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  • Virtual Rad…

    Posted by pranav.devata on July 27, 2023 at 10:21 am

    At what price point do you tell vrad to go eff themselves? We have a good payor mix and they bill for everything they read. They recently TRIPLED the subsidy they demand on top of those fees. It’s not enough to afford a new rad, but its like starting salary big. Absolute effing greed by PE radiology. They claim it’s because they are increasing raqdiologist pay so much….yeah, I would like to see that data. I have to wonder how many groups will drop vrad and go with someone else, or internal nights. We will be doing some hardline beancounting in the next few weeks……

    tdetlie_105 replied 11 months, 3 weeks ago 26 Members · 43 Replies
  • 43 Replies
  • alex.nieto_484

    Member
    July 27, 2023 at 10:46 am

    there is something ironic about this post

    • alvarezgga1

      Member
      July 27, 2023 at 3:42 pm

      we cut the cord last year with VRAD and have been happy

  • tdetlie_105

    Member
    July 27, 2023 at 4:03 pm

    Quote from dysdiadochokinesia

    At what price point do you tell vrad to go eff themselves? We have a good payor mix and they bill for everything they read. They recently TRIPLED the subsidy they demand on top of those fees. It’s not enough to afford a new rad, but its like starting salary big. Absolute effing greed by PE radiology. They claim it’s because they are increasing raqdiologist pay so much….yeah, I would like to see that data. I have to wonder how many groups will drop vrad and go with someone else, or internal nights. We will be doing some hardline beancounting in the next few weeks……

     
    How large a group are you?  Alternatives are hiring dedicated overnight rads or internal overnight coverage.  Each comes with their pros/cons.  I will say in general. most/many rads are not interested in working overnights
     
    Other ideas would be asking the hospital to subsidize, and (this is likely a pipe dream) but renegotiate your next contract to cover 7am-midnight and let the hospital figure out the overnights 

    • Zuleyka

      Member
      July 27, 2023 at 5:33 pm

      Maybe hire me? I would love to move to Norway with my Norwegian wife and would be happy to read anything and everything overnight for a US practice. But then the morning radiologists would have to over-read medicare studies, and possible other studies.

      • tdetlie_105

        Member
        July 27, 2023 at 6:31 pm

        Quote from TripleJumper

        Maybe hire me? I would love to move to Norway with my Norwegian wife and would be happy to read anything and everything overnight for a US practice. But then the morning radiologists would have to over-read medicare studies, and possible other studies.

         
        I wouldn’t think this is a deal-breaker.  None of the groups that I worked for have had final overnight night hawk reads.
         
        Inability to cover overnights could potentially become an issue for many groups since its too expensive to pay for night hawk, very hard to find FT overnight rads that are working at a significant discount, and group demographics/culture may not be conducive to in-house overnight coverage.

      • alex.nieto_484

        Member
        July 28, 2023 at 8:03 am

        Quote from TripleJumper

        Maybe hire me? I would love to move to Norway with my Norwegian wife and would be happy to read anything and everything overnight for a US practice. But then the morning radiologists would have to over-read medicare studies, and possible other studies.

         
        Would that work on a 6 hour time difference? Covering east coast US from 10 PM to 7 AM would be 4 AM to 1 PM in Oslo.
         
        I think your Norwegian wife is stuck living in the US. Poor girl.

        • Zuleyka

          Member
          July 28, 2023 at 8:59 am

          I’d wake up at 330 for the opportunity to live in Oslo and make her happy. 
           
           

          • abd.fawzi_217

            Member
            July 28, 2023 at 9:30 am

            With the rad shortage you’d think it wouldnt be that hard to find a west coast practice that could use a reliable overnight tele guy and the hours would work perfectly

          • alex.nieto_484

            Member
            July 28, 2023 at 9:52 am

            Quote from TripleJumper

            I’d wake up at 330 for the opportunity to live in Oslo and make her happy. 

            It wouldn’t be impossible for this to work.
             
            What kind of group is your current group? How are they currently handling nights? These things are always easier to arrange when you already have a good working relationship with the group.

