Robert Pyatt, MD, a radiologist with Chambersburg Imaging Associates in Pennsylvania, recalls well the decision that his practice made to contract with a teleradiology group, almost 10 years ago. “We started with teleradiology in the fall of 2002,” he says. “Before then, we would be up all night reading cases. Then, life got a lot better—we would only work until midnight, the teleradiology group would take over from midnight to 6 am.”

Today, Pyatt sees much broader potential for the load balancing in radiology services made possible by technology, especially in his specialty area of breast imaging. “We’ve had trouble recruiting radiologists to this state, and younger radiologists aren’t going into mammography as much,” he notes. “Mammography is going to be a valuable future specialty for teleradiology here (and in other parts of the country).”

This experience mirrors that of many practices nationwide: Teleradiology, which began as a way to give busy radiologists a break from an unrelenting on-call schedule, has grown into much more, according to Pat Basu, MD, CMO of Virtual Radiologic (vRad), Eden Prairie, Minnesota, which celebrates its 10th anniversary this year.

“We find ourselves in a time of incredible emphasis on quality, increased access, and lowered costs,” he says. “Teleradiology, with its ability to map supply and demand, has helped meet that need.”

In his 1877 History of a Crime, Victor Hugo (1802–1885) wrote, “One resists the invasion of armies; one does not resist the invasion of ideas” if their time has come. Basu says, “The ability to deliver excellent quality and increased access, with a much more effective distribution of costs, is an idea whose time has come.”

In November, CMS released the final rule for the formation of accountable-care organizations (ACOs), intended to spark a transition away from fee-for-service medicine and toward value-based purchasing. Groups of providers can begin registering as ACOs as early as April 2012, positioning themselves to be paid according to their ability to reduce costs while meeting quality and patient-satisfaction targets.

What this will mean for radiology is not yet clear, but industry thought leaders have noted a risk of commoditization if radiologists are treated as vendors under the new payment paradigm. Kenneth Schwartz, MD, medical director of New York Radiology Alliance (NYRA) in Bedford Hills, says, “Radiologists will be under even more pressure to prove their value—their ability to drive the whole imaging process in such a fashion that patients get the best possible outcomes at reduced cost. They will have to get the patient to the quickest, and most accurate, means of diagnosis, so that the rest of the care team can handle its functions as efficiently as possible.”

Charleston Radiologists in South Carolina is an 18-radiologist group that covers three hospitals, as well as several urgent-care centers and physicians’ offices that offer medical imaging. Michael Garovich, MD, a radiologist with the group, says, “For images from these smaller, outside entities to get into our PACS, the demographic information had to be entered manually. There are three PACS we read from—one for our imaging center, one for the hospitals, and one for outside interpretations.”

The challenge inherent in managing so many clients (with such disparate IT capabilities) is that Charleston Radiologists’ physicians have never had a unified worklist from which to read, Garovich says. “It’s hard to be very efficient because every system has different nuances, and every time, you have to remember them,” he notes. “If you do any one thing a million times, you get faster, but if you do a million things one time, you’re not being as efficient as you could be.”

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