How should radiologists handle outside imaging studies?

Numerous researchers have documented the benefits of obtaining a second opinion on the review of imaging studies performed at another institution. However, little has been published on how to handle such outside data in terms of payment and keeping records. 

Wanting to provide clarity on the topic, radiology experts with Johns Hopkins and the University of British Columbia recently polled dozens of leaders to try and find a consensus on best practices. They found that about 77% of those surveyed incorporate outside studies into their picture archiving and communication system (PACS), while 37% require formal internal reports on all outside studies.

The article’s authors did not find clear consensus among respondents, according to their analysis, published online in the American Journal of Roentgenology. One key takeaway is the need to develop a uniform method of addressing this issue.

“Developing a best practices statement that addresses patient care, medicolegal implications for radiology departments and referring physicians, financial implications, and quality and safety precepts would be a useful endeavor for organized radiology,” Parisa Khoshpouri, a research assistant at Vancouver General Hospital, and colleagues concluded.

“In so doing, radiologists may gain more clarity from a malpractice mitigation standpoint and have greater leverage with payers for appropriate reimbursement for their professional expertise,” she added.

Khoshpouri et al. reached their conclusions by interviewing more than 90 experts with the Society of Chairs of Academic Radiology Departments (SCARD). Some other notable findings from the online survey included:

  • Nearly 74% bill insurers for second-opinion consultations, while 67% billed patients.
  • More than 16% choose to repeat studies rather than including the outside information in their PACS.
  • Almost 62% said they add outside studies to their PACS, whether they have read the cases officially or not, and 14% said they add only studies for which they provided an official interpretation.
  • Only about 3% said they completely disallow outside studies from their PACS.

The study’s investigators also interviewed experts from the Association of Administration in Academic Radiology and found largely the same results, with a few exceptions. For example, 60% of administrators said they provide official readings for all outside studies compared to just 37% of SCARD respondents.