Nighthawk coverage?

[Hyperthymestic]

I read an article about how this company has contracts with physicians around the globe (ie. non-american physicians) and utilizes them for reads to cover hospitals at night. How can these foreign docs practice medicine in the U.S. without a license, I mean reading scans is technically a procedure and it is for patients here in the U.S. no matter where the docs are physically located, right? Did I miss something?

See last paragraph ---> http://www.spokesman.com/blogs/offi...hawk-radiology-approved-no-word-yet-cda-jobs/

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[DrBowtie]

Prelim reads overnight with on site rads reading them as finals in the AM. Article is from 2010 too.

 

[cowme]

They are US trained radiologists working overseas

 

[colbgw02]

I did not see anything in that article about not having licenses in the U.S.

 

[Hyperthymestic]

I did not see anything in that article about not having licenses in the U.S.

I was asking. The article said they contract with physicians from around the globe. Are they in fact us licensed? How does that work, do they pay them to live overseas?

 

[colbgw02]

I was asking. The article said they contract with physicians from around the globe. Are they in fact us licensed? How does that work, do they pay them to live overseas?

Yes, they're licensed in the U.S., usually in many, many states. These overseas teleradiology companies exist chiefly to administer the considerable logistical support required to maintain the licenses and credentials required. That, and to provide IT support.

They're not paying them to live overseas, per se. They're paying them to read studies. Historically, it's been worthwhile for a subset of radiologists to move to places like Australia or Switzerland since they can have a normal workday while reading after-hours U.S. exams.

This practice has generally fallen out of favor. One cannot bill for interpretations rendered from outside of the U.S., so practices are required to overread the preliminary interpretations the next morning. They're also required to fork over part of their profit for that study to the overseas radiologist. This was worthwhile at one point, because reimbursements were such that sleep for the U.S. radiologist was more valuable than the extra money. That calculus has changed in light of declining reimbursements, and the poor job market has made it easier to hire "internal nighthawk" radiologists.

Overall, I'd say the latest trend of "taking back the night" is good for radiology.

 

[Hyperthymestic]

Yes, they're licensed in the U.S., usually in many, many states. These overseas teleradiology companies exist chiefly to administer the considerable logistical support required to maintain the licenses and credentials required. That, and to provide IT support.

They're not paying them to live overseas, per se. They're paying them to read studies. Historically, it's been worthwhile for a subset of radiologists to move to places like Australia or Switzerland since they can have a normal workday while reading after-hours U.S. exams.

This practice has generally fallen out of favor. One cannot bill for interpretations rendered from outside of the U.S., so practices are required to overread the preliminary interpretations the next morning. They're also required to fork over part of their profit for that study to the overseas radiologist. This was worthwhile at one point, because reimbursements were such that sleep for the U.S. radiologist was more valuable than the extra money. That calculus has changed in light of declining reimbursements, and the poor job market has made it easier to hire "internal nighthawk" radiologists.

Overall, I'd say the latest trend of "taking back the night" is good for radiology.

I see, I was thinking there would be a problem with billing, like you mentioned.

 

[dhavalp]

Yes, they're licensed in the U.S., usually in many, many states. These overseas teleradiology companies exist chiefly to administer the considerable logistical support required to maintain the licenses and credentials required. That, and to provide IT support.

They're not paying them to live overseas, per se. They're paying them to read studies. Historically, it's been worthwhile for a subset of radiologists to move to places like Australia or Switzerland since they can have a normal workday while reading after-hours U.S. exams.

What prevents non-U.S. licensed foreign radiologists from providing preliminary reads? Since preliminary reads cannot be billed for, medicare & insurance companies wouldn't have any say in this. I assume state medical boards do not allow this, but how would they be able to enforce this?

A radiologist in the U.S. could potentially provide night coverage at multiple hospitals and have subcontracted non-U.S. licensed radiologists from foreign countries provide preliminary reads which he signs off in the morning. How would a state medical board know whether the preliminary read was provided by an unlicensed foreign radiologist or licensed one if the name that appears on the final report is the name of a licensed US radiologist?

