An employee of a New Jersey manufacturing plant fell from a ladder and sustained a painful injury to his right shoulder earlier this year. The attending orthopedic physician prescribed an MRI but was not able to get him into the imaging lab for three days. The lab sent films nearly a week later to the physician who diagnosed a shoulder contusion. The total time it took to get the patient's prognosis was almost two weeks.
If a musculo-skeletal sub-specialist had read the films—or better, yet, a digital image—they would have seen that the worker actually had a rotator cuff tear, a different injury requiring a different treatment. The patient would have returned to work much sooner, saving the firm and insurer tens of thousands of dollars in workers' compensation dollars and unnecessary medical fees.
Unfortunately, this scenario is not uncommon.
The U.S. workers' compensation industry pays over $55 billion in benefits annually with over $32 billion spent on medical procedures—including $1.3 billion in radiology services. This component of the healthcare market is growing and compounding at 10%-15% per annum, but an estimated 30%-50% of diagnostic tests are deemed inaccurate or unnecessary. Plus, workers can face waits of two to six weeks to obtain the results of an X-ray, MRI or CT scan, delaying diagnosis and the start of treatment and costing insurance companies millions in lost wages and indemnity insurance.
There is a better way for claims professionals at workers' comp carriers, third party administrators, and self-insured employers to manage their radiology services. It involves utilizing the most advanced imaging and scheduling technology.
Digital Access and Storage
Advancements in imaging technology have resulted in unprecedented levels of detail for non-invasive diagnosis of medical injuries, producing three-dimensional renditions of ailments that can be as clear as invasive exploratory procedures at a fraction of the cost. However, many physicians and radiology centers rely on films, and too often the wrong doctor is reading the images.
Teleradiology and PACS (picture archiving and communications systems) are two technologies that can fundamentally change the handling of diagnostic imaging in workers' compensation claims and improve the success of return-to-work strategies.
Teleradiology is the digital transmission of radiological patient images, such as X-rays, CTs and MRIs, from one location to another for interpretation and/or consultation. This means that the right specialist or sub-specialist in the field can pull up an image on their computer and read it, regardless of the location of the imaging center.
Contrast such instant access to the time delays in shipping film or copying a disk, sending it through the mail, and then having the radiologist, the treating physicians, or the consulting doctor read the image. Teleradiology turns these days and weeks into minutes and hours.
In addition to the speed in which images can be read, teleradiology can help make sure the most appropriate specialist or sub-specialist is reading the image. National teleradiology companies are available, and they have some of the leading board-certified radiologists in the country reading millions of studies per year. These radiologists specialize in specific injuries so the injury is diagnosed correctly the first time, thus avoiding re-reads and potentially unnecessary surgery.
Along with teleradiology, radiology services management should utilize PACS for image storage. PACS make digital image archiving possible, which means the injured worker is not responsible for delivery of the image and images are available immediately for follow-up study or secondary surgery. This technology is available at leading hospitals and radiology centers across the country.
Through PACS, all images are stored electronically, and immediate radiology results are available, thus reducing the time to diagnosis by up to three weeks. PACS archive images for future reference, allowing them to be read by the most qualified specialists or sub-specialists anytime after the initial diagnosis and making follow-up care faster and easier.
Scheduling and Quality
As described above, the radiologist acts as a gatekeeper in a crucial first step in getting an accurate diagnosis and treatment, but the radiology services management process begins with scheduling.
A great example of how electronic scheduling can speed customer service is found in the travel industry, where customers are matched to the most appropriate flight, hotel or other service. Not only does each airline and hotel chain have its own system, but discount services like Expedia, Priceline or Orbitz coordinate multiple services.
Similar technology is available in radiology services management to make sure injured workers are scheduled at the most appropriate imaging center as quickly as possible. This first step, when combined with the instant access of teleradiology and digital archiving, can further the efficiencies and cost savings in managing radiology services used in workers' compensation cases.
Along with improvements in access, storage and scheduling, radiology services management must utilize quality control. When scheduling, it's essential that certification and credentialing requirements are used to select the best physicians and imaging centers. Sometimes a radiology services company will utilize a medical review board to check tests and reports from imaging providers for accuracy and appropriateness.
The vetting process should include on-site inspections of the providers for verification of appearance, staffing, hours and equipment, and the radiology services company should conduct ongoing quality review of a random selection of images from each center for image quality, appropriateness, report accuracy, consistency and timeliness.
Through these four components—access, storage, scheduling and quality—radiology services management can reduce the one-to-three-week industry average for reading diagnostic images to just 24-48 hours. That can significantly reduce the time an injured employee is off the job, saving thousands of dollars in indemnity payments per case.
is CEO of NextImage Medical
, the technology leader in radiology services management. www.nextimagemedical.com