Radiologists reading Echos

[BLADEMDA]

---

Members don't see this ad.

Some of the older radiologists at my hospital will do echochardiograms. They read the study and issue the report.

Has anyone else seen this? Do they get special certification in Echo? I know they do advanced Coronary imaging and a lot of angiograms but echocardiograms?

 

[urge]

Some of the older radiologists at my hospital will do echochardiograms. They read the study and issue the report.

Has anyone else seen this? Do they get special certification in Echo? I know they do advanced Coronary imaging and a lot of angiograms but echocardiograms?

I have always wondered why they don't do it. Make more sense to me than a cardiologist doing it.

 

[BLADEMDA]

Cardiologists, radiologists, and nuclear medicine physicians receive training and may be allowed to perform cardiovascular imaging by using echocardiography, nuclear cardiology, or cardiovascular computed tomography. Given the tremendous variability in training and expertise, physician certification in each of these areas has been developed as a measure of providing quality studies for accurate patient diagnosis and management. In this paper, the history, the process of examination development and administration, eligibility requirements, the results of physician testing, and board recognition will be presented for each of the 3 boards. Payers and government regulators have recognized these boards as a measure of physician quality, and they are often required for physician reimbursement and licensure.

http://imaging.onlinejacc.org/article.aspx?articleid=1109347

 

[BLADEMDA]

DEFINITION: An echocardiogram uses sound waves to produce images of your heart. This test is commonly used to see how your heart is beating and pumping blood to identify various abnormalities in the heart muscle and valves.

WHAT TO EXPECT: You will be asked to undress from the waist up and change into a hospital gown. Before you start the test, stickers/patches (electrodes) will be placed on your chest. You will then be asked to lie on an examining table or bed for the exam.

If you will have a transesophageal echocardiogram, your throat will be numbed with a numbing spray or gel, and you will likely be given a sedative to help you relax.

During the echocardiogram, the technician will dim the lights to better view the images on the monitor. You may hear a pulsing sound while the machine records the blood flow through your heart. Sometimes the transducer must be held very firmly against your chest to help the technician produce the best images of your heart. Our technologist will take special care to make sure you are as comfortable as possible during the procedure. You may be asked to breathe in a certain way or to roll onto your left side in order to obtain necessary images.

Most echocardiograms take less than an hour, but the timing may vary depending on how many images need to be taken.

HOW TO PREPARE: No special preparations are necessary for a standard transthoracic echocardiogram. Your doctor will ask you not to eat for a few hours beforehand if you’re having a transesophageal or stress echocardiogram. If you’re having a transesophageal echocardiogram, be sure to make arrangements for someone to drive you home because of the sedating medication you will receive.

RESULTS: One of our specially trained radiologists will interpret your results. Depending on your results, you may be referred to a heart specialist (cardiologist) for more tests. Treatment depends on what’s found during the exam and your specific signs and symptoms. You may need a repeat echocardiogram in several months or other diagnostic tests, such as a cardiac computerized tomography (CT) scan or CT angiogram.

 

[BLADEMDA]

William F. Burke III, M.D., Section Chief of Cardiovascular and Thoracic Imaging and Radiology Residency Program Director
Dr. William F. Burke is board certified with expertise in cardiovascular imaging, specifically coronary CTA and cardiovascular MRI. Dr. Burke received his undergraduate and medical doctor degrees from The Pennsylvania State University and Hershey Medical Center. He completed his internship at St. Vincent’s Medical Center in Manhattan and diagnostic radiology residency at Hahnemann University Hospital/Drexel College of Medicine in Philadelphia. After completing a cardiovascular imaging fellowship, he confirmed his expertise in the latest cardiac imaging techniques by being awarded a certificate of Advanced Proficiency in cardiac CT by the American College of Radiology. His participation in numerous ongoing research studies keeps him on the forefront of this new and rapidly evolving field.

 

[vector2]

I have always wondered why they don't do it. Make more sense to me than a cardiologist doing it.

Probably had no appeal to them. Same reason that antepartums get their anatomy scans done by MFM and not radiologists. In my institution, it's cardiologists that do all the cardiac PET/MRI/CT reads even though I'm sure some of the body and nuke rads folks are more than capable.

Blade, I would be curious to find out whether those older rads guys who read echo at that hospital are NBE certified...I know from my senior rads resident buddy that they do get some exposure to advanced cardiac imaging, but I know ridiculously more about echo than him after three months of cardiac and a TEE elective.

