ACR’s teleradiology task force weighs in

Although teleradiology services offer a number of benefits to healthcare providers and their patients, the American College of Radiology’s (ACR’s) Task Force on Teleradiology Practice stated that the traditional practice model of on-site, local radiology groups may better serve most communities.

This opinion, as well as recommendations to providers, radiology practices and the ACR on teleradiology best practices, comes from the ACR White Paper on Teleradiology Practice, authored by task force chair Ezequiel Silva III, MD, of University of Texas Health Science Center at San Antonio, and colleagues, and published online May 20 in the Journal of the American College of Radiology.

“Teleradiology services are now embedded into the workflow of many radiology practices in the United States, driven largely by an expanding corporate model of services,” wrote the authors. “This has brought opportunities and challenges to both providers and recipients of teleradiology services and has heightened the need to create best-practice guidelines for teleradiology to ensure patient primacy.”

The task force, established January 2012 by John A. Patti, MD, chairman of the ACR Board of Chancellors, said teleradiology services can simplify geographic and overnight coverage challenges. They allow smaller hospitals to provide interpretations around the clock and can strengthen subspecialty expertise.

A major issue, however, is that teleradiology companies focused exclusively on report delivery are “devaluing” the specialty, according to Silva and colleagues. They undermine the role of the radiologist as a member of a consulting team and commoditize the practice of radiology. Some radiology groups also have complained of unfair competition from teleradiology services.

“Examples of radiology groups recently displaced from long-standing hospital coverage have generated considerable discussion of ‘predatory’ business practices by teleradiology providers and raised the notion that outsourcing to teleradiology firms facilitates such upheaval,” wrote the authors.

The task force stated that the ACR represents its entire membership and doesn’t take sides in business conflicts, though they noted that an increase in competition made possible by advances in communication technology doesn’t necessarily mean the competition is “predatory.”

As teleradiology companies begin to more aggressively market themselves to hospitals, established radiology groups must in turn understand they should concentrate on meeting expectations, advised Silva and colleagues. “Failure to provide rapid turnaround, subspecialty interpretations, or adequate coverage can force hospitals to consider alternatives.” They also advised radiologists to involve themselves in the planning processes of health systems.

The task force expressed concern that the teleradiology model is evolving faster than the development of safeguards and best practices, and advised the ACR to educate its members and monitor the practice of teleradiology.

With regard to contracts with teleradiology services, the white paper provided a list of issues that must be considered and addressed, including:

• Definitions of exam and interpretations
• Hours of coverage
• Minimum and maximum volumes of exams
• Response time
• Modalities covered
• Subspecialty interpretations
• Credentialing
• Quality assurance
• Malpractice coverage
• Accreditation
• Records
• IT requirements

Newly implemented place-of-service rules from the Centers for Medicare and Medicaid Services have special relevance for teleradiology, and you can read more from Silva on these rules in a previous Health Imaging story.