            • Zuleyka

              Member
              July 28, 2023 at 10:26 am

              Agreed with both RadCog and boggles. My group is a no-go as they already have an agreement with another practice and we are short-staffed as it is so they wouldn’t be too keen on my moving.
               
              I would think I could find a group willing to give this a try – I just don’t know how to get in touch with all of them, to say “Here I am. Any interest?”
               
              Any ideas how to essentially put my idea out there where many will see it? AuntMinnie is one way and hence my replies here.

              • cody.a.keller_68

                Member
                July 28, 2023 at 10:42 am

                Try facebook telerad group. 

              • alex.nieto_484

                Member
                July 28, 2023 at 11:18 am

                Quote from TripleJumper

                Agreed with both RadCog and boggles. My group is a no-go as they already have an agreement with another practice and we are short-staffed as it is so they wouldn’t be too keen on my moving.

                I would think I could find a group willing to give this a try – I just don’t know how to get in touch with all of them, to say “Here I am. Any interest?”

                Any ideas how to essentially put my idea out there where many will see it? AuntMinnie is one way and hence my replies here.

                 
                I would imagine the tele companies would be the first place to start. I would contact every single one of them and see if they have an interest in hiring a US board certified radiologist who wants to read from outside the US. The pay per case for tele is not good and I imagine it might be even lower if you can only do prelims or some final reads depending on insurance.
                 
                But if you want to wake up at 330 every morning to churn through cases at $25/RVU there might be a job for you out there. Please report back if you end up finding anything out.

                • daberechimoses59_164

                  Member
                  July 28, 2023 at 3:25 pm

                  At some point in the very near future, at least in most cases, if hospitals want on demand after hours rad coverage , they are going to have to foot the entire bill for it. Hospital administrators are usually incredibly dense, but in my anecdotal experience at least , they are starting to see that there is no where else to turn in this market and they arent going to be able to bring in a new group just because they dont like the terms of what a group is offering in a renegotiated contract

                  • kmh0667

                    Member
                    July 28, 2023 at 3:50 pm

                    Not to sound like an a…, but —If you don’t want to pay Virtual Radiology or whoever to read your overnights—-just take your own call. Why are you even asking?? Easy answer.

                    • abananarest

                      Member
                      July 28, 2023 at 8:50 pm

                      For people in smaller groups (like 3-5 rads), its typically not possible to cover deep nights and there is a reliance on telerad groups such as vrad. So just saying if you dont like it then cover your own nights! isnt really feasible.

                    • kmh0667

                      Member
                      July 29, 2023 at 5:58 pm

                      Sure it is, you only have 3 options- cover your own nights, pay V-rad/whoever, or have the hospital pay.

                    • Unknown Member

                      Deleted User
                      July 29, 2023 at 9:35 pm

                      Supply and demand. Same groups were slashing what they paid Vrad in 2012. Now pendulum has swung the other way. Deal with it.

                  • tdetlie_105

                    Member
                    July 28, 2023 at 4:57 pm

                    Quote from tiger81

                    At some point in the very near future, at least in most cases, if hospitals want on demand after hours rad coverage , they are going to have to foot the entire bill for it. Hospital administrators are usually incredibly dense, but in my anecdotal experience at least , they are starting to see that there is no where else to turn in this market and they arent going to be able to bring in a new group just because they dont like the terms of what a group is offering in a renegotiated contract

                     
                    We do cover out overnights but getting harder to get our in-house rads to volunteer despite high compensation/shift.  Hard to tie in time-off with these shifts as we are already short-staffed.   This is why I was thinking why not renegotiate a contract for 7am-MN and let the hospital figure out the overnights. 

                    • ipadfawazipad_778

                      Member
                      July 28, 2023 at 5:36 pm

                      My limited experience says rather than pay up. TAT expectations will be adjusted for overnights now that its possibly on the hospital to solve the problem. Because hey lets be honest Im pretty sure the only problems most administrators solve are financial and creating more non clinical jobs.

                    • tdetlie_105

                      Member
                      July 29, 2023 at 7:58 am

                      Quote from AKOMAN

                      My limited experience says rather than pay up. TAT expectations will be adjusted for overnights now that its possibly on the hospital to solve the problem. Because hey lets be honest Im pretty sure the only problems most administrators solve are financial and creating more non clinical jobs.