 

[WholeLottaGame7]

My wife informs me that rads residents do plenty of cardiac CT/MR imaging, but no echos. Makes sense, there's a lot of diastology/other physiology that they aren't particularly interested. Echo is a lot more than just anatomy.

 

[deleted162650]

Probably had no appeal to them. Same reason that antepartums get their anatomy scans done by MFM and not radiologists. In my institution, it's cardiologists that do all the cardiac PET/MRI/CT reads even though I'm sure some of the body and nuke rads folks are more than capable.

Blade, I would be curious to find out whether those older rads guys who read echo at that hospital are NBE certified...I know from my senior rads resident buddy that they do get some exposure to advanced cardiac imaging, but I know ridiculously more about echo than him after three months of cardiac and a TEE elective.

Radiology does prenatal anatomy scans where I'm at as well as MFM. They do it for quite a bit cheaper too.

 

[meister]

Radiologists used to do echoes every now and then, older crotchety rads could tell you all about it. IRs are probably more likely to do cardiac caths than a radiology US section getting their hands on an echo study anymore, which is to say pretty damn unlikely.

Maybe once we are all salaried cardiologists will be more than happy to give us some of this long lost turf.

 

[Doctor4Life1769]

Radiology does prenatal anatomy scans where I'm at as well as MFM. They do it for quite a bit cheaper too.

Same here.

 

[Doctor4Life1769]

The question is how much reading an Echo reimburses vs going through as many plain films, MRIs, CTs, bone scans, HIDAs, etc as possible. I honestly don't know the reimbursement rates on all these studies. If it's not much then I could see why most radiologists would be happy to turf it to whoever wants to deal with all that. As mentioned above, Echo isn't purely anatomy either, but I suspect they are probably okay to interpret them if push came to shove. They do OB antenatal US, TVUS, etc. where I am as well.

 

[kidthor]

Why don't Anesthesiologists push to read TTEs? We know more about cardiac physiology than Radiologists, and it's at least a better "peri-operative-physician" activity than being a de facto surgical PA via the PSH nonsense.

 

[Doctor4Life1769]

Why don't Anesthesiologists push to read TTEs? We know more about cardiac physiology than Radiologists, and it's at least a better "peri-operative-physician" activity than being a de facto surgical PA via the PSH nonsense.

Probably.
Good luck grabbing that from Cardiologists.

 

[Psai]

Probably.
Good luck grabbing that from Cardiologists.

They are mad about letting people do intraop tees. They fight hard to expand their practice into legs and carotids while asserting that others can't read images like they can which is absurd

 

[DrBowtie]

The question is how much reading an Echo reimburses vs going through as many plain films, MRIs, CTs, bone scans, HIDAs, etc as possible. I honestly don't know the reimbursement rates on all these studies. If it's not much then I could see why most radiologists would be happy to turf it to whoever wants to deal with all that. As mentioned above, Echo isn't purely anatomy either, but I suspect they are probably okay to interpret them if push came to shove. They do OB antenatal US, TVUS, etc. where I am as well.

The physiologic information on echo is no different than cardiac MRI or retrospective gated cardiac CT. EF, valvular flow and abnormality, wall motion etc.

It's not like Cards or Anes have a monopoly on that information. A cardiothoracic radiologist could probably easily do them. It all comes down to local turf battles like cardiac nucs.

 

[kidthor]

We're collectively silly for allowing everyone else (midlevels and physicians alike) to steal our turf while not pushing into theirs. I quite frankly don't see why we couldn't do routine endovascular work either (IVC filters, diagnostic imaging, etc.) or place tunneled CVCs and mediports. Why not push our specialty into procedures and turf we can actually bill for?

 

[Doctor4Life1769]

We're collectively silly for allowing everyone else (midlevels and physicians alike) to steal our turf while not pushing into theirs. I quite frankly don't see why we couldn't do routine endovascular work either (IVC filters, diagnostic imaging, etc.) or place tunneled CVCs and mediports. Why not push our specialty into procedures and turf we can actually bill for?

You really think anesthesiologists have the time to place these lines and ports on every pt needing them in the hospital, all the while having to be in the preop, OR, PACU? You can have every patient show up in a procedural room near the PACU or Preop holding area and see how long the folks will want to put up with all that. I'm sure most hospitalists would LOVE to turf all procedures to the anesthesia dept if they could (they usually tried to where I was in training, and being the float resident was at times hell because you had to coordinate with the attending, the PACU nurse, etc and we were still liable for acute pain consults and the first responders for all codes/RRTs and backups for OB codes).

 

[Doctor4Life1769]

The physiologic information on echo is no different than cardiac MRI or retrospective gated cardiac CT. EF, valvular flow and abnormality, wall motion etc.

It's not like Cards or Anes have a monopoly on that information. A cardiothoracic radiologist could probably easily do them. It all comes down to local turf battles like cardiac nucs.

So the question is reimbursement. If it's not worth a radiologist's time to eval/interpret echo and more money is to be had interpreting other images, that may be the answer. Cardiologists are already getting reimbursements slashed, especially invasive, so I can see why they'd want to maintain their turf on Echos.

 

[Doctor4Life1769]

They are mad about letting people do intraop tees. They fight hard to expand their practice into legs and carotids while asserting that others can't read images like they can which is absurd

Oh they love coming into the OR and doing TEE interpretations. We had some faculty who were not cardiac/TEE trained so they'd run on down to the OR with the fellow and try to "push us out of the way"

 

[kidthor]

I'm not talking about placing routine lines and PIVs on floor patients - agreed, that'd be a waste of time and I'd want nothing to do with it.

I'm talking about placing fluoro guided tunneled HD lines and the like that IR or Surgery currently collect PLENTY for. Why not pick up that sort of thing and bill/collect for it? I'd rather do procedures I'd get paid for, rather than doing PSH nonsense that pays literally nothing.

 

[Doctor4Life1769]

I'm not talking about placing routine lines and PIVs on floor patients - agreed, that'd be a waste of time and I'd want nothing to do with it.

I'm talking about placing fluoro guided tunneled HD lines and the like that IR or Surgery currently collect PLENTY for. Why not pick up that sort of thing and bill/collect for it? I'd rather do procedures I'd get paid for, rather than doing PSH nonsense that pays literally nothing.

I wasn't referring to PIVs either - there's IV nurses for that.

Good luck in that fight with surgeons and IR - no way they give up placing tunneled caths. I've not met an anesthesiologist in real life who was able to take a stand against surgeon, nonetheless the surgery dept, IR dept, or the hospital admin/culture. The SDN folks are different, but I've not met them either IRL. You have to prove that you are an expert in such procedures to get privileged in it, and quite frankly the only time fluoro is used by anesthesiologists are for needling the spine. I'm sure anesthesiologists can do it (you have fluoro after all) but good luck in that fight.

Anesthesiologists don't bring value to the hospital administration and thus you have no leverage.

 

[Psai]

I'm not talking about placing routine lines and PIVs on floor patients - agreed, that'd be a waste of time and I'd want nothing to do with it.

I'm talking about placing fluoro guided tunneled HD lines and the like that IR or Surgery currently collect PLENTY for. Why not pick up that sort of thing and bill/collect for it? I'd rather do procedures I'd get paid for, rather than doing PSH nonsense that pays literally nothing.

I think making enemies with surgeons by pushing into their turf is probably a bad idea when you don't bring in your own patients. But psh is definitely crap

 

[Doctor4Life1769]

I think making enemies with surgeons by pushing into their turf is probably a bad idea when you don't bring in your own patients. But psh is definitely crap

Take what you can get and be happy with it. That's the philosophy. You know what they say about the runt of the litter..

 

[Chloroform4Life]

Fighting for your piece of the pie is easier said than done. Hospitals can replace an anesthesia group without much thought. I know because it's happening with my current practice. You cost them too much money or you upset administration by not playing ball and you can easily lose your job. Upsetting surgeons won't help you because they bring patients to the hospital, which the hospital depends on for income. If you're not heavily invested in your location and don't mind moving, it's easier to fight back because worst case scenario, you practice somewhere else. For many people who have put down roots, it's more difficult.

 

[kidthor]

Fighting for your piece of the pie is easier said than done. Hospitals can replace an anesthesia group without much thought. I know because it's happening with my current practice. You cost them too much money or you upset administration by not playing ball and you can easily lose your job. Upsetting surgeons won't help you because they bring patients to the hospital, which the hospital depends on for income. If you're not heavily invested in your location and don't mind moving, it's easier to fight back because worst case scenario, you practice somewhere else. For many people who have put down roots, it's more difficult.

