Top 10 Things to Look For in a Teleradiology Group

Written by Douglas K. Smith, MD, founder and owner, Musculoskeletal Imaging Consultants | August 04, 2011 | Print  |
Musculoskeletal Imaging Consultants' radiologists are seasoned experts, selected by their clinical experience and commitment to serving the needs of fellow physicians as well as their ability to communicate effectively as consultants. MSKIC radiologists select and annotate pertinent key images and attach them to accurate detailed reports. When you have questions, MSKIC radiologists can easily be reached by phone or by an interactive online consultation session. MSKIC radiologists are clinicians at heart and strive to be your trusted colleague. We're like having a university professor right in your clinic; Teleradiology in the palm of your hand! Douglas K. Smith, MD, is the founder and owner of Musculoskeletal Imaging Consultants. He pursued training at the Mayo Clinic in orthopedics during the pioneering days of MRI. He founded MSKIC in 1995, is licensed in 35 states and provides expert orthopedic teleradiology services throughout the United States.

In today's constantly changing healthcare environment, it's important for orthopedic and spine surgeons and practices to work with reliable radiologists who are experienced in reading musculoskeletal reports. Here are 10 key qualities to look for in a teleradiology group to ensure efficient and effective services.

1. Specialization and expertise in orthopedics, spine and pain management radiology.
Limit your search to teleradiology companies focusing on orthopedics and spine. Your physicians need detailed, clinically relevant reports from experts in the field. The radiologists reading your studies should be seasoned, clinically oriented subspecialists with at least a decade of musculoskeletal imaging experience. Many large teleradiology companies farm studies out to lower cost, less experienced radiologists or outsource your studies to offshore radiologists in India.

Language and dialect differences among offshore radiologists can produce interpretive or contextual errors that can be costly to your group prestige and medical liability. Imprecise wording in reports can be a reason for insurance denying your surgical procedures. You and your patients deserve the best, and for a price, you can obtain readings from leaders in the field. Accurate detailed reports by experienced subspecialty radiologists can be priceless compared to the real costs of the lowest cost bidder.

2. Physician ownership and active management. Physician owners empathize with your clinical requirements and are more responsive to your needs as a practicing physician. Many of the largest teleradiology companies are publicly held corporations run by businessmen responding to the demands of the corporate stockholders rather than to your needs as only one of thousands of small clients. When you have a request or clinical need, having a fellow physician responding directly to your request rather than talking to a corporate board is often easier and more personal.

3. Radiologist accessibility. When you are busy with your clinic or in the OR and have questions about a radiology study, you need an answer right now. Look for a teleradiology group that has online collaborative session capabilities so you can access the radiologist who read the imaging study. As you investigate a potential teleradiology company, call the corporate office and ask to speak with the owner/CEO. If the owner promptly takes your call, this is a strong indicator of the clinical response of this teleradiology company to your future concerns about clinical service.

4. Annotated key images attached to reports. Insist on having the radiologist annotate key images and attach them directly to the report. It makes your reports much more understandable and distinguishes your reports from competitors in your community. Surgical authorization rates increase with inclusion of annotated key images but very few teleradiology companies offer this service because it takes the radiologist more time. Patients really love this service and providing reports with the images attached will add prestige to your practice.

5. Dedicated radiologist(s) assigned to your group.
Most teleradiology groups farm your studies out to a large pool of radiologists so you rarely know the radiologists reading your study. Insist on having the teleradiology company commit one to three radiologists to your group's studies so that you have a close working relationship with your teleradiology consultants. Insist on seeing CVs of the specific radiologists who will be reading your studies and ask for sample of their reports. Additionally, ask to speak with the radiologists before you sign a contract to get a feel for how well they interact with members of your group.

It is also reasonable to ask for an online interactive session between your physicians and prospective radiologists to review a test case before making this important decision. Demand that all radiologists be trained at leading U.S. medical schools, undergo musculoskeletal radiology residency training and be American Board of Radiology-certified with participation in the ABR Maintenance of Certification program.

6. Universal access to your reports and images. Cloud computing and secure internet-based radiology software can allow you to view your radiology reports and images from virtually anywhere. If you use handheld devices like the iPAD in your practice, make sure that the teleradiology company uses a clientless or zero footprint image viewer so your patients' protected health information (PHI) on the cloud is not transferred to your handheld device. Loss or theft of a handheld device with this information can result in a PHI security breach. If the PHI is viewed remotely on the cloud rather than the handheld, there is no PHI transferred to the handheld or potential exposure with device loss.

7. Capability of handling STAT examinations within 15 minutes. In sports medicine practices, having the ability to review the MRI report with the patient within minutes after the scan is a great medical and marketing advantage. With this ability, the report with annotated images can be submitted to the insurance company for surgical authorization and a treatment plan can be developed during a single office visit. Patients traveling from a distance can have a prescheduled MRI appointment with the follow-up office visit right after the MRI if the teleradiology company can generate a report within a few minutes using voice recognition technology.  

The use of voice recognition can also allow immediate availability of an addendum to a report during an online collaboration session. Very few teleradiology companies offer this service but it can be a huge marketing advantage to your group.

8. Peer review process. The teleradiology company should actively participate in a peer review process such as RadPeer, administered by the American College of Radiology. The teleradiology company should have policies and procedures in place to notify you of any clinically relevant discrepancies or changes in the report content.

9. Experience with MIPPA/CMS mandates and MRI scanner accreditation procedures.
If your orthopedic group owns or operates an MRI scanner, you must achieve accreditation by one of three Medicare-approved accreditation entities: the American College of Radiology, the Intersocietal Accreditation Commission and The Joint Commission before Jan. 1, 2012 in order to receive payment for the technical component of scanning under Part B of the Medicare Physician Fee. Insist on using a teleradiology group that is familiar with Medicare Improvements for Patients and Providers Act and provide the "supervising physician" role required for continued MIPPA certification.

Medicare approval requires designation of a "supervising physician" with extensive training and documented experience with diagnostic imaging to monitor the required quality assurance and maintenance program. This is best addressed by a teleradiology group that can monitor and adjust your scanner's performance and the peer review process of your radiology reports.

10. Reputation of the teleradiology group.
Before you agree to a service contract, interview current clients including other physicians, practice managers and MRI technologists to learn what others think about the service they receive. Ask their MRI technologists if the radiologists are accessible for questions or suggestions on scanning protocols. Ask the practice manager if the reports are timely and if the service is consistent. Ask the physicians if they are happy with the reports they receive and if the radiologists are readily available for their questions. Finally, ask if the client sees the teleradiology group as an asset.

Learn more about Musculoskeletal Imaging Consultants.

More Expertise From Musculoskeletal Imaging Consultants:

iPad-Based Radiology Interface for Orthopedic and Spine Surgeons: Virtual Viewbox From Musculoskeletal Imaging Consultants

Changes for CMS Imaging Reimbursement: 6 Things for Orthopedic and Spine Providers to Know
Trends and Insights Into Orthopedic Teleradiology: Q&A With Radiologist Douglas Smith

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