                       
                      While I don’t disagree with your overall sentiment, the stroke code metrics are pretty strict and increased TAT means decrease in TAT for pt disposition/freeing up beds which equals money lost.

                    • farzadahmadimedrn710_43

                      Member
                      July 29, 2023 at 9:31 am

                      As if a radiologist is actually needed for code strokes at many places. Where I work the neurologist has looked at the scan, interpreted the scan and acted upon that interpretation before any image is sent to PACS.

                    • tdetlie_105

                      Member
                      July 29, 2023 at 4:09 pm

                      Quote from bluedeep

                      As if a radiologist is actually needed for code strokes at many places. Where I work the neurologist has looked at the scan, interpreted the scan and acted upon that interpretation before any image is sent to PACS.

                       
                      I wish hospital admin would look at this but unfortunately we are stuck with documenting metrics.  Its a b*tch as we are trauma 1 and are expected to drop everything we are doing for these stroke codes.  We tend to get the CTA and perfusion via the app before they do as well.

                    • mikestein

                      Member
                      July 29, 2023 at 11:35 pm

                      Telling the hospital admin that nights are their problem may sound nice but hospital admins are typically reptilian in their thinking. They’ll see you as the problem, not the currently distorted marketplace, and get rid of you all together even if it entails pain for them. They may have the telerad group take the entire contract. They tend to care more about short term stability than money. Average hospital admin is gone in a few years, out to greener pastures, just like their soul brothers in private equity.  

                    • ruszja

                      Member
                      July 30, 2023 at 4:43 am

                      Quote from TarverForPresident

                      Telling the hospital admin that nights are their problem may sound nice but hospital admins are typically reptilian in their thinking. They’ll see you as the problem, not the currently distorted marketplace, and get rid of you all together even if it entails pain for them. They may have the telerad group take the entire contract. They tend to care more about short term stability than money. Average hospital admin is gone in a few years, out to greener pastures, just like their soul brothers in private equity.  

                      The only time you may be able to tell the hospital that it is their problem is if you have a small difficult to staff hospital contract that is coming up for renewal (or if you work without a hospital contract).
                      Sure, you could re-negotiate the terms of your existing contract, but short of the threat of group collapse, there is little reason for the hospital to re-negotiate.

                    • ehabmashaal_882

                      Member
                      July 30, 2023 at 7:57 am

                      The other thing is – do you find anyone to replace them and are they much cheaper? Several telerads outfits don’t take new clients and some even kick (have to) existing clients to the curb. It just seems that it is what you have to pay if you have less than 1 FTE night work or partners cannot cover nights themselves.

                    • DanielQuilli

                      Member
                      July 30, 2023 at 11:17 am

                      Quote from TarverForPresident

                      Telling the hospital admin that nights are their problem may sound nice but hospital admins are typically reptilian in their thinking. They’ll see you as the problem, not the currently distorted marketplace, and get rid of you all together even if it entails pain for them. They may have the telerad group take the entire contract. They tend to care more about short term stability than money. Average hospital admin is gone in a few years, out to greener pastures, just like their soul brothers in private equity.  

                       
                      Good luck replacing any group right now. And I really doubt any of the big telerad outfits have the capacity to replace a group.

                    • mwakamiya

                      Member
                      July 30, 2023 at 1:50 pm

                      Plenty of guys wanting to do late night work, however issue is they usually want to be 1 week on and 2 weeks off and are about 1.5 to 2 times the expense of daytime rads.  Thus to have an effective internal nighthawk team, think of at least 3 rads.  This is a tall order these days even for bigger groups as they are ALL short on daytime coverage. 

                    • tdetlie_105

                      Member
                      July 30, 2023 at 2:24 pm

                      Quote from tigershark06

                      Quote from TarverForPresident

                      Telling the hospital admin that nights are their problem may sound nice but hospital admins are typically reptilian in their thinking. They’ll see you as the problem, not the currently distorted marketplace, and get rid of you all together even if it entails pain for them. They may have the telerad group take the entire contract. They tend to care more about short term stability than money. Average hospital admin is gone in a few years, out to greener pastures, just like their soul brothers in private equity.  

