Imaging on the Road
Mobile imaging units are convenient for patients, but adding one to an existing practice is not a decision that should be made lightly.
Traditionally when patients need imaging services, they visit their local hospital or outpatient imaging center.
But for people living far from the nearest hospital or imaging clinic, for those with difficulty getting around due to health issues or other circumstances, and for patients who simply have trouble fitting a trip to a clinic into their schedule, mobile imaging is an alternative that can provide the care they need at a convenient location — and it's a service that many expect to grow as technology continues to advance.
Several types of mobile imaging programs exist today. Some provide specific screenings such as mammograms that patients may not have access to otherwise, while others offer a slate of services for homebound, nursing home, and incarcerated patients unable to visit a clinic. Hospitals and radiology practices operate mobile units as extensions of their business, while mobile imaging services companies are dedicated to mobile radiology exclusively. "Mobile imaging provides a convenience for the patient," says Dean F. Berger, chief operating officer of Dynamic Mobile Imaging (DMI), a family-owned mobile imaging services company that offers digital X-rays, electrocardiograms, Holter monitoring, and ultrasound throughout Virginia, Washington, D.C., and parts of Maryland. "We can do everything with our equipment that can be done in a hospital."
In addition to providing another avenue for patient care, mobile imaging can help attract new patients to an existing health-care system. But not every hospital or clinic is well positioned to operate such a program. Things that must be considered include the size of the existing practice, maintenance and upkeep costs for the vehicle and scanning equipment, staffing and scheduling, image transmittal, follow-up care for patients, and marketing. "You really have to look at whether you have the business to support a mobile unit on an ongoing basis and consider what it does for you in the long run," says Anne E. Pileggi, administrative director of system imaging services for Trinity Mother Frances Hospital and Clinics in Tyler, Texas, which has operated two mobile MRIs and a mobile mammography unit for approximately 10 years. "You have to really be careful because it's an expensive proposition."
Maintaining Quality of Care
Mobile imaging services companies usually operate out of mini vans. Their equipment is not fixed to the vans, so it can be taken into the facility where the scan is to be performed. In addition to serving nursing homes, prisons, and homebound patients, these providers often supplement rural health-care practices that cannot financially sustain radiology equipment and staff. The companies usually visit those practices on a regular schedule, setting up their equipment in a vacant room so patients don't have to travel to the hospital or imaging center. "You might have a physician out there who sees 10 patients a day," explains Deborah A. Berger, chief executive officer of DMI. "The cost of getting X-ray equipment is roughly $75,000 to $100,000 plus the cost of a full-time technologist; it makes no sense."
Other types of units use equipment mounted within the vehicle, which patients board for their scans. Depending on the need, these vehicles can be cargo vans, recreational vehicles, or 18-wheelers. These mobile units are often set up in a way that is similar to a traditional office, with a small waiting area, changing room, and exam space. Women's Center for Radiology in Orlando has operated a digital mobile mammography unit in central Florida for nearly three years. Arlyn S. Grant, the mobile unit coordinator, says patient comfort is a key to the success of the mobile unit. "When a woman walks in the door, there's generally nobody else in the waiting area because of the way we schedule patients, so they're not walking into a crowded space," Grant explains. "We say, 'Sit down on the sofa and kick up your feet.'" The goal, she says, is to make the experience as pleasing as possible so that the women return for their mammograms every year.
Most mobile imaging units are staffed by radiology technologists and, often, assistants who greet and register patients, schedule the unit, and, in some cases, drive the vehicle. Scans are typically performed with the same type of equipment and in the same manner as in a traditional office setting. The primary difference is that, because they are on the road, the technologists' direct interaction with radiologists is limited. "The technologist on the mobile unit needs to be able to anticipate the needs of the radiologist," Grant says. If they technologist has a question, she will call the radiologist of consultation.
Mobile units operated by hospitals and radiology clinics transmit their images from the unit to the practice's radiologists, who then red the scans just as they do with those taken in the office. But most mobile imaging services companies contract with teleradiology groups to read their images. "The images are read by the radiologists and then, of course, we get the final reports back," explains Dean Berger, whose company has a staff of registered and licensed radiology technologists. "We have it set up so that the ordering physicians also have ways of viewing the images and reports, just like a hospital PACS system."
Not a Moneymaker
Maintaining and operating mobile units, particularly large ones with mounted scanners, can be costly because often the equipment is heavy, the gas mileage poor, and the driving time extensive. "These mobile units will never make money," says Jennifer A. Harvey, MD, professor of radiology at the University of Virginia School of Medicine in Charlottesville, Va., which has operated a mobile mammography unit for the past 10 years. "If you're driving four hours and then doing 30 mammograms, there's no way that the reimbursement for those 30 mammograms is going to cover your costs."
For this reason, many hospitals and clinics operate mobile units as a community service, not a revenue generator. This is particularly true for those with mobile mammography programs, whose goal is to make it convenient for women of the appropriate age to get preventive annual screenings. "Women are so busy between careers and families and all of their responsibilities that they put their own health last," Grant says. "It's important for us to get out there and get to these women. If we just sit and wait for them to come to us, they're not coming." Statistics show that breast cancer mortality has declined significantly in the past 15 years as a result of mammographic screening, Harvey notes. "But if women aren't getting their mammograms, we can't have much of an impact on their breast cancer mortality," she says.
While mobile imaging is not without its challenges, many believe demand will only grow as the population ages and real-time data transmission improves. "In places like nursing homes, for instance, patients can't move as easily, and we're going to have to bring health care to them in different ways, whether it is mobile ultrasound, mobile X-ray, or other types of health care projected into these types of facilities," says Arthur J. Greene, MD, president of Excalibur Healthcare, a telemedicine company headquartered in Maple Shade, New Jersey. "It's there now, and it's just going to grow."
By Jenny Jones
Jenny Jones is a freelance writer.