On the surface, the work of Dr. Arl Van Moore Jr. in some ways mirrors that of a photographer. During an appointment, images are made. Each will tell a story. And some reveal more than others. But unlike a photographer, Moore’s work literally captures what lies on the inside.
A well-established and respected radiologist, Moore is the president of Charlotte Radiology, a group that has burgeoned from a handful of radiologists in 1967 to nearly 70 today. In addition to offering an MRI scanner dedicated solely for breast imaging and biopsy, Charlotte Radiology offers a host of subspecialties within radiology and specifically trained staff to handle each. Its thrust is to provide quality health care through its screening and imaging services throughout greater Charlotte.
“One goal was to make radiology more convenient: to bring services to where our patients live and work,” says Mark Jensen, Charlotte Radiology COO. “By working with hospitals in and around Charlotte and developing an outpatient radiology strategy with Carolinas HealthCare System, we have made our subspecialized imaging services more accessible to patients.”
Charlotte Radiology administers 24/7 coverage for more than 10 hospitals, including those in the Carolinas HealthCare System, with which it jointly owns four Carolinas Imaging Service centers in Ballantyne, Matthews, Morrocroft and Northcross. The group also owns and operates 12 breast centers and the Charlotte Radiology MRI Center.
“We are as far west as Lincolnton, as far east as Laurinburg, as far north as Statesville and have breast operations in Rock Hill,” Jensen says.
Though Charlotte Radiology has done some radio and print advertising, much of their business comes from referring physicians.
Some may view a radiologist’s job as simply photographing body parts, taking slide after slide and viewing them in a light box, but Moore explains, “A radiologist is not just someone who walks into a room and takes your picture. He or she is a person involved in the entire gamut of medical care. Frequently, a radiologist will make the diagnosis before an internist or someone else does because of what they see on the imaging. Some call us the ‘doctor’s doctor.’”
A Closer Look
Charlotte Radiology has certainly flourished since it began 41 years ago, when a few radiologists practicing at CMC got together and formed a business relationship, recalls Moore, who trained at Duke University. Moore joined Charlotte Radiology in 1983 and specializes in interventional radiology and cross-sectional imaging.
“Then (in 1967), only a few radiologists were needed full-time at a hospital, and one radiologist did everything,” Moore asserts. “Now we have dozens and we’re highly sub-specialized, what I call approaching hyper-sub-specialization.”
Some of Charlotte Radiology’s subspecialties include body imaging, diagnostic radiology, emergency radiology, neuroradiology, musculoskeletal, interventional oncology, and pediatric radiology.
Most people know of an MRI (magnetic resonance imaging), a PET/CT scan (positron emission tomography / computed tomography) or an ultrasound, which produces images of soft tissue and organs in the body through the use of sound waves that reflect back and are displayed as a real-time image.
The MRI was patented in 1977 and Moore says it has become one of the key tools they use, especially in diagnosing and imaging of the neuro-axis musculoskeletal system and areas within the chest and abdomen.
In 1974-75, when the CT scan came out as a single-slice scanner, Moore adds, it took more than 10 minutes to scan a head for eight to nine pictures and in some cases up to four minutes to generate one slice of an image. “Now we can do that in a few seconds with a much higher spacial resolution.”
“There are facets of radiology that didn’t exist 30 years ago,” furthers Moore, “that’s why it’s become an explosive field, very technologically oriented as you can imagine, with no one person able to do it all anymore.”
Moore and his team use improved reading technology to interpret their findings. Much of what Charlotte Radiology reads today is done via computers, computerized workstations and TV monitors. Teleradiology has enabled Charlotte Radiology to transport images electronically next door as easily as they can halfway around the world, Moore remarks.
He adds, “We have a large number of hospitals whose imaging data we cover and send to one central place. So we don’t have 13 radiologists sitting in 13 hospitals, but we are able to transport the subspecialty expertise of several radiologists to many different hospitals.”
Additionally, that sophisticated software typically negates a need for a second read of a screening mammogram, for example, because it facilitates any deficiencies by analyzing the breast images.
Behind the Screens
Charlotte Radiology has taken great care to welcome visitors to its Web site as a source of information. Given the staggering amount of services Charlotte Radiology offers and the fact that patients may be dealing with critical medical issues, it provides for easy navigation. Each of the breast and imaging centers offer a mapping segment allowing patients to route their trip to a facility.
Services and procedures are described. For example, for Carolinas Imaging Services the procedures of Computed Tomography (CT), X-ray, Ultrasound and CT Lung Cancer Screening are listed with a brief description of each. Patients can read how to prepare, what to expect, view a bio and photo of a radiologist, and be given a cross-reference to other Charlotte Radiology facilities offering the same procedures. Phone numbers are direct, with one each for the Breast Center, General Imaging and Vein and Vascular.
