A Day in the Life of Radiology

The RPC Indices – A Day in the Life of Radiology – highlight critical insights based on day of week and hour of day segmentation of imaging studies from the vRad clinical database.

vRad analysis has defined three radiology shifts, Onsite, Midhawk and Deephawk, each with distinct implications for operational efficiency, cost control and quality of patient care. The chart below outlines the timeframes for each of the three radiology shifts.

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Consolidated 24/7 View

Economic Value (RVU Yield)

Weekday (M-F) View

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Onsite M-F 7AM to 6PM; 8AM to 12PM on Sat

Midhawk M-F 6PM to 12AM

Deephawk M-F 12AM to 7AM; 12PM Sat to 7AM Mon


Consolidated 24x7 View: Economic Value - Summary

Onsite Midhawk Deephawk
Shift Hours 59 30 79
% of Total Hours 35% 18% 47%
% of Total Volume 61% 16% 23%
% of Total RVU Value 70% 19% 11%
RVU/Study Ratio .97 .86 .73

Consolidated 24x7 View: Economic Value - Onsite

Onsite
Shift Hours 59
% of Total Hours 35%
% of Total Volume 61%
% of Total RVU Value 70%
RVU/Study Ratio .97

Radiology Shift Insight

  • The most challenging of the 3 shifts due to constant interruptions and volatility caused by intermingling Outpatient, Inpatient and ED imaging demands
  • Volume peak and greatest modality mix
  • 96% of Functional IR procedures occur during this shift
  • 97% of Women's Imaging occurs during this shift

Consolidated 24x7 View: Economic Value - Midhawk

Midhawk
Shift Hours 30
% of Total Hours 18%
% of Total Volume 16%
% of Total RVU Value 19%
RVU/Study Ratio .86

Radiology Shift Insight

  • Efficient RVU Yield based on duration of shift
  • Shift is dominated by acute ED imaging
  • 87% of the CTs that are ordered during this shift are STAT
  • Constant need to communicate critical findings to various EDs: impact on efficiency without administrative and operational support

Consolidated 24x7 View: Economic Value - Deephawk

Deephawk
Shift Hours 79
% of Total Hours 47%
% of Total Volume 23%
% of Total RVU Value 11%
RVU/Study Ratio .73

Radiology Shift Insight

  • Lowest RVU/Study Ratio of all 3 shifts
  • Much higher % of Inpatient studies (including priors) vs. Midhawk shift
  • 58% of volume in this shift is X-ray
  • ED volume often prevents Rads from getting to more complex Final Inpatient X-rays toward the end of the shift which impacts morning rounds and ability to start the Onsite shift "flat." Impact to length of stay and Onsite shift scheduling.

Onsite M-F 7AM to 6PM; 8AM to 12PM on Sat

Midhawk M-F 6PM to 12AM

Deephawk M-F 12AM to 7AM; 12PM Sat to 7AM Mon


Weekday View: Modality Mix

Onsite Midhawk Deephawk Total
XR 47% 56% 64% 50%
CT 17% 30% 29% 21%
MG 13% 1% .01% 9%
US 10% 8% 6% 9%
MR 6% 3% .36% 5%
NM 3% .5% .63% 2%
FL 2% .39% .17% 2%
IR 2% .54% .01% 1%
Total 100% 100% 100% 100%

Key Insights

  • The majority of the CTs during the Deephawk shift are STATs from the ED
  • Inpatient X-rays replace higher value US and MRIs with transition from the Midhawk to the Deephawk shift
  • The Deephawk shift provides an opportunity to deliver final interpretations in time for morning rounds during the Onsite shift

Onsite M-F 7AM to 6PM; 8AM to 12PM on Sat

Midhawk M-F 6PM to 12AM

Deephawk M-F 12AM to 7AM; 12PM Sat to 7AM Mon


Weekday View: Patient Type

Onsite Midhawk Deephawk Total
Emergency 35% 78% 71% 51%
Inpatient 27% 17% 27% 25%
Outpatient 38% 5% 2% 24%
Total 100% 100% 100% 100%

Key Insights

  • The Onsite shift balances high value Outpatient volume with high volatility from ED and Inpatient imaging
  • The majority of Women's Imaging and Interventional Radiology occurs during the Onsite shift
  • Inpatient imaging requirements increase dramatically when transitioning from the Midhawk to Deephawk shift

Onsite M-F 7AM to 6PM; 8AM to 12PM on Sat

Midhawk M-F 6PM to 12AM

Deephawk M-F 12AM to 7AM; 12PM Sat to 7AM Mon


Weekday View: Functional IR*

Onsite Midhawk Deephawk Total
IR 69% 84% 17% 70%
US 21% 16% 83% 21%
CT 5% .48% 0% 4%
FL 3% 0% 0% 3%
MG .9% 0% 0% .85%
MR .15% 0% 0% .14%
Total 100% 100% 100% 100%
% of Total IR Procedures 94% 6% .17% 100%

Key Insights

  • Functional IR includes many more modalities than Angio/IR when properly categorized
  • Nearly all Functional IR occurs during the Onsite shift
  • Functional IR is "High Touch" - and the high value add of Radiology

* Functional IR is a classification of each CPT code based on whether the study requires an interventionist, irrespective of the imaging modality used to provide the guidance. For example, a CT-guided biopsy is "functionally speaking" an IR procedure.

Onsite M-F 7AM to 6PM; 8AM to 12PM on Sat

Midhawk M-F 6PM to 12AM

Deephawk M-F 12AM to 7AM; 12PM Sat to 7AM Mon


Weekday View: Reading Location

Onsite Midhawk Deephawk Total
Local - Onsite 6% .64% .35% 4%
Remote 88% 91% 92% 89%
Supervision Required - can be read remotely 6% 9% 8% 7%
Total 100% 100% 100% 100%

Key Insights

  • Hospitals must understand the need of reading laterally (across facilities) when balancing their requests for onsite staffing with reading within 11 different sub-specialties
  • The majority of diagnostic imaging can be read laterally during all 3 shifts
  • Women's Imaging and Interventional Radiology are the face and hands of a radiology department during the Onsite shift

Onsite M-F 7AM to 6PM; 8AM to 12PM on Sat

Midhawk M-F 6PM to 12AM

Deephawk M-F 12AM to 7AM; 12PM Sat to 7AM Mon


Weekday View: Economic Value (RVU Yield)

Onsite Midhawk Deephawk
Shift Hours 55 30 35
% of Total Hours 46% 25% 29%
% of Total Volume 70% 20% 10%
% of Total RVU Value 74% 19% 7%
RVU/Study Ratio .96 .85 .76

Key Questions

  • How many weeks per year can an individual Radiologist cover the Deephawk shift?
  • When stipends are eliminated, does it still make sense to do preliminary reads?
  • Have you ever isolated and analyzed the economics of your Deephawk shift? Can you?