 

[colbgw02]

What prevents non-U.S. licensed foreign radiologists from providing preliminary reads? Since preliminary reads cannot be billed for, medicare & insurance companies wouldn't have any say in this. I assume state medical boards do not allow this, but how would they be able to enforce this?

A radiologist in the U.S. could potentially provide night coverage at multiple hospitals and have subcontracted non-U.S. licensed radiologists from foreign countries provide preliminary reads which he signs off in the morning. How would a state medical board know whether the preliminary read was provided by an unlicensed foreign radiologist or licensed one if the name that appears on the final report is the name of a licensed US radiologist?

Assuming that this issue even gets beyond the U.S. radiologist or his company, the specific answer is that the hospital or clinic who is receiving these preliminary reads wants to know who is providing them. The nighthawk guy is probably going to have to get at least teleradiology privileges, if not full privileges, and you can bet they're going to want to see a state license.

The general, and more instructive, answer is that everyone has a lot to lose by not playing by the rules. We can all imagine a thousand different what-ifs, and, sure, people from all specialties get caught practicing without a license. But it's generally an uncommon thing. Why? Because we're all pretty risk adverse people and the system actually does a pretty good job of keeping everyone in line. And I don't want to even think about the field day a plaintiff's attorney would have if a U.S.-based entity knowingly permitted an unlicensed physician to practice and the standard of care was breached.

I guess if you're looking for direct governmental supervision - like cold-calling practices to verify licensure, then you're not going to see that. The system relies on the insurance companies, the hospitals, and the physicians to do what they're supposed to. That may not be comforting to some, but empirically it works.

 

[shark2000]

What prevents non-U.S. licensed foreign radiologists from providing preliminary reads? Since preliminary reads cannot be billed for, medicare & insurance companies wouldn't have any say in this. I assume state medical boards do not allow this, but how would they be able to enforce this?

A radiologist in the U.S. could potentially provide night coverage at multiple hospitals and have subcontracted non-U.S. licensed radiologists from foreign countries provide preliminary reads which he signs off in the morning. How would a state medical board know whether the preliminary read was provided by an unlicensed foreign radiologist or licensed one if the name that appears on the final report is the name of a licensed US radiologist?

Long story short, this system is going to be extinct.

Right now, Teleradiology is done from inside US. Some big companies who hire US radiologists.

This system is not growing that much. Most groups are providing internal night coverage. These days the volume is high enough to justify hiring one radiologist staying the night and read the studies. Doing prelims needs someone to finalize the next day, which is one day work and also all the discrepancies in reading.

Regarding unlicensed versus licensed, Teleradiology licence takes almost 6 months to get and is not as easy as you think. It is strictly regulated. The name of prelim provider will stay in the file always. It is like saying that a surgeon in US hires foreign trained surgeons and send them to OR rather than him. It is doable in theory, but not in practice.

 

[dhavalp]

Assuming that this issue even gets beyond the U.S. radiologist or his company, the specific answer is that the hospital or clinic who is receiving these preliminary reads wants to know who is providing them. The nighthawk guy is probably going to have to get at least teleradiology privileges, if not full privileges, and you can bet they're going to want to see a state license.

The general, and more instructive, answer is that everyone has a lot to lose by not playing by the rules. We can all imagine a thousand different what-ifs, and, sure, people from all specialties get caught practicing without a license. But it's generally an uncommon thing. Why? Because we're all pretty risk adverse people and the system actually does a pretty good job of keeping everyone in line. And I don't want to even think about the field day a plaintiff's attorney would have if a U.S.-based entity knowingly permitted an unlicensed physician to practice and the standard of care was breached.

I guess if you're looking for direct governmental supervision - like cold-calling practices to verify licensure, then you're not going to see that. The system relies on the insurance companies, the hospitals, and the physicians to do what they're supposed to. That may not be comforting to some, but empirically it works.

Regarding unlicensed versus licensed, Teleradiology licence takes almost 6 months to get and is not as easy as you think. It is strictly regulated. The name of prelim provider will stay in the file always. It is like saying that a surgeon in US hires foreign trained surgeons and send them to OR rather than him. It is doable in theory, but not in practice.

Thank you.