                      Good luck replacing any group right now. And I really doubt any of the big telerad outfits have the capacity to replace a group.

                       
                      Not going to underestimate Hospitals/HC systems but I kinda agree.  Replacing a small/mid-sized group (20-30 rads) that requires 5-7 boot on the ground IR/breast imagers is no small task.  This should result in higher subsidies for IR/DR overnight call but guess we will see.

                    • Zuleyka

                      Member
                      July 30, 2023 at 2:30 pm

                      Right. if it costs 1.5-2x FTE to have US-based radiologists work overnight.
                       
                      I would work for 1.0x from overseas, but then the morning rads have to over-read the reports.

                    • bcrockrell_412

                      Member
                      July 31, 2023 at 4:08 am

                      After VRAD essentially doubled their cost for our medium sized group of 17, we started looking elsewhere for overnight coverage. Then VRADs TAT began to get worse. We decided enough was enough and switched overnight telerad coverage for better rates. Been with the other group (rhymes with fat lad) for a few months now. In my opinion, you get what you pay for. Lots of misses, some minor and some major. Terribly brief reports. Long TAT. Cautiously optimistic that it will improve if they can hire more readers. Would like to hear of others experience with different telerad options.

                    • seb_arrosa_904

                      Member
                      July 31, 2023 at 9:08 am

                      are you talking about stat rad

                    • bcrockrell_412

                      Member
                      July 31, 2023 at 12:11 pm

                      Stat rad
                      Fat lad
                      That bad

                      Yup. Winner winner.

                    • 22002469

                      Member
                      July 31, 2023 at 1:15 pm

                      Quote from DrTimWhatley

                       In my opinion, you get what you pay for. Lots of misses, some minor and some major. Terribly brief reports. 

                       
                      No doubt about that.
                       
                      Many of the rads on the other end those “reports” are pulling in 7 figures/year to spend 20 seconds on a CT. With little care for the patient or the outcome. Noble work.

                    • smfst7_929

                      Member
                      July 31, 2023 at 1:57 pm

                      Well we need more competition- more telerads companies. Can’t get that until shortage abates.  If shortage abates, you have other pressures that affect compensation- hospital breathing down your neck, wanting better TaT so have to hire another rad, etc. In this game, the system always wins. 
                       
                      Funny though, because I’ve heard plenty of stories of groups being hit with a massive upcharge by vrad, etc yet they are more than happy to pay it. The fear of working nights is real, particularly in those far removed from such things. At the end of the day, OP is going to pay through the nose and say thank you for the privilege.  That is the market we are in.

                    • gmail.com

                      Member
                      July 31, 2023 at 3:59 pm

                      I think it is too expensive to run a telerad company especially w/ most clients wanting final reads.  Prelims is cheaper to administer.  Plus rad compensation needs are getting higher and higher.
                       
                      I think you hit the nail on the head.  The thought of working nights is so unappealing for the average rad who is in their 40s and tired of staying up late.
                       
                      At least if the quality was top notch, then the prolonged tats would be acceptable.  Maybe.  But when you are paying for avg TATs exceeding 1 hr, getting ripped apart by admin or the ED chief and then getting major discrepancies thrown in your face, it is really hard to accept all this.  If one were getting a peaceful night of sleep then maybe it would be worth it.
                       
                      I don’t know.  Radiology in the USA is such a mess. 
                       
                       

                      Quote from sartoriusBIG

                      Well we need more competition- more telerads companies. Can’t get that until shortage abates.  If shortage abates, you have other pressures that affect compensation- hospital breathing down your neck, wanting better TaT so have to hire another rad, etc. In this game, the system always wins. 

                      Funny though, because I’ve heard plenty of stories of groups being hit with a massive upcharge by vrad, etc yet they are more than happy to pay it. The fear of working nights is real, particularly in those far removed from such things. At the end of the day, OP is going to pay through the nose and say thank you for the privilege.  That is the market we are in.

                    • sraghuvanshi1

                      Member
                      July 31, 2023 at 4:48 pm

                      Quality, TAT and cost have to be traded off against each other. There are certain tele providers that emphasize quality, but they usually cost more.
                       
                      Many groups complain about misses, but revealed preference shows they’d rather pay less and get lower quality reads with higher TAT.

