FEATURE · IMAGING


we don’t want people come into the read- ing rooms as much as in the past [per guarding against infection]. Petersilge: Alex alluded to not want-


ing the radiologists to come down to the reading rooms. I totally understand that. One of my concerns is that we’re becoming more and more removed physically from our referring physi- cians; and I’ve had a long-term concern over the commoditization of radiology. On the other hand, I see many vendors are now adding in collaboration tools, so that a radiologist and a clinician can both be at home, and share the same radiology screen and communicate with one another. I’m just curious if anyone working full-time clinically on a regular basis is seeing an increased use of col- laboration tools. Rosen: One of our oncologic imagers


now has office hours on Monday from 11 a.m. to 1 p.m. where all the oncologists in the community know they can call her and conference in to review cases; and it’s been enormously successful. And the technology was there before COVID, but wasn’t being used. But now that every- one has a Zoom account, it’s happening. Siegel: I had actually written a journal


article about the decrease in interaction following PACS (picture archiving and communication system): with PACS, the number of in-person consults dropped dramatically after film was dropped. Ironically, we’re seeing more commu- nication now, in the wake of COVID, with our entire hospital on Microsoft Teams, so ironically, in our own facility, we’re actually seeing more consultation; it’s electronic, though, rather than in person. Hagland: One of the things I’ve


heard about, with the growth of these large teleradiology firms, is the emergence of this commoditization of radiological practice, as you had referred to, Dr. Petersilge. Dr. Siegel, as you mentioned, presumably, you could interact with more radiologists, remotely. Siegel: Yes, I am actually consulting


with more referring physicians now than before. Wendt: And we’ve been seeing that


consolidation of teleradiology. And at the UW Hospital and Clinics system—we were serving patient care organizations all over the state, but it was essentially the University of Wisconsin system. But now, over half of our book of business has nothing to do with the UW system. Petersilge: In whatever format it comes,


the essence of what we need to preserve in radiology are the radiologist-physician relationship and the radiologist-patient relationship, and that latter relationship is still emergent, except in interventional


radiology. I’ve seen teleradiology prac- tices that can be extremely successful when the radiologist makes the effort to develop relationships with the phy- sicians they’re reading for. And the practice is set up so that the referring physician really knows several key radiologists and knows their reading style; the opposite situation is the most detrimental. Now, when you’re part of an organization and are making operational efficiency improvements in your organization, that’s one setting for teleradiology. But as the venture capitalists are mov-


ing into the teleradiology market, you’re facing challenges because of the ways in which the practices are structured;


“The essence of what we need to preserve in radiology are the radiologist-physician relationship and the radiologist-patient relationship, and that latter relationship is still emergent, except in interventional radiology. I’ve seen teleradiology practices that can be extremely successful when the radiologist makes the effort to develop relationships with the physicians they’re reading for.” -- Cheryl Petersilge, M.D.


but also, those VC firms are entering the market to make money. And many smaller groups need the cover of larger groups; and personally, I’d rather see that happening in the guise of physician- owned practices or ownership by large academic medical centers—those can offer a lot of the benefits of being in an employed model, while not depleting their practice. Hagland: Dr. Petersilge, you put


your finger on something interesting, the ultimate fear of some radiologists, that radiological practice in the hands of some corporatists could become, well, corporatist; practice could feel very anonymous or miscellaneous. What other panelists would like to comment on the idea of the danger of


12 hcinnovationgroup.com | NOVEMBER/DECEMBER 2020


anonymization, versus having collegial relationships that feel supportive all around? Rosen: I think there’s a Goldilocks


sort of size, where you’re not too big or too small. I encourage our radiologists to leave the hospital and meet with referring practices; for example, we’ll do a lunch meeting with a large urol- ogy practice; and even if you do it just once a year, that contact and face-time is enough. And if they’re going over a case over the phone or remotely, if they’ve interacted with that person at least once, it makes it a more personal relationship. Now, you can’t do that on a national level, but you can do it on a local level. Wendt: I agree; we went from one


organization to seven in the time I’ve been here. But to avoid anonymization, we do have a core director of radiology at each site. If there were a hundred faces rotating through a rural hospital in a year, the referring physicians would be disenchanted with that. Also, we use the organization of the group to keep the turnaround time brief, but try to keep a small core group, so we don’t get that total revolving-door-type feeling. Towbin: Thinking about the consolida-


tion of radiology practices, there are two main benefits. One is around economy of scale and allowing services to grow, leading to 24/7 coverage and rapid turn- around times; those things are possible because you have a large practice. The other major benefit ties into that, and that’s super-specialization. I can be that pediatric abdominal radiologist, focus- ing on liver tumors. That’s possible in a large group. And that super-sub-spe- cialization is where we can start to really add value, in addition to 24/7 coverage and rapid turnaround. And that also can help to build research collaboration and partnerships. And with my specializa- tion of interests, we can build a focus around a specific clinical area. What it gets to is, how do we as radiologists and radiology departments show value? Per commoditization, any radiologist can read studies, but this adds value to that. Wendt: In our environment, we have


an academic group that’s very subspe- cialized, with, for example, pediatric neuroradiologists,but also a significant body of generalists. Some people do not want to be looking at head and neck tumor cases all day; for others, that’s appealing. So creating that variety is satisfying to everybody. And if it’s a referring community physician, if they see a bizarre head-and-neck case, it’s great that they can connect to that head- and-neck neuroradiologist with just a right click, and we can improve service to everyone. HI


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