Radiology and Outsourcing

[dr dr]

Hello everyone,

I am new to this new forum.........I have heard this few times in the past. I would appreciate if someone could comment on outsourcing of radiology. Is it possible that in future, outsourcing of radiology will be in direct competition with MD radiologists? I appologise if this question has asked before. Thanks for reading this post.

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[hans19]

Hello everyone,

I am new to this new forum.........I have heard this few times in the past. I would appreciate if someone could comment on outsourcing of radiology. Is it possible that in future, outsourcing of radiology will be in direct competition with MD radiologists? I appologise if this question has asked before. Thanks for reading this post.

I'll be happy to answer the question on condition that you dress up in a horse costume... lie perfectly still (as if you were dead), and allow me beat you senseless.

OR

if you are resourceful, you could use the 'search' function. Enter keywords 'radiology' and 'outsourcing'.

 

[f_w]

..

 

[Whisker Barrel Cortex]

Try these:

http://forums.studentdoctor.net/showthread.php?t=163856&highlight=outsourcing+radiology

http://forums.studentdoctor.net/showthread.php?t=178679&highlight=outsourcing+radiology

http://forums.studentdoctor.net/showthread.php?t=118593&highlight=outsourcing+radiology

http://forums.studentdoctor.net/showthread.php?t=128962&highlight=outsourcing+radiology

http://forums.studentdoctor.net/showthread.php?t=81525&highlight=outsourcing+radiology

http://forums.studentdoctor.net/showthread.php?t=64475&highlight=outsourcing+radiology

 

[Back34]

I spoke with an attending on this very subject today and he said one of the driving forces for outsourcing is the fact that U.S. radiologists don't/won't do call. If he needs a film read at 3 A.M. then he has no choice but to beam it over the Pacific.

 

[LAZYGUY]

I spoke with an attending on this very subject today and he said one of the driving forces for outsourcing is the fact that U.S. radiologists don't/won't do call. If he needs a film read at 3 A.M. then he has no choice but to beam it over the Pacific.

Let's think about this logically:

There isn't an oversupply of Radiologists anywhere in the world.

If they are beaming things anywhere around the world, that physician must possess a US licensed and be boarded in Radiology by the ABR

Last I checked, Radiology is one of the most important factors in diagnosing patients and guiding treatment. Its no joke, people do not want tumors being missed, at least I don't.

Training in Radiology is 5 years after medical school for a reason, not everyone can do it! While other physicians might think this is a feasable option, it is more feasable for their job to be outsourced to a robot than that of a Radiologist.

Lastly, the imaging is becoming so advance. The US is the leader in technology...physicians in other countries aren't trained in some of the newer modalities.

 

[f_w]

> There isn't an oversupply of Radiologists anywhere in the world.

That is true, but there is a good supply of radiologists in the world who will do the job at 1/4th the price of a US radiologist. Even with a 100% additional overhead for transmission and credentialing cost, whoever benefits from the deal (insurer, provider) will make a good cut.

> If they are beaming things anywhere around the world, that
> physician must possess a US licensed

At this time, interpretation of radiology studies is considered the practice of medicine and you have to have a medical license. A couple of telerad providers sidestep this requirement by having one licensed radiologist sign the reports generated by an army of 15 'local' radiologists. This country is ruled by a very industry friendly regime, if employers and insurers realize that they can save money by outsourcing radiology interpretation, there will be a federal law pre-empting the states ability to regulate radiology interpretation in no time. It will be a big free for all, quality assurance in this deal will be up to the telerad companies (kind of like the NRC nowadays). Look at what happened to the states abilities to regulate LNG terminals.

> and be boarded in Radiology by the ABR

Just as you don't have to be board certified or even board eligible in order to perform surgery, there is no law requiring any specific training to interpret imaging studies. A recent effort by the ACR to get such a law enacted was shot down by other physician groups who profit from this lack of regulation (mainly cardiologists and orthopedic surgeons).

> Last I checked, Radiology is one of the most important factors in
> diagnosing patients and guiding treatment.

While I am proud of what I am doing, I still believe that the presence of brain matter inside of the skull of the person doing the H&P on the patient is the most important factor in diagnosis and treatment guidance.

> Its no joke, people do not want tumors being missed, at least I don't.

Unfortunately, the public is stupid and ignorant to the role of the radiologist in medical care. While you seem to see the value added by trained radiologists, the general public still thinks we are the people 'taking the x-rays'. The same patients believe that their surgeon 'diagnosed the cancer' and get upset if the pathologist sends them a bill.

> Training in Radiology is 5 years after medical school for a reason,
> not everyone can do it!

Agree.

> Lastly, the imaging is becoming so advance. The US is the leader
> in technology...physicians in other countries aren't trained in
> some of the newer modalities.

You vastly underestimate the abilities of radiologists in other developed countries. While here in the US the quantity of advanced imaging is larger than in many other places, the quality of this imaging flood is no better or worse than in most other developed places. (If you want to take the monthly quiz in the yellow journal as a measure of 'quality' in radiology, then Argentina and Greece would represent the places with the 'best' radiologists. In the past couple of years regularly radiologists from abroad have won the annual prize for the highest number of correct 'unknowns'.)

 

[LAZYGUY]

> There isn't an oversupply of Radiologists anywhere in the world.

