New readers

When it comes to practicing medicine, Dr. James Schlund has a traditionalist streak. He’s not averse to technology or breakthroughs—in fact, he’s championed 3-D mammograms for detecting breast cancer when private insurers insisted on paying only for 2-D imaging. That push, with staff at the Chico Breast Care Center, prompted statewide change (see “Chico vs. the Man,” cover story, Sept. 28, 2017).

Yet, as radiology progresses to where specialists can read digital images from monitors in remote locations, Schlund sticks to the old-fashioned notion of in-person contact.

“My joy is in working at the bedside or on the bench,” he told the CN&R. “The highest quality or standard of care is when you have a close understanding and/or first-person knowledge of what’s happening with [patients] and their lives. Do the exam, see the study, know the referring physician community—and interact.

“It’s really difficult to do that with teleradiology.”

Mike Wiltermood feels the same way. The CEO of Enloe Medical Center, he harkens to the days of X-rays on film when, by necessity, hospital physicians would gather in the radiology reading room. As a result, in that proximity, they’d discuss patients’ conditions and collaborate on care.

“We have kind of lost that over the years,” Wiltermood continued, “as physicians have worked more and more remotely from each other.”

Having a group of radiologists in-house, rather than rotating from an outside radiology group—even one based just blocks away—contributed to Enloe’s decision to discontinue its professional services agreement with North State Radiology.

Effective Sept. 1, Enloe began contracting with a set of eight radiologists to read all images taken in the hospital. Six came from North State Radiology (NSR). That practice, which previously had contracts with other area hospitals, has converted to an outpatient-only model—ready to serve those who need a mammogram, MRI or ultrasound, for example, who aren’t seeking hospital treatment.

Dr. Kiran Singh, president of NSR, said her group remains viable. It will continue to operate the Breast Care Center, which rents space to Enloe’s Comprehensive Breast Care practice. North Valley Advanced Imaging—a joint venture between Enloe and NSR, located across East Seventh Avenue on The Esplanade—remains in operation, with its future ownership under negotiation. NSR has a sale pending for one of its buildings.

Along with the physicians who left for Enloe, several others took jobs elsewhere and several retired, Singh said. Under the Enloe contract, NSR devoted four to five full-time equivalents to hospital duty daily.

“One of the things that evolved out of this is we have the right number of physicians moving forward,” she said. NSR now has seven full-time radiologists, including four breast-imaging radiologists and three who also read studies for North Valley Advanced Imaging.

Wiltermood expressed the same sentiment. He told the CN&R by phone, without casting aspersions on NSR, that the staffing change has made a positive impact. Previously, radiologists could start a day shift with a backlog of 100 images or more to review; “with the new group, we’ve actually had days where we’ve had zero in the queue waiting for the next day. So I think that’s a really good sign that the customer service is going to be there.”

Finances played a major role in the changes, both sides say. Enloe and North State Radiology negotiated for several years, going so far as to have an independent mediator, and operated without a contract until signing the one-year pact that expired Aug. 31.

Singh said the discontinuation of services at Enloe by NSR “was not our decision.” Schlund noted a shared history of more than 60 years, back to when NSR was Chico X-Ray Medical Group—“It wouldn’t surprise me that the old guys knew N.T. Enloe.”

Wiltermood said it became evident to his team around the beginning of the year that the parties would not reach a long-term agreement. Knowing what it would cost to retain NSR, Enloe could establish its own service, with advantages.

“The requirements are getting so onerous—and they’re just going to increase—that for us to be able to pivot quickly, when the government changes its mind on something, tacks on another unfunded mandate; [it’s better] that we just have a group dedicated solely to the hospital,” he added.

On the fiscal front, Enloe has contentious renegotiations underway with Anthem Blue Cross, a leading insurer in the region. The hospital issued contract termination notices effective Nov. 1, aiming to secure higher reimbursement rates; Enloe asserts that Anthem pays it less than other North State hospitals.

NSR, meanwhile, is focused on its new direction. Management decided to outsource billing and business, effective Sept. 1—coincidental to the Enloe contract, Singh says, as the practice has considered this move for a half-dozen years.

Patients shouldn’t notice a difference, she emphasized: “Being at Enloe was one of the key ways in which we serviced our community and we took care of patients—that’s sad for us—but our outpatient practice is going to continue as-is, and our main goal is to make sure we have cost-effective access to quality imaging for patients in Chico and Butte County.”

Schlund has cut back at NSR. With his daughters out of the house, he’s moved to a cabin he and his wife own by Lake Tahoe, above Truckee. He’s semi-retired at age 60, practicing part-time in Truckee—where he can mountain bike to work—and part-time here.

He stressed the importance of independent outpatient providers remaining part of the medical landscape. Should places such as NSR close, in underserved areas such as Chico patients will find themselves with less access and higher costs.

“Hospitals have absolute reasons to be in communities,” Schlund said. “Communities benefit for having hospitals in them to provide critical access to care for disasters of the commons. But at the same time, you also have to have cost-effective access to outpatient care. They both have a reason to exist.”