Comment: Hurdles to remote credentialing protect radiologists and quality of care

August 10, 2010
Alan Kaye, MD

There is another perspective on the analysis of proposed CMS regulations as described in your article "CMS plan could take a bite out of teleradiology night reads," published July 29. There is a problem with hospitals accepting the credentials of others. That approach bypasses normal medical staff oversight. This is inimical to patