A Duty to Scan

Imagine a Veteran’s Hospital where taxpayers have provided tens of millions of dollars of CT and MRI equipment. Imagine that hospital has a 8-12 week backlog of veterans who would benefit from these exams and salaried radiologists ready to interpret the images and pass that knowledge back to the organization’s customers.

Continue to imagine there is a bottleneck; the technologists needed to move veterans through the scanners are not available. Does that Veteran’s Hospital have a duty to hire as many technologists as possible and maximize the capacity of those scanners? Does the hospital have a duty to scan, and is it negligent not to do so? If a principle mission of the Veteran’s Hospital is responsible stewardship of taxpayer resources, the answer is yes. Let me explain.

Currently our Veterans Administration has the ability to outsource clinical duties to private hospitals when demand cannot be met internally. However, when they do so in Radiology, taxpayers must reimburse a small piece of the investment that the private hospital made in their own scanner. This is known as the technical component of the fee and that private hospital will send a bill to the taxpayer that includes it. If the scanner at the VA were being run at peak capacity this technical component paid to the private hospital would be justifiable. However, if there is idle capacity in the hardware at the Veteran’s Hospital, taxpayers are effectively buying something that they have already purchased.

Stewardship of taxpayer resources would suggest there is a duty to scan within the VA system and that outsourcing of imaging is only appropriate when that VA equipment is being run on weekends and second shifts. It is critical to have an administration and Human Resources department that understands this duty.

3 thoughts on “A Duty to Scan

  1. Pingback: The Importance of Human Resources in Customer Service – Seth M. Hardy, MD

  2. David S. Martin, MD.

    Clearly the VA has a duty to those veterans who have earned their rights. If the only thing standing in the way of ridding the backlog is the lack of technologists then the reasons need to be sought and remedied. If the lack of technologists is due to salary, the adjustment needs to be made. If the technologists are willing to work for the salaries offered and the impediment is human resources offices that are slow to react, then human resources needs to be made more agile. At our VA, the scanners are being utilized on weekdays and weekends with late shift technologists and, soon, overnight technologists. But we are in a metropolitan area and are situated within two miles of two university medical centers. I do not know if the same rules apply for VA hospitals less well situated.


    1. Completely agree. The culture at the local civilian hospital is so bad that technologists would love to come over to the VA, so supply isn’t a problem. However admin doesn’t want to blow their budget, so they use Choice to outsource imaging. Our LEAN black belts were told to disengage with HR because they needed to focus on areas that directly effected patient access.

      If you have seen one VA, you have seen one VA. Unfortunately my wife, who is a VISN1 trained psychologist, and I left shortly after this was written.


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