JACR: Ironclad contracts protect from teleradiology pitfalls

Teleradiology contracts that are well-written and take into account all legal, regulatory and compliance issues can mitigate many of the risks involved in working with a teleradiology group, according to an article published in the August issue of the Journal of the American College of Radiology.

“Although it is impossible to predict every conceivable situation that could adversely affect patient care, a well-written contract can go a long way in protecting all parties, including patients,” wrote Jacqueline Finnegan, Esq, senior attorney at Garfunkel Wild in Great Neck, N.Y.

Finnegan acknowledged that the appeal of teleradiology—with its ability to provide remote coverage and improve efficiency—comes paired with concerns about miscommunication and overdependence on technology. She recounted the story of a patient who was imaged after complaining of a headache. The patient was discharged and later went into a coma and suffered a life-altering injury because teleradiology results were not communicated effectively to the patient’s physician.

“Unquestionably, it is the most egregious cases of negligence that generate publicity and call attention to the liability risks inherent in contracting with offsite teleradiologists,” wrote Finnegan. “Although these types of cases fuel the ongoing debate regarding teleradiology, they also provide some valuable lessons on what could have been done and can be done in the future to avoid similarly tragic outcomes.”

Finnegan outlined key teleradiology contract provisions, including:

• Professional qualifications of the interpreting physician: Ensuring the credentials of physicians providing teleradiology services is of “paramount importance,” wrote Finnegan. Contracts should require physicians possess valid licenses and are in good standing in both the state where the patient is receiving care and the state where the reading is taking place. Physicians should not be suspended from any federal healthcare program or convicted of an offense related to provision of services.
• Scope of services: Finnegan advised that contracts should clearly delineate the scope of services, including coverage times, type of interpretation, time frames in which interpretations must be reported, report formats and expectations for the reporting of urgent or abnormal findings.
• Insurance coverage: Interpreting physicians should be required to have professional liability insurance in the state where the patient is receiving care, said Finnegan.
• Representations by the teleradiology group: “Representations are important because they are contractual promises that, if breached, can provide grounds for terminating the contract or other relief (eg, indemnification),” wrote Finnegan. Requirements that reading sites satisfy applicable standards and comply with HIPAA and other regulations are examples of suggested representations.

Requirements for third-party billing should be addressed, wrote Finnegan, as should the process for reviewing the quality of the interpretations provided by the teleradiologists.

“Daunting though it may seem, the risks of contracting with a teleradiology group are not insurmountable, and a comprehensive, ironclad contract can go a long way in addressing these risk areas,” wrote Finnegan.