Academic radiology should reexamine how it handles outside studies

Academic radiology departments vary in how they handle second opinion consultations on outside studies, according to new research published in the American Journal of Roentgenology. A more uniform approach, the researchers argued, could help radiologists and patients alike.

Care centers receive imaging studies completed at outside institutions daily, in some cases reinterpreting up to 4,500 outside studies each year. Parisa Khoshpouri, MD, with Vancouver General Hospital’s Department of Radiology, and colleagues found most practices add outside studies to their PACS without an internal report and bill insurers but not patients for a second opinion.

If academic radiology departments could create a standard for these situations, radiologists would be better prepared for potential problems.

“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,” the researchers argued. “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.”

Khoshpouri and colleagues sent a survey to members of the Society of Chairs of Academic Radiology Departments (SCARD) and the Association of Administration in Academic Radiology (AAARD); response rates were 59.6% and 33%, respectively. Of the 91 SCARD respondents, 70 added outside exams to their PACS. And while 34 mandated internal reports for such studies, 74 allowed at least “some” outside studies into their PACS without a required internal report.

Additionally, most (73.6%) SCARD respondents billed insurers but not patients (67%) for second opinion consultations. Fifteen percent repeated studies instead of including outside exams in the PACS. These results were similar across all AAARD respondents.

“Institutional management of outside studies clearly raises numerous financial (e.g., billing, second opinion interpretation reimbursement) and technical (uploading, information technology uniformity, electronic medical record management and storage) issues,” the researchers wrote. “However, the legal implications surrounding an institution's handling of outside studies must be addressed, preferably in a policy that both protects the institution and enhances patient rights.”

What might that look like? From an institution’s perspective, the authors noted, a policy should clearly define the circumstances under which outside studies are accepted; when a second reading is needed; and when imaging studies should be repeated, among other things.

And from a patient’s perspective, the authors suggested that all patients coming in with outside studies should sign a document explaining how their outside exam or report will be handled and why.

“The primary legal directive to reduce litigation is to establish a clear policy on the management of this information,” the authors concluded. “Although this may be a cumbersome task given the array of issues to be addressed and the lack of uniformity in addressing them, it will prove to be a worthwhile endeavor.”