Doctor, HRMC slam new ultrasound business

Kim Gardner

Oct. 5, 2009 (McClatchy-Tribune Regional News delivered by Newstex) -- Blue Ridge Ultrasound will take revenue away from hospital, HRMC?CEO says

A new ultrasound business has attracted concern from a local radiology doctor.

Blue Ridge Ultrasound opened its doors Friday, but had resistance before the owners saw their first patient.

On Sept. 24, Dr. Mark Mittelman, physician director for Haywood Medical Imaging, sent out a letter to Haywood County doctors' offices urging them to carefully consider six issues before referring patients to the new business. The letter was signed only by Mittelman, but he said it reflected the views of all in his department.

Haywood Medical Imaging contracts with the hospital to provide imaging services and Mittelman spoke out because he felt the new business would negatively impact the hospital.

"I think it's important for physicians to support the hospital," he said. "I wrote the letter to point out difference between us and them."

Blue Ridge Ultrasound owners Tammy Corzine and Kendren Cooper say they are offering services the hospital does not that will allow patients to receive ultrasounds in the county rather than travel to Asheville.

One of the issues Mittelman listed in his letter is the fact that his organization has radiologists on site to read scans, whereas Blue Ridge Ultrasound has contracted with Asheville Radiology to read scans. He has concerns about remote scan reads from another county.

"(Ultrasound), unlike other modalities, depends uniquely on the skill and acuity of the technologist working in harmony with the interpreting radiologist. That is, if the technologist does not recognize pathology during the exam, there will be no hint of it on the images saved and presented to the radiologist for interpretation," Mittelman states in his letter. "The best (ultrasound) program culminates from a close collaboration between ultrasonographer and radiologist. The technologists at HRMC are accustomed to and demand the radiologists' involvement, especially when their findings are confusing, atypical or are inconsistent with prior exams or the clinical scenario. (And there are some (ultrasound) exams which are routinely scanned by the radiologist in conjunction with the ultrasonographer.) This joint effort occurs real-time when feasible, and, when not, the patient is asked to return for (ultrasound) re-evaluation by the radiologist. This synergy is not feasible when interpretations are made off-site and long after the patient has left the facility."

Tammy Corzine and Kedren Cooper started Blue Ridge Ultrasound and said they will work in real time with the radiologists in Asheville when performing scans. They say all their work is digital and they have 40 radiologists at their disposal.

"We can call them up right away (during a scan) and they can give us feedback right away," Corzine said. "The radiologists look at the scans simultaneously while the scan is going on."

With office hours from 9 a.m. to 5 p.m. five days a week, Mittelman said there is no service for those who need scans outside of regular business hours -- something the hospital can provide.

"The hospital makes great sacrifice to provide services in the middle of the night," he said.

In his letter, Mittelman states, "This is a very expensive endeavor in Haywood County, where the population and work flow do not justify a dedicated overnight shift and the on-call burden falls upon two to three technologists (their typical profile: young mothers). Their dedication to HRMC and their jobs (on-call service is a requirement) is surely tested when they evaluate your patients at 3 a.m. who present to the ED with an obstetrical concern or scrotal pain, for instance. The on-call recompense is a pittance when you factor in the lost sleep (they will begin a new workday at dawn) and drama of leaving their husbands, young children and hearth in the midst of a January snow storm."

Mittelman added that by referring patients to Blue Ridge Ultrasound takes money from the hospital.

But Corzine and Cooper said they do not want to take patients from the hospital. In fact, they approached Mittelman's organization to read their scans, but were turned down and were referred to Asheville Radiology, they said.

"We feel targeted because there are other physicians that offer services the hospital offers," Cooper said. "We're very supportive of our regional hospital and we want to be collaborative with them."

Mittelman said reading their scans would again go against the hospital.

"We could read them here, but we have a contract with the hospital, and it would be disadvantageous to interpret those exams," he said.

Blue Ridge Ultrasound owners said their intent is to bring a cost-effective, quality ultrasound service to the county.

"I'm a life-long resident," Corzine said, "and we just want to bring our specialty to the county. There was a lot of research, groundwork put into this, and we talked with a lot of people in the community."

"We did our research to see if there was a need," Cooper added.

Corzine worked at Haywood Women's Medical Center for years, and both have worked at Mission Hospital for years. They have 16 years combined of experience in the ultrasound field and have secured certification in numerous areas in their field. Some of the scans they offer include a full range of diagnostic and screening ultrasound exams, with specialized expertise in the area of ultrasound testing and cutting edge technology -- including a state-of-the-art vascular machine -- for vascular studies such as peripheral artery disease screening, carotid artery scans and venous testing for blood clots and general ultrasounds, such as abdominal and thyroid scans.

The women said they offer services the hospital does not.

"We will complement them and our services overlap to a degree, but our services are very unique," Corzine said.

The hospital maintains they offer the same services as Blue Ridge Ultrasound, said Rich Egan, radiology director.

Michael Poore, president of Haywood Regional Medical Center, said that while he wishes Corzine and Cooper well, their business will pull revenue away from the hospital.

"They won't have to respond to ER calls in the middle of the night," Poore said. "Most freestanding centers want to take the cream of the crop, and they don't want to take all of the patients all of the time. I understand Dr. Mittelman's perspective."

Poore shares Mittelman's concern about not having a radiologist on site to read scans and that many physicians the hospital works with want to talk face-to-face for scan consultations.

"(Blue Ridge's radiologists) are in Buncombe County and they can pick up the phone, I guess, but you can't stand side-by-side (for a consult)," Poore said.

He is also concerned about a loss of revenue from patients who can pay, which helps the hospital for those that cannot pay for services. While he does not mind competition, it is different in the health care business.

"I haven't seen anyone clamoring to open a facility to offer $10 million to $15 million in free care we give every year," Poore said. "We have competition with Mission, but Mission takes care of all patients, not just those who can pay and come through 9 a.m. to 5 p.m. Our responsibility is a 24-seven responsibility."

Corzine and Cooper said they just want to support the community by providing service to residents of Haywood County. "Our top priority is to provide services to the people here in Haywood County who cannot get the services they need," Corzine said. "Hopefully we can compliment the hospital with some healthy competition," Cooper added.

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