That is true, but there is a good supply of radiologists in the world who will do the job at 1/4th the price of a US radiologist. Even with a 100% additional overhead for transmission and credentialing cost, whoever benefits from the deal (insurer, provider) will make a good cut.

It still seems difficult to conceive that with the volume of studies going into radiology that foreign physicians could put a dent into the market. What happens when they get sued? Will insurance want to take them?


At this time, interpretation of radiology studies is considered the practice of medicine and you have to have a medical license. A couple of telerad providers sidestep this requirement by having one licensed radiologist sign the reports generated by an army of 15 'local' radiologists. This country is ruled by a very industry friendly regime, if employers and insurers realize that they can save money by outsourcing radiology interpretation, there will be a federal law pre-empting the states ability to regulate radiology interpretation in no time. It will be a big free for all, quality assurance in this deal will be up to the telerad companies (kind of like the NRC nowadays). Look at what happened to the states abilities to regulate LNG terminals.

Again, this is already being done like you say....money doesn't seem to be saved a whole lot? What happened in MassGen, their plan fell apart and the chief of radiology lost his job.

Just as you don't have to be board certified or even board eligible in order to perform surgery, there is no law requiring any specific training to interpret imaging studies. A recent effort by the ACR to get such a law enacted was shot down by other physician groups who profit from this lack of regulation (mainly cardiologists and orthopedic surgeons).

are they compensated for this? What if they are sued for misinterpretation of the study, are they more likely to lose the case since it was out of their "scope" and specifically out of their discipline?


While I am proud of what I am doing, I still believe that the presence of brain matter inside of the skull of the person doing the H&P on the patient is the most important factor in diagnosis and treatment guidance.

well, ok.

Unfortunately, the public is stupid and ignorant to the role of the radiologist in medical care. While you seem to see the value added by trained radiologists, the general public still thinks we are the people 'taking the x-rays'. The same patients believe that their surgeon 'diagnosed the cancer' and get upset if the pathologist sends them a bill.

LOL, that is so true

 

[f_w]

> It still seems difficult to conceive that with the volume of studies
> going into radiology that foreign physicians could put a dent
> into the market.

Who knows what the volumes are going to be. I think it is a matter of principle.

> What happens when they get sued?

Their insurance co will hire an attorney and defend them against the suit. Not much different from a US physician. If they are to be served with documents, they will have to sign a 'waiver of personal service' and their attorney will receive the filings on their behalf.

> Will insurance want to take them?

It is all a question off money. If there is money to be made and the providers can demonstrate that the quality of their readings is comparable to the standard of care, they won't have a problem to cover these foreign radiologists.
And remember, General Electric tried to get into the telerad market. And guess what, they own a big insurance co, so they can just self-insure.

> Again, this is already being done like you say....money doesn't
> seem to be saved a whole lot? What happened in MassGen,
> their plan fell apart and the chief of radiology lost his job.

I don't think anyone at MGH lost his job over the WiPro dustup. Saini went to Emory as chairman, so yes in a way he 'lost' his job at MGH.

> are they compensated for this?

Sure they are. At least in the goverment medicare program which pays for a good share of patient care. A couple of HMO's think about limiting imaging reimbursement to trained physicians, but the goverment is actually barred from requiring membership in a 'cartel' to be able to bill for services (in the antitrust law sense, fellowship of an ABMS member board is a 'trust')

> What if they are sued for misinterpretation of the study, are they
> more likely to lose the case since it was out of their "scope" and
> specifically out of their discipline?

See, an orthopedic surgeon misinterpreting a CT scan will be measured against the standard of care 'in the local medical community'. His expert witness, another orthopod, will testify that it was within the standard of care in orthopedic surgery in this town to call it thisandsuch. Of course, the plaintiffs expert will try to hold him to the standard of a fellowship trained MSK radiologist. But in the end it is up to a jury of 12 village idiots to decide which expert witness they give more credibility (and god beware one of the experts snaps his fingers at the jury. that sides case is lost).

 

[GoPistons]

self-referral is clearly Rads biggest problem... outsourcing is definitely not... at the end of the day... everything that is done in a hospital requires a Dr.'s signature... hell... my nurse knows every drug to use and at what dose, yet, she still calls me at 4 AM to get it signed off... why? cuz I'm the doctor... in the same way, a US trained Rads guy must sign-off on any tumor, dz, etc.

Outsourcing very very very unlikely... too many forces against it at this point...

 

[f_w]

> in the same way, a US trained Rads guy must sign-off on any tumor, dz, etc.

says who ?

A licensed physician has to sign a radiology report, there is no state or federal law beyond that.

In most hospitals with their credentialing standards, that will typically mean a board certified (or at least BE) radiologist. But there is no law to require this standard of training. And as I said, attempts to require this level of qualification for participation in the medicare program have been shot down by the ACC lobby.

 

[GoPistons]

yes you are correct... my point was mistated... bottom line... is somebody has to be accountable with the final signature... whether it's a rads guy, cards guy, etc... point being... that person has to be accountable for any mistakes/law suits, etc. if you have reads from mysterious people, from countries with poor legislation, then you can't have the accountability for mistakes that are so in-grained in the US medical system...

U need a US trained person to interpret films... not necessarily a radiologist... but US trained for sure...