Radiology continues to lead the commoditization of medicine

A year ago in Let the commoditization of medicine begin, I wrote that telereadiology company Telerays was making radiology a true commodity by auctioning bundles of radiology reads to the lowest  bidder. Now an article in DiagnosticImaging (Teleradiology day reads shake up the specialty) reveals the extent to which teleradiology and the peculiarities of radiology practice are combining to shift the balance of power away from radiologists to the purchasers of their services.

Radiologists get paid to interpret images, and that’s it. They receive essentially no compensation for consulting with referring physicians or (God forbid) patients. So they sit in their dark rooms reading images  and issuing reports. Of course there are exceptions, but generally even if they’re down the hall they may as well be on the other side of the world as far as communications go.

Teleradiology started as a way to do preliminary reads during the night (“nighthawking”), when regular radiologists are home in bed. Often the customer is a radiology group that can avoid taking call by paying remote readers to cover for them. But as teleradiology companies look for growth they are adding “dayhawking,” i.e., reading images during the day. Inevitably they are starting to compete with their radiologist customers. Hospitals, accustomed to having to bend to the demands of local radiologist groups, are finding that they now have a realistic alternative. They can fire the local radiologists and deal with a remote group instead. Here’s an example:

Back in June, the Mercy healthcare system in Toledo, OH, shocked the radiology community when it replaced the local radiology group that staffed its three hospitals with an out-of-town practice-management firm that used teleradiology for primary daytime interpretations. According to the Toledo Blade, St. Vincent Mercy Medical Center had been unable to reach a contract agreement with Consulting Radiologists and decided to hire Imaging Advantage, based in Santa Monica, CA.

The relationship between the 19-member radiology group and Mercy hospitals that had endured for over half a century broke up nastily last May. Contract negotiations had been stalled for about a year when Consulting Radiologists got—almost literally—its two-weeks’ notice. The radiologists were on the faculty at the University of Toledo, which retaliated by pulling all of its radiology residents from the Mercy hospitals.

We’re going to see more of this and really the radiologists have no one but themselves to blame.

“Teleradiology has contributed to commoditization, but it has been able to do that because we radiologists in the community have enabled it,” [Dr. Eliot] Siegel [of the VA Maryland Health Care System] said. “It’s very difficult to commoditize high-quality patient care, but it is very easy to commoditize just the image interpretation.”

This factor alone might have forever diminished radiologists’ bargaining power with their hospitals. When radiologists do not communicate properly with their referring physicians, shy away from training technologists or lecturing peers, or avoid in any way the responsibilities or issues associated with being part of the hospital community and focus instead only on reading images, they are setting themselves up to be ratcheted down, Siegel said.

Radiology is the extreme edge of the wedge but other specialties will be subject to the same forces over time as bandwidth and computer processing power increase and as people get used to dealing with doctors from a distance.

October 15, 2009

7 thoughts on “Radiology continues to lead the commoditization of medicine”

  1. Wow, I found this post very interesting. I can just imagine the outrage of the radiologists but as you say, they aren’t completely filling a need, so someone will find a way to fill it. It is unfortunate that people with jobs in healthcare sometimes seem to operate within a bubble. The profession is about PEOPLE but communication often seems lacking.

  2. Nice post. Its great for an affordable health system that we’re seeing competition expand and low-cost alternatives enter the market. Ideally, the next step would be for quality markers to assert themselves so you see a value curve (low cost for simple, higher cost where true expertise required) so that we don’t just see a race to the bottom.

    Are you seeing the quality markers (either prospective or retrospective) starting to emerge? The binary licensing process (in or out) seems grossly insufficient for the task.

  3. This is a great post David! The threat of remote reading services has existed for years, but technology is now ready and referring physicians and hospital administrators are weary of bad customer service from radiologists. We will read more stories like Toledo. Radiology groups better get service focused fast! And yes, that means 24×7 primary reads.

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