WAILUKU - The loss of Maui Memorial Medical Center's exclusive contract for radiology services is coming as a bitter pill for island physicians who've helped build the hospital's Radiology Department into a state-of-the-art facility, particularly well-known for its acclaimed stroke intervention program.
RadCare, a division of EmCare, a national company based in Dallas, has been awarded the hospital's radiology contract through a request for proposal process. That process is being challenged by incumbent radiology services provider Maui Radiology Associates, with a July 3 hearing scheduled in Honolulu before the state Department of Commerce and Consumer Affairs' Office of Administrative Hearings.
If that hearing does not alter RadCare's signed, two-year contract, then the company will take over radiology services at Maui Memorial beginning July 5.
Dr. Andrew Kayes works at the controls of a mammogram machine Friday at Maui Radiology Associates office in Kahului. Maui doctors are concerned about the potential loss of quality radiology care as the result of the award of a two-year, exclusive radiology services contract at Maui Memorial Medical Center to a Texas-based company.
The Maui News / MATTHEW THAYER photo
And, if that happens, then the hospital will lose the services of Maui Radiology's physicians for what the incumbent doctors say is a corporate, not-a-homegrown model of doing business.
They argue that RadCare won't be able to employ the caliber of physicians currently providing radiology services.
RadCare and Maui Memorial administrators dispute that claim, maintaining that RadCare will get doctors to provide the same or better service.
Dr. David Heeney, president of Maui Radiology, said he doesn't believe that RadCare will be able to deliver its promise of hiring qualified radiologists.
"They're only going to be able to get ne'er-do-wells and people who aren't wanted anywhere else or retired," he said.
Heeney said that it will be very difficult for a company like RadCare to convince doctors to uproot their families and work on Maui.
"They view radiologists as a commodity," he said of RadCare. "You can buy some, sell some. They're a dime a dozen. That's their view of it."
Dr. Chris Neal, an interventional neuroradiologist with Maui Radiology, said his Mainland colleagues have warned him about RadCare.
"They're known as Walmart radiology on the Mainland," he said, adding that RadCare represents a shift to a corporate model of providing health care.
Instead of bringing in the most qualified doctors to work on Maui, "they can bring in whoever they want," he said. "It's like a revolving door of people who think they can come to Maui for two weeks for vacation and do a little work and leave. They're not going to work the 80 to 100 hours a week we put in to take care of sick people."
He said that's not what the community of Maui deserves for its health care.
Maui residents "want people that they can count on who are going to be here five years later, or 10 years later and some kind of stability," Neal said.
One doctor who has signed on to work with RadCare is Dr. Ronald Boyd, an interventional radiologist who currently works for Maui Radiology. In 2007, Boyd and Neal were recognized by The Maui News as "People Who Made A Difference" for their work as stroke intervention specialists at Maui Memorial.
Last week, Boyd said he had signed a contract to work for RadCare beginning Aug. 1.
He disagreed with his colleagues' contention that RadCare's takeover of the radiology services contract would result in a decreased quality of medical service.
"They're bringing some very capable people on board," Boyd said last week of RadCare, although he did not immediately have the names or backgrounds of doctors expected to be hired with the new company.
RadCare spokeswoman Deborah Hileman has said RadCare "has highly experienced recruiting specialists who are dedicated specifically to the specialty of radiology."
She said RadCare would be ready with a full staff as of midnight July 4. She added that RadCare is working with Maui Memorial administrators to provide a seamless transition.
Boyd said he understood that RadCare had communicated with the incumbent group of radiologists about hiring them, but they decided not to accept.
Heeney said that he had not been sought out by RadCare but was aware that Boyd had been approached by the new company.
Heeney called Boyd, a former partner with Maui Radiology, "one man apart" from the group's other radiologists.
"We've had a stormy relationship with Ron and the rest of the group," Heeney said. "He's like his own man. There's the team, and there's him."
Boyd said that he is a "little bit" an odd man out, but he made it clear to his Maui Radiology colleagues that he would want to work with RadCare. He said that he had differences with Maui Radiology - not over health services, but over business issues.
The current group of radiologists working with Maui Radiology include Neal, who teaches part time at the Stanford University School of Medicine; Dr. Elizabeth Ignacio, who is part of the medical faculty at George Washington University; and Dr. Andrew Kayes, who is an assistant professor at the University of California at Los Angeles' Department of Radiological Sciences.
Heeney said that he did not believe any of those doctors would work with RadCare, which will need at least three radiologists to adequately staff the hospital.
Kayes said he believes that RadCare intends to operate with only a minimal amount of staffing. He said he believes that RadCare will employ temporary physicians and those who will "rotate to a community or location for a few months, then leave."
"The (hospital) administration is throwing out a group of radiologists who are raising their families here and who are a strong part of the community," he said.
Hospital officials have said that RadCare came out on top of the four companies that submitted proposals for radiological services. Maui Radiology finished last in the rankings of the companies submitting proposals. Others were AllegiantMD Inc., which finished second; and Tacoma Radiological Associates P.S., which was third.
