two years, both in terms of the economic climate and technology. He suggests the substantial increase in teleradiology firms could be one reason why individual vendors may have seen a decrease in business volume. Lead author the AJR study, Rebecca Lewis, MPH, a statistician in the ACR’s research department, says the teleradiology market may well be growing. She adds that one of the study’s major findings was that 44 percent of U.S. radiology practices reported using EOTSs in 2007, compared to 15 percent of practices four years earlier. The authors write, “Results showed large increases in use in 2007 compared with 2003 in almost all geographic regions, location types, practice types, and practice sizes.” David Charles, CEO of International Teleradiology LLC, a San Diego, Calif., firm with about 20 radiologists primarily serving hospitals and some clinics in the central and northeastern U.S., says there has been “substantial growth” in the field since 2003. According to him, the AJR study offers a fair assessment of the market. “I have reasonable regard for the article,” Charles adds. LOOKING AT THE FINDINGS The study draws on an ACR survey of radiologists in 2003 and a survey of member radiologists in 2007. The study shows that depending on practice characteristics, there are large differences in the prevalence of teleradiology. For instance, only 15 percent of primarily academic practices reported using EOTSs, compared to 59 percent of private radiology-only practices. The authors explain that “academic practices typically use residents for routine off-hours call coverage and thus have far less use for an EOTS than does a typical radiology practice.” That sounds right to Davis, who says: “Academic institutions have never really suffered from some of the same issues that private practice institutions have, because academic radiologists don’t work at night. They just come in during the day, and they do research, they teach residents, they interpret things during the day. They don’t do a lot of things at night because that is the training ground for residents to learn how to be very good at reading exams under different types of pressures.” The AJRarticle also reports that relatively few practices with 30 or more radiologists use EOTSs. In explaining this phenomenon, the authors cite a 2008 study reporting that having enough radiologists to cover night hours was the most important factor in practices’ decision not to use EOTSs. Lampron says his perception is that there has been a decline in the volume of business from larger practices. He adds. “There’s certainly been a shift in the use of teleradiology. The larger radiology groups that are out there [are] finding themselves in a situation where they’re starting to try to gain the capabilities of trying to bring it back in-house. Now, the smaller groups are looking to outsource. They’re not in the position where they can have the additional headcount or the subspecialty, so they’re almost being forced for the same financial reasons to outsource.” The study’s findings show that practices with 10 or fewer radiologists have a high likelihood of using EOTSs. “Call responsibilities would be expected to be especially taxing in these practices, where there are few radiologists to share them,” the authors write. Lewis says one of the surprising findings in the study is the relative lack of use of EOTSs in rural areas. “Perhaps the logistics and the soft- ware and hardware required to link up with an EOTS are relatively complex or expensive for these geographically distant practices and the relatively small hospitals they serve,” the authors write. Lynn Delphus, business administrator for Royersford, Pa.- based Nighthawk Pros, says none of the 22 clients – mostly hospitals – the company’s four radiologists serve in eight states are in rural locations. However, she adds, “I know in groups that I talk to that handle the rural sites, they’re so accustomed to handling it themselves, with one doctor serving hospitals across the state of Nebraska, they might have one doctor serving four hospitals in four different counties. That’s how they’ve always functioned, and they’re not really interested in making any changes because it’s not broken in their line of thinking.” But according to Lampron, demand for teleradiology in rural areas is growing. “I see us picking up more and more rural contracts, especially as technology has really started to help out here. Having the need for less bandwidth, having the availability of higher bandwidth to rural locations, has really increased the ability for these small locations to look at teleradiology,” he says. Lampron wonders whether the study’s comments reflect the time frame under consideration. THE CURRENT ECONOMY AND PROSPECTS FOR THE FUTURE The AJR study says that recent reports have indicated that, because of a softening of the market, there is currently a small surplus of radiologists. On the one hand, the authors say, that could increase the number of professionals available to work for teleradiology firms. But it could also mean that radiology practices could increase their own staffing, thus undercutting the need to use EOTSs. But Lampron says he sees two things working to the advantage of the teleradiology market. An increasing number of people are looking at options to outsource as a possible way to cut costs. At the same time, there is an increased pool of available radiologists who are interested in the teleradiology arena. “That’s really helping out the teleradiology companies, and the more people we can hire with subspecialties, the more sense it makes for other people to outsource some of that imaging,” Lampron says. In supporting their conclusion that growth in the market has slowed, the authors of the AJR study cite quarterly reports from Scottsdale, Ariz.-based Nighthawk Radiology Services showing slower growth in the number of number of examinations performed. Additionally, the study says a separate survey of “radiology practice leaders” found relatively little use of teleradiology for daytime reads or subspecialty needs. Also, “a considerable number” of practices that had previously used EOTS were no longer doing so. According to Delphus, customers industry-wide “are looking long and hard” at whether to renew their teleradiology contracts and take the work back inside as a cost-savings measure. But she sees this as just a temporary measure, because radiologists enjoy the convenience of turning work over to outside firms for readings. “I think, in the long run, the work will be switched back out to |www.rt-image.com| January 4, 2010 |25| Publication List |
