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For example, when doctors at Children's Hospital of Wisconsin in
Milwaukee dictate information about a patient's condition, their
words are sometimes whisked electronically to India, where trained
medical transcriptionists type them and send them back, to be
incorporated into the patient's medical record.
Then there is Botsford General Hospital in Farmington Hills,
Mich., which uses a company with operations in India to help collect
unpaid bills. "They came in with a rate that is less than half of
what a U.S.-based collection agency would charge me," said Luke
Meert, corporate director for accounts receivable at Botsford Health
Care Continuum, the parent company.
Coding - the assignment of numbers for medical procedures to
bills - is also heading offshore. The American Academy of
Professional Coders now has chapters in India. Some insurance-claims
processing is moving, too: Aetna
Inc., the health insurance giant, has 400 people in that
country.
Bob Burleigh, the president of Alpha Thought Global, a medical
billing company in Chicago that has operations in India, said he had
witnessed an incident in which a worker in Chennai, India, handling
the billing for an American medical practice, needed to check on the
status of an insurance claim. When he called the American insurance
company's "800" number, the phone was answered by someone else in
Chennai.
Companies have sprung up to offer services like billing and
transcription in India. For example, Ajuba International Inc., based
in Novi, Mich., does the billing follow-up for Botsford Hospital.
And Manor
Care Inc., an operator of nursing homes, owns the majority of
Heartland Information Services of Toledo, Ohio, which does the
transcription in India for the Children's Hospital of Wisconsin.
The movement of back-office jobs offshore has raised some
concerns about privacy, in that foreign workers could not be easily
prosecuted under American laws governing confidentiality of American
records.
But the outsourcing of radiology overseas raises more issues.
Unlike back-office functions, radiology is performed by doctors and
is directly related to patient care. A mistake could conceivably
cost a patient his or her life.
Massachusetts General is not the only place where controversy has
arisen. Yale-New Haven Hospital ended a program in which a doctor
was reading X-rays in India.
The doctor, Arjun Kalyanpur, had been on the staff at the
hospital and on the faculty of Yale but decided to move back to his
native India for family reasons. "It was not that I was taking a job
away from anybody," he said. "I was taking my own job with me."
After a trial run, he and some Yale colleagues even published a
paper showing that interpretations from India were as accurate as
those done in New Haven.
But Yale stopped the program, apparently because of internal
complaints. "I think Yale was not ready for it yet," Dr. Kalyanpur
said.
A spokeswoman for Yale said that communications with the doctor
in India were too costly and that the hospital had no need for such
a program because an attending radiologist was always on call.
So far, Teleradiology Solutions, which is Dr. Kalyanpur's
company, and Wipro
Ltd., the one working with Massachusetts General, appear to be
the main providers of radiology services in India for American
hospitals.
Dr. Kalyanpur and a partner read about 100 scans a day in their
office in Bangalore, a high-tech center in India. He said the scans
come from more than 30 hospitals in the United States, including
several community hospitals in Pennsylvania.
Wipro is one of India's largest companies, with nearly $1 billion
in annual sales, mainly from handling computer programming jobs for
American and other foreign companies. To the company, the
outsourcing of health care jobs is a new opportunity.
Wipro now has about 12 radiologists in India and counts four
American hospitals or radiology practices as clients, said T. K.
Kurien, its chief executive for health sciences. He said he could
not name the clients because of the sensitivity surrounding the
issue. Even Massachusetts General has now prohibited Wipro from
discussing its relationship with that hospital.
Marketing is difficult, he said, because the idea of patient
X-rays being analyzed in a third-world country does not sound so
appealing to Americans. "Wouldn't you be scared to death if it was
being done in India?" he said. "That's the real issue for us." When
the company takes on a client, he said, "we know the person at the
other end is going to get a lot of flak."
Yet both Wipro and Teleradiology Solutions are simply responding
to a widely acknowledged shortage of radiologists in the United
States.