"The selection process was based on the work of a committee of five leaders from our hospital community, two of which were physicians," said Wesley Lo, Maui Memorial's chief executive officer. "The other three committee members were required to be state employees. These members are key leaders of departments that work very closely with the Radiology Department, including the Radiology Department itself; the Emergency Department; and the Angiography Department, where interventional radiology procedures are conducted."
The Maui Regional Board of Hawaii Health Services Corp. made the final selection for the radiological contract May 29, overriding the recommendation of the hospital's Medical Executive Committee in favor of Maui Radiology.
Lo said RadCare was selected because "they had the highest score of the four proposals received, making them the best choice for providing radiology services to our community."
He said the factors in the score, which were in accordance to state procurement procedures, were weighted 10 percent on background experience and references; 30 percent on service delivery plan; 30 percent on management and control; and 30 percent on cost.
In its legal challenge to the awarding of the contract, Maui Radiology objected to the way this year's request for proposal minimized the importance of "background, qualification and experience" in the selection criteria.
In prior selection processes, this component was given a 35 percent weight and reducing it in this most recent selection process was seen by Maui Radiology as a disadvantage.
Lo said RadCare promises to provide a number of key services that hospital officials believe "will help our patients receive high-quality care."
According to Lo, those services include:
* Dedicated, on-site physician coverage focused solely on the hospital's radiologic needs and an on-site staffing level at or above the existing coverage level, including interventional neuroradiology.
* An on-site coordinator who would be the single point of contact for concerns that may come up and would help ensure high-quality, seamless delivery of care.
* Deep coverage for on-site radiologists if there should be a large volume of cases, then the company's radiology team would include a number of employed radiologists who can pick up the higher volume if help is needed.
* Real-time monitoring of turnaround times for the radiology staff so that problems can be identified in a timely manner.
Hospital officials said they expect Maui Memorial will save $600,000 per year with RadCare.
Kayes said the reported savings of $600,000 is debatable.
The hospital "has the potential to lose a lot of business from referring physicians since they went against the recommendations of the Medical Executive Committee," he said. "Since the doctors on the Medical Executive Committee have the power to send the referred patients elsewhere, it is certainly possible that the MMMC executive staff have shot themselves in the foot and any savings on call pay will be lost due to lost referrals."
Heeney said that Maui Radiology has turnaround times of less than an hour, and he questioned whether RadCare would be able to match that.
"The other thing that will suffer immensely is the personalized service to the physicians," he said. "That personal service will crumble."
Neal said the hospital's Radiology Department has improved to the point where patients seek out service on Maui.
"Until today, people are referred here from all over the state," he said. "There is a huge amount of faith in what we can do. There is a reputation that exists for excellence.
"We have one of the best stroke outcomes of any hospital in the state," he said.
* Brian Perry can be reached at email@example.com.
WHAT IS RADIOLOGY?
Radiology is a medical speciality in which doctors use various imaging technologies to peer into the human body to diagnose and treat diseases and injuries, such as cancer and broken bones. One of the most well-known techniques is the use of X-ray radiology to capture images inside the body. Other imaging technologies include ultrasound, computed tomography (CT), nuclear medicine, positron emission tomography (PET), magnetic resonance imaging (MRI), angiogram and mammogram.
Glossary of terms:
* Angiogram, an imaging study depicting blood vessels in which a dye is injected into the bloodstream and X-rays are taken to see the blood vessels.
* Computed tomography (CT), or CAT scan, an imaging technique linking X-ray sensors to a computer and using a mathematical technique called algebraic reconstruction to assemble images from a cross-sectional plane of the body. CT scans reveal both bones and soft tissues, including organs, muscles and tumors. Image tones can be adjusted to highlight tissues of similar density or cross-sections of images can be assembled into three-dimensional images. Such scans are often used in cancer treatment in which radiation therapy needs to be applied on the precise density, size and location of a tumor.
* Magnetic resonance imaging, a method of getting pictures of various parts of the body without the use of X-rays. A patient lies in an MRI scanner, which consists of a large, strong magnet, and a radio-wave antenna is used to send and receive signals from the patient's body that are converted into images by a computer connected to the scanner.
* Mammography, an imaging examination of the breast using X-rays to check for breast cancer.
* Nuclear medicine, a clinical discipline using radionuclides (isotopes that exhibit radioactivity) to provide real-time images of biochemical processes.
* Positron emission tomography, also called PET or a PET scan, is a diagnostic examination that involves the development of images based on the detection of subatomic particles that are emitted from a radioactive substance given to the patient.
* Radiographs, an imaging technique in which X-rays are passed through a patient's body and captured on a device that turns the X-rays into visible light and a transparent plastic sheet for review and diagnosis. The original procedure involved using silver-impregnated films. Now, doctors use digital radiography techniques that allow them to capture X-ray images for display on a computer screen. This allows a doctor to send images via the Internet to doctors around the world for second opinions and consultations.
* Ultrasound, an imaging technique also known as ultrasound scanning or sonography, is a method of obtaining images by using high-frequency sound waves. The sound waves' echoes are recorded and displayed as a real-time, visual images, such as a fetus in a mother's womb.