Passion, lifestyle and basic economics surround the issue of so-called teleradiology "nighthawking," and during a session at the Radiology Society of North America conference this week, all three were in full swing.
Perhaps a victim of its own success, Coeur d'Alene, Idaho-based Nighthawk Radiology Servicesan outsourcing firm of teleradiologists that built its business by touting the ability to read images from other parts of the globe while it's the middle of the night in the U.S.has become a more generic term. Teleradiologists who offer these nighttime services have become known as "nighthawks," and as their popularity has grown, radiologists have begun giving them other names.
" 'Nighthawking' is morphing into 'dayhawking,' " according to one of the RSNA speakers, Michael Modic, division chairman of the Neurological Institute Office at the Cleveland Clinic.
David Levin, a radiologist at 901-bed Thomas Jefferson University Hospital in Philadelphia, and another speaker, suggested this group could also be known as "nightvultures."
The use of nighthawking services has grown in the past decade into a $3 billion to $5 billion industry, as technology improves and makes reading images from remote locations easier and more efficient. About half of all U.S. hospitals use teleradiologists, who are trained and credentialed in this country before moving to overseas offices, from which they e-mail, fax or phone results. Hospitals pay the outsourced radiologists directly, typically between $50 and $70 for each read; in-house staff bill patients and insurers according to coded rates.
Radiologists are alarmed at how smoothly nighthawks have been able to grab hospitals' attention. Although basic economic principles drive consumers to seek out the best quality for the lowest costs, nighthawks are a contentious issue among radiologists who insist that teleradiology is a threat to patients.
Besides competitive pricing, teleradiologists offer something else: the ability for radiologists to sleep through the night without being called in after-hours to read emergency scans.
This doesn't sit well with some who believe that the bottom line, and not patient safety or quality, drive teleradiology. Nighthawking businesses were not started for the patients, Modic said. "We did it so we can sleep."
Some radiologists view the lower costs of nighthawking services as devaluing the field of radiology. Outsourcing the expertise turns radiology into a commodity and gives the impression that anyone can do it, said Michael Brant-Zawadzki, medical director of radiology at 353-bed Hoag Memorial Hospital Presbyterian, Newport Beach, Calif., during the RSNA session.
But technology has only improved the field, according to William Bradley, chairman of the radiology department at the University of California at San Diego School of Medicine and a former Nighthawk Radiology Services board member. He currently serves as a consultant to the company.
Teleradiologists are licensed and credentialed in America, but can work in places during the day while radiologists can get needed sleep here, Bradley said. The high-quality technology used in creating scans allows teleradiologists to read them with less difficulty than older pictures, he added.
In addition, teleradiologists still are required to hold malpractice insurance as any medical practitioner, and they charge premium prices, he said. "This is not based on low price; this is based on quality," he said.
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