                    • tdetlie_105

                      Member
                      July 31, 2023 at 4:58 pm

                      Quote from golden gate

                      Quality, TAT and cost have to be traded off against each other. There are certain tele providers that emphasize quality, but they usually cost more.

                      Many groups complain about misses, but revealed preference shows they’d rather pay less and get lower quality reads with higher TAT.

                       
                      At the end of the time when its comes to metrics, TAT is much easier to objectively quantify, thus appeasing hospital administration…We all know what a “miss’ is, but defining “quality” becomes subjective and tricky 

                    • reuven

                      Member
                      July 31, 2023 at 8:40 pm

                      Getting overnight help for cheap became an expectation when it should have been clear that it was temporary.  These companies grew over a multiyear bad job market.  Now that the job market has reversed overnight work in radiology needs to be paid a significant premium.  VRad is owned by RP which seems to be struggling financially.  So it shouldn’t be suprising that they’re increasing rates.  Either directly hire radiologists to cover your and other practices under a cooperative agreement or deal with the high priced crappy overnight coverage and consider yourself fortunate to have had the benefit of getting this service for cheap for many years

                    • g.giancaspro_108

                      Member
                      August 1, 2023 at 7:53 am

                      Is everyone only having trouble with overnights, or you having difficulty getting/keeping coverage for evening “second shift” as well?
                      We have trouble keeping evening shift and no trouble with overnight shift, thus we’ve been paying more for evenings than overnights. (all shifts covered internally).

                    • farzadahmadimedrn710_43

                      Member
                      August 1, 2023 at 9:56 am

                      do you give your overnight people more time off than evenings? do you understaff one shift more than the other so it’s more stressful?

                    • g.giancaspro_108

                      Member
                      August 1, 2023 at 10:10 am

                      Overnights work 2 hours more than evening shift.  The volumes are similar and each team can adjust their own staffing so if they feel volume is a the problem they can titrate to their liking.  The complaints are that the difficulty of the studies is greater in the evenings (more cancer studies, more trainwreck inpatients) whereas the overnights tend to be more straightforward ER patients. Since most of us have done all the shifts their is general agreement, hence our efforts to make it equitable. We pay the evening shifts the most and we would have no trouble recruiting if we didn’t mind turnover but we want long term partners so try to make every shift equally challenging/rewarding. We let people move shifts but the evenings are the trouble spot. It is not super easy to balance.
                       
                      Are you seeing anything like this or only have trouble with overnight coverage?

                    • tdetlie_105

                      Member
                      August 1, 2023 at 4:16 pm

                      Quote from sandeep panga

                      Overnights work 2 hours more than evening shift.  The volumes are similar and each team can adjust their own staffing so if they feel volume is a the problem they can titrate to their liking.  The complaints are that the difficulty of the studies is greater in the evenings (more cancer studies, more trainwreck inpatients) whereas the overnights tend to be more straightforward ER patients. Since most of us have done all the shifts their is general agreement, hence our efforts to make it equitable. We pay the evening shifts the most and we would have no trouble recruiting if we didn’t mind turnover but we want long term partners so try to make every shift equally challenging/rewarding. We let people move shifts but the evenings are the trouble spot. It is not super easy to balance.

                      Are you seeing anything like this or only have trouble with overnight coverage?

                       
                      Covering weekly block of overnight shifts have not been an issue yet.  However a smallish minority does the majority of these.  Once one or two of these rads retire, there will be issues unless newer/other rads step up.  Related issue is that this is slowly but steadily become more than 1 rad to handle.  Despite paying extremely well, the intervening weekend overnights are becoming harder to fill but eventually they do. 
                       
                       
                       
                       

                    • sehyj1

                      Member
                      July 31, 2023 at 2:21 pm

                      Quote from Radsoxfan

                      Quote from DrTimWhatley

                      In my opinion, you get what you pay for. Lots of misses, some minor and some major. Terribly brief reports. 

                      No doubt about that.

                      Many of the rads on the other end those “reports” are pulling in 7 figures/year to spend 20 seconds on a CT. With little care for the patient or the outcome. Noble work.

                       
                      We pay them way too much for their shitty work