Medical outsourcing is a growing trend in American hospitals, driven by shortages of on-call radiologists and intensivists, economic pressures, and advances in telemedicine. Hospitalists will likely encounter—if they haven’t already—outsourced services that range from off-site medical transcription and language interpreters to long-distance radiology and, increasingly, electronic intensivist services.1 What are the implications for quality patient care and collegial interface when hospitals contract with outsourced providers? What are the advantages, possible disadvantages, and opportunities for hospitalists as teleradiology and eICUs become facts of life?
A Variety of Configurations
According to Rick Wade, senior vice president for strategic communications for the American Hospital Association (Chicago), it’s difficult to quantify the extent to which outsourcing is currently being used in U.S. hospitals. VISICU, Inc., a leader in the provision of eICU services, currently has 150 client hospitals. Eight hospitalists contacted at community and university hospitals in Colo., Fla., Maine, Minn., Ga. and N.M. reported that they were not directly involved with outsourcing other than with transcription services.
Robert M. Wachter, MD, professor and associate chairman, Department of Medicine, and chief of the Medical Service at the University of California at San Francisco (UCSF), whose “Perspective” piece on medical outsourcing appeared in the February 16 New England Journal of Medicine, is intrigued by the implications of outsourcing trends for medicine: “I think medicine has been peculiarly insulated from [the globalization of services], and it’s just very interesting and exciting—and troubling as well.”1
Off-Site X-Ray Reads Common
According to the American College of Radiology, teleradiology has become a fixture in most practices and hospitals.2,3 Some institutions have retained their own radiologists, who take advantage of teleradiology by reading digitized radiographs and CT scans from home instead of within the hospital building. A shortage of radiologists has led others to contract with off-site providers of teleradiology services. Those who provide services at night are sometimes called “nighthawk” companies.1 Outsourcing of radiology, Dr. Wachter believes, is a logical step due to technological advances, though he admits that visiting the radiology department in his hospital often yields educational and collegial opportunities that online X-ray reading does not.
At Saint Clare’s Hospital in Weston/Wasau, Wis., a new, 107-bed state-of-the-art facility built by Ministry Health Care, Richard Bailey, MD, is medical director of Inpatient Care and Hospitalist Services. Radiology and other ancillary specialist services are provided by the Diagnostic and Treatment Center (DTC), jointly owned by Ministry Health Care and the Marshfield Clinic. The DTC, through a relationship with a radiology group in Hawaii, provides night coverage for full reads of radiographs and scans from 5 p.m. to 5 a.m. The interactions are virtually seamless, according to Dr. Bailey. “We don’t even notice they’re in Hawaii” when conferring with radiologists on the phone, he reports.
Off-site radiology also created an opportunity for his hospitalist group, Dr. Bailey says. Saint Clare’s hospitalist group provides supervision of contrast administration when needed during night and weekend coverage times. “This is one more way our hospitalist program supports the hospital and provides value beyond just seeing patients,” he says.
Overseas Outsourcing a ‘Hot Button’
Using an overseas teleradiology company provides many advantages, says Sunita Maheshwari, MD, a consulting pediatric cardiologist and director of Teleradiology Solutions, a four-year-old teleradiology company located in Bangalore, India. The company’s radiologists do mostly preliminary night-reads but also do final-reads on approximately 20% of their cases. If contrast must be administered for an imaging study at the client hospital, a local tech, emergency department physician, or resident usually handles the procedure, with the Teleradiology Solutions radiologist in constant voice contact.