How radiology practice works

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I think there's a lot of confusion and lack of knowledge about how diagnostic radiology is actually practiced, ie whether it's hospital-based, office-based, group, individual etc. I was hoping some of you could clarify the different ways diagnostic radiology is practiced.

I would be especially interested in hearing about telerads. Is telerads pretty much always outsourced to other countries? Can US radiologists read films at home via the internet?
I'm nocturnal and would be very happy to cover hospitals from home at night - is that something that is done?

Thanks in advance.

 

[f_w]

> Is telerads pretty much always outsourced to other countries?

It is sometimes outsourced to US credentialed rads located in other countries. The majority of the nighthawk companies are located in the US, either the mainland (Baltimore, Minneapolis) or Hawaii. The reputable overseas companies are located in Israel, Australia and Switzerland to name a few.

> Can US radiologists read films at home via the internet?

Yes. As a matter of fact, many radiologists who don't outsource the overnight reads have a workstation at home (such as the one I am sitting at right now). It allows them to read on-call cases without having to haul themselves into the hospital (except for procedures).

> I'm nocturnal and would be very happy to cover hospitals from
> home at night - is that something that is done?

Yes, this can be done. There are US based telerad companies that take care of the significant paperwork overhead for you (credentialing at every hospital you read for, medical licenses with varying CME requirments in several states etc.). In turn, they take a good chunk of the fees you generate. There are more enterpreneurial rads who run a little telerad business by themselves. They will usually contract with a couple of the local groups to cover their hospitals at night. They might not be able to offer the 7 day a week 30min service that the big companies can provide, but a smaller 5 or 6 rads group can be quite happy to have someone to cover for example the weekday nights.

 

[fedor]

f_w,

A little clarification please about the reads by the foreign telerad firms (ie, Israel, Australia, etc.). It is not possible for Medicare to reimburse for work done outside of the US and her territories even if the radiologist in question is US trained and board certified. How do the telerad groups get around this?

Do they have an American-based radiologist rubber-stamp the read in the morning and then bill the patient?

 

[f_w]

> It is not possible for Medicare to reimburse for work done outside
> of the US and her territories even if the radiologist in question is
> US trained and board certified. How do the telerad groups get
> around this?

The way it works is that the telerad provider although fully credentialed will only provide a 'prelimnary' report (usually something simple such as 'CT of the head without contrast shows no mass effect or hemorrhage' which is all the ED doc usually cares about). The next day, the radiologist AT this hospital, will pull up the study, and dictate a complete report (including that pesky little lytic bone lesion in the skull and other stuff that might or might not be of interest to the patients PCP and the ED doc). He then compares his findings with the prelim report and decides whether there is a significant discrepancy. Usually there is no significant discrepancy. The hospital based rad then bills medicare or the insurance for HIS read. Payment of the telerad provider is for the prelim read service he provides to the radiology group. Not the service to the patient. ( Payment is based on a flat fee for every read + usually a monthly fee. These arrangements have been found by CMS NOT to violate the 'fee-splitting' or Stark statutes).

 

[fedor]

> It is not possible for Medicare to reimburse for work done outside
> of the US and her territories even if the radiologist in question is
> US trained and board certified. How do the telerad groups get
> around this?

The way it works is that the telerad provider although fully credentialed will only provide a 'prelimnary' report (usually something simple such as 'CT of the head without contrast shows no mass effect or hemorrhage' which is all the ED doc usually cares about). The next day, the radiologist AT this hospital, will pull up the study, and dictate a complete report (including that pesky little lytic bone lesion in the skull and other stuff that might or might not be of interest to the patients PCP and the ED doc). He then compares his findings with the prelim report and decides whether there is a significant discrepancy. Usually there is no significant discrepancy. The hospital based rad then bills medicare or the insurance for HIS read. Payment of the telerad provider is for the prelim read service he provides to the radiology group. Not the service to the patient. ( Payment is based on a flat fee for every read + usually a monthly fee. These arrangements have been found by CMS NOT to violate the 'fee-splitting' or Stark statutes).

The preliminary read I believe is called the "wet read" if I am not mistaken. Does the wet read go into a patient's chart or just the final read?

Let's say the wet read and the final read differ and they bring the patient into surgery based on an erroneous wet read. At this point they can't go back and erase the wet read from the chart and leave only the final read. So I am assuming that you will have both preliminary and final reads in the patient's chart, which would be embarassing in those few cases where the findings differ.

Is there a standard for this? I can see this would cause numerous problems between the doctors who have to rely on wet reads and the radiology groups.

 

[f_w]

Let's say the wet read and the final read differ and they bring the patient into surgery based on an erroneous wet read.

Luckily, this doesn't happen too often. If the local rads notices a potentially significant discrepancy there is typically a protocol in place to follow up with the clinician. A discrepancy between the two reports in the chart is not so much different from any contradicting charting information (often two physicians of different specialties won't agree on fairly straightforward physical exam findings).