Agreed... and like you said it'd be unrealistic for a comfortable anesthesiologist to individually create turf wars with risk of getting fired.

It's really the ASA/ABA that needs to step up their game and, from a top level, advocate for expansion of compensated practice rather than push for PSH nonsense.

Here's more food for thought - when indicated, why aren't we routinely performing point of care (or intraop) TTEs and billing for them? EM docs do this sort of thing regularly with FAST exams, and they've figured out how to bill appropriately. Yeah there's red tape - but we can figure this out as a specialty with the appropriate leadership.

Or, we could create ERAS protocols for free and let surgeons and floor nurses take all the credit for them.

But whatever, APRNs are going to perform and bill for all the aforementioned procedures after a weekend course anyway.

 

[Taurus]

Echoes saw a huge reimbursement cut a few years ago along with several other cardiac imaging studies. That's why a lot of cardiology pp groups sold out to hospitals. It didn't make sense to continue owning the equipment. I've been told that the majority of cardiologists in the US are now employees and not in pp.

 

[Doctor4Life1769]

Agreed... and like you said it'd be unrealistic for a comfortable anesthesiologist to individually create turf wars with risk of getting fired.

It's really the ASA/ABA that needs to step up their game and, from a top level, advocate for expansion of compensated practice rather than push for PSH nonsense.

Here's more food for thought - when indicated, why aren't we routinely performing point of care (or intraop) TTEs and billing for them? EM docs do this sort of thing regularly with FAST exams, and they've figured out how to bill appropriately. Yeah there's red tape - but we can figure this out as a specialty with the appropriate leadership.

Or, we could create ERAS protocols for free and let surgeons and floor nurses take all the credit for them.

But whatever, APRNs are going to perform and bill for all the aforementioned procedures after a weekend course anyway.

Echoes saw a huge reimbursement cut a few years ago along with several other cardiac imaging studies. That's why a lot of cardiology pp groups sold out to hospitals. It didn't make sense to continue owning the equipment. I've been told that the majority of cardiologists in the US are now employees and not in pp.

Figured it had to do with reimbursement.
Thanks for your reply.

 

[BLADEMDA]

Echo Reimbursement by CMS is horrible. Still, it would be nice to see a BASIC TTE offered by the ASA/ABA so we can screen our patients at night and on the weekend. We are talking about reimbursement usually well under $100 for a TTE so I doubt there would be a turf war for Anesthesiologists wanting to perform TTE after hours, holidays and weekends.


http://www.umiultrasound.com/cardiology-cpt-codes

Looks like they get $64 for reading a TTE performed by a hospital technician.

 

[pjl]

Echo Reimbursement by CMS is horrible. Still, it would be nice to see a BASIC TTE offered by the ASA/ABA so we can screen our patients at night and on the weekend. We are talking about reimbursement usually well under $100 for a TTE so I doubt there would be a turf war for Anesthesiologists wanting to perform TTE after hours, holidays and weekends.


http://www.umiultrasound.com/cardiology-cpt-codes

Looks like they get $64 for reading a TTE performed by a hospital technician.

My cardiology group approached me and asked us to take over all off hour TTE and TEE.


Sent from my iPad using SDN mobile app

 

[jthedestroyr]

They are mad about letting people do intraop tees. They fight hard to expand their practice into legs and carotids while asserting that others can't read images like they can which is absurd

I don't think this is true. I just got off cardiology and my attending was very unique.
He was Trained in cardiology and also a fellowship in nuclear medicine with emphasis on cardiac imaging. He told me he would rather read ekg or do nuclear/cardiac studies all day than do TEE as he felt the time it takes him to do tee Doesn't pay like it does for him to do the former.

He mentioned the radiologist didn't like him doing the nuclear studies since that's mostly their turf, but it paid way better than tee.


Didnt see blades post before I wrote mine, but appears what I was told by my cardiology attending was spot on.

 

[periopdoc]

I would be perfectly happy to let the cardiologist do the "official" read on my TEEs. Reads simply don't pay enough to be worth the time. I do reads as a courtesy to the surgeon. I also do after-hours TEE on cardiac surgical post-ops as a courtesy.

I get paid 2.5 times as much for placement of a PA catheter. Less time, less liability. Of course the cardiologists know this too so they aren't interested in reading intraoperative TEEs anymore either.

-pod