“We try to centralize it,” acknowledges Jensen, a CPA who joined Charlotte Radiology more than 20 years ago. “If there’s a backlog at one site, it makes it easier for patients to have an option to go to another one.”
With the exception of a screen mammography, all other exams require a referring physician’s order. So, he continues, “If one is symptomatic, having a lump in her breast or a discharge, she would see her ob-gyn or primary care provider, and that person would order a diagnostic mammogram. But if a woman is asymptomatic and needs only a screening mammography procedure to look for undetected cancers at an early stage, she can schedule her own exam.”
Systemwide, Charlotte Radiology handles more than one million “patient encounters,” cites Moore, adding that that number includes patients who have had one or more appointments.
Bolstering that number is the fact that many people are more aware and vigilant about screening.
“They’re typically religious about having their annual mammograms,” Moore affirms. “A lot of that comes from community education, health fairs, branding of our own name, women’s magazines and reminder cards we send.”
Because of the nature of their business, Charlotte Radiology’s competition comes from other radiology practices, of course, but also from referring doctors who may elect to put equipment in their own offices. Jensen rues the latter, pointing out, “Just having the equipment is not the equivalent of having the same degree of training that a radiologist goes through.”
In April, the North Carolina Radiological Society bestowed its highest honor, the Silver Medal Award, on Moore, who weighs in on Jensen’s statement.
Moore has met with Congress and others outside and within the medical realm to emphasize the importance of having well-trained radiologists to perform exam-specific medical imaging.
“My concern is that there may be individuals who would want to perform imaging studies and may not have the same qualifications,” says Moore. “After medical school, we go through four years of residency, and one or two years of fellowship in order to learn how to do that subspecialty, whereas other physicians may not.”
The Price for Progress
The technological advances such as with the MRI and CT scan, though undoubtedly beneficial, come at a premium. “Technology is a great tool but not an inexpensive one,” acknowledges Jensen.
“With all of Charlotte Radiology’s radiologists, its breast and imaging centers and the Dilworth corporate office, that’s a wealth of equipment. You’re talking about substantial investments in capital infrastructure,” says Moore. He likens radiological equipment to that of a laptop computer; its shelf life is relatively short before a new model arrives.
CT scans 10 years ago, Moore adds, comprised up to 10 pictures; “Today these examinations can have more than 1,000 pictures and have more data embedded.”
And those images, as with most medical records, not only need to be stored and delivered in a timely manner, but along the way may encounter impediments such as compatibility issues when interfacing with other software in the transfer of these images.
As with the 1,000-picture CT scan, the file sizes are obviously much larger. And a physician may want the data embedded in a patient’s electronic health record.
Depending on the platform one uses, say, a PC or a Mac, the two don’t always play well together. Or, as Jensen points out, another glitch may be that one may use a quicker high-speed Internet connection to open an e-mail as opposed to the telephone dial-up, which takes considerably longer to download files.
“Today, everyone wants more, ‘I want that thing to pop up and be able to access the prior film, split the screen and look at it now,’” Moore observes. “You need to have the technology to deliver that, the speed, the characteristics and complexity, the manipulation of it—in real time.”
Charlotte Radiology accepts 25-plus insurance plans. And as many know, the terms of insurance policies in general can be bewildering, begat billing headaches and in turn delay payment.
“There is a lot of complexity in all of these areas of subspecialization,” Moore concedes. “It depends on the nature of the exam, the disease process you’re trying to evaluate.”
Hampering further the intricacies of billing and paying for those subspecializations are other factors, and Jensen cites a growing problem.
“There’s a significant amount of uninsured or under-insured individuals,” he says. “So our ability to get paid is obviously going to be more challenged.” Consequently, Jensen adds, it’s becoming harder to manage the lack of or decline in reimbursement, given the rising operating expense environment.
Challenges aside, the group has achieved some impressive accolades along the way. Moore, who is an interventional radiology CAQ (Certificate of Added Qualification) examiner for the American Board of Radiology and a clinical assistant professor at Duke University Medical Center Department of Radiology, was rated by RT Image magazine as the country’s Fourth Most Powerful Person in Radiology.
And just last year, Charlotte Radiology was ranked by a local business publication as the Eighth Best Place to Work.
Jensen credits that to Charlotte Radiology’s staff, “an amazing team.”
“From our couriers and transcriptionists to our technologists and radiologists, we have a talented group of individuals who understand the importance of quality and patient satisfaction. That commitment has carried over into our internal work philosophies as well,” says Jensen.
“We want to be the best in the area, the Southeast,” Moore says. “We pride ourselves on working very hard to stay on the cutting edge and be a leader in imaging services.”