Executive Summary: Report on the 2000-2001 Survey of Small and/or Rural Practices, June 2001(adapted for publication)
Background
The American College of Radiology's (ACR's) Commission on Small and/or Rural Practices was organized in 1998 to serve the needs and promote the interests of small and/or rural practices. To gain further information about factors that may influence the status of small and/or rural practices, the ACR research department conducted the 2000-2001 Survey of Small and/or Rural Practices for the commission. This survey involved the administration of a 29-item questionnaire to 146 radiologists between October 2000 and February 2001 using primarily mail survey methods. Eight-two individuals returned the survey questionnaire about small and/or rural practices, yielding a response rate of 56 percent.
After removing those who did not provide diagnostic radiology services and those who did not view themselves as part of a small and/or rural practice, the ACR research department analyzed the data for the remaining 72 radiologists. Highlights of the findings are presented below and are listed according to the six major areas outlined in the survey questionnaire: (1) human resources, (2) emergency room coverage, (3) compliance, (4) continuous quality improvement/quality control, (5) accreditation and (6) demographics. The number of individuals responding to each item is noted to make the reader aware of the number of observations on which the results were compiled. In some cases, the number of observations used for analyses was fewer than 72, mainly due to questionnaire skip patterns and question nonresponse. For some analyses, percentages may not add to 100 because of rounding, or because respondents could provide more than one response to a particular question. For many of these questions, each response option was considered to be its own variable.
Survey Results
1. Human Resources. Approximately 60 percent of 69 respondents indicated that their practice actively recruited diagnostic radiologists over the past 12 months. Of those that reported recruiting for generalized-task diagnostic radiologists (N=29), 45 percent stated that they filled all of these positions during this 12-month period. Fifty-three percent of 68 respondents stated that their practice will actively recruit diagnostic radiologists over the next 12 months.
Responding to a question about the recruitment of technologists at their practices over the past 12 months, 52 percent of 58 physicians reported that their practices actively recruited technologists during this period. In response to questions about technologist recruitment at facilities served by their practices over the past 12 months, 88 percent of 58 respondents reported actively recruiting technologists. Approximately 60 percent of 17 respondents reported filling all their technologist positions in general radiology at their practices. When asked about the number of technologist positions filled at facilities served by their practices, 70 percent of 35 respondents reported filling all available positions.
2. Emergency Room (ER) Coverage. Fifty percent of 66 respondents indicated that 24/7 teleradiology coverage, involving either multiple or all modalities, was used at the smallest hospital with an emergency room that their practice serves. Fourteen percent of these 66 respondents reported that the ER is not covered 24/7.
The median number of beds reported for the smallest hospital with an ER served by responding practices was 54. Out of the 60 respondents who reported about the number of beds, 75 percent stated that these hospitals had 100 beds or fewer. Generally, on-site service was provided five days a week, beginning between 7:30 and 8:00 in the morning and ending between 5:00 and 6:00 in the evening. Weekend/holiday on-site service generally began between 8:00 a.m. and 9:00 a.m. and ended between noon and 5 p.m. that same day.
Most respondents—95 percent of 60 physicians--stated that when a radiologist is not on-site, radiography exams are first "interpreted by an ER physician and then officially interpreted by a radiologist." A different pattern existed for the interpretation of computed tomography, magnetic resonance, ultrasound, and nuclear medicine exams when a radiologist was not on-site. In these modalities, respondents reported that films were mainly "officially interpreted by a radiologist at time of the exam" (presumably, this would be by teleradiology or by coming to the hospital). In response to a question on whether their practice actively monitors ER physician film interpretation for accuracy, approximately 80 percent of 66 respondents replied that this type of monitoring is conducted.
3. Compliance. Twenty-nine percent of 69 respondents reported that their nonhospital practice implements a formal set of compliance activities. Twenty-two percent of the 69 respondents reported that no formal set of activities had been implemented; most of the remainder practice only at hospitals. Sixty percent of 20 respondents--those with compliance activities at nonhospital practices--indicated that they perform at least four of the six compliance activities listed in the questionnaire. The compliance activity most frequently cited was the "auditing of billing and coding," whereas the least cited was the "review of billing company compliance plans." For hospital practices, approximately 50 percent of 65 respondents coordinate compliance activities with those of their hospital.
4. Continuous Quality Improvement (CQI)/Quality Control. Ninety-two percent of 61 respondents reported that a quality assurance program was in effect at their hospital. About half of respondents with nonhospital activity--54 percent of 35 respondents--stated that these programs were in effect at their nonhospital sites. The quality assurance activities that were most frequently reported were checks on image quality, monitoring of mammograms for accuracy, and image interpretation. The least-reported CQI activity was the review of medical record formats. Approximately 75 percent of 48 respondents reported that their practice is one of the entities that decide what CQI activities (at either hospital or non-hospital sites) are implemented.
5. Accreditation. The "implementation of an umbrella accreditation program" and the "reduction of cost" were ranked most highly as methods that could be used to enhance accreditation program participation among approximately 35 respondents. In contrast, the "establishment of a help line" and, even more so, the "acceleration of the accreditation process" were viewed by a lower percentage of respondents as likely to enhance program participation. Approximately 60 percent of 70 respondents reported that they would be interested in participating in an accreditation program currently required by government or third-party payers even if it was not required. Approximately one-fourth of 69 respondents reported that program criteria (particularly quantitative criteria) are keeping them from applying to accreditation programs. Cost and staffing issues comprised the other major reasons for not applying to accreditation programs.
6. Demographics. The imaging procedures that were reported to be performed most frequently by at least three practice members were magnetic resonance, computed tomography, mammography, and ultrasound. The median number of diagnostic radiologists (full-time plus part-time) reported working in practices was three (N=70). Eighty percent of 70 respondents reported being affiliated with practices containing five or fewer (total) post-training diagnostic radiologists. When specifically asked about part-time staff, 25 percent of 72 respondents reported having part-time staff in addition to their full-time staff; the number of part-timers ranged from one to three. The most frequently reported full-time equivalent of the part-timers was 0.5 (N=20; 30 percent of these responses were reported as "0.5").
Approximately 75 percent of 69 respondents reported that their practices served three or fewer physically separate settings. In terms of practice location, 46 percent of 70 respondents reported that their practice predominantly operates in a city, town, or suburb(s) with an area population of 10,000 to under 50,000. Approximately 70 percent of 70 respondents reported that the members of their practices used the Internet and/or e-mail services for practice-related purposes.
Conclusion
The conduct of the 2000-2001 survey exemplifies the efforts of the ACR's Small and/or Rural Practice Commission to serve the needs of radiologists in small and rural practices. The commission plans to apply the findings from the survey to guide upcoming actions, validate areas of concern, detect issues that may require further investigation, and, ultimately, to provide commission direction. Currently, commission members are volunteering their time to help resolve such critical issues as ER coverage, the appropriate role of the radiology assistant, and the potential advantages of loose networks or confederations of smaller radiology practices. Most recently, the commission has been involved in facilitating Internet discussions via the Small and/or Rural Practices Forum on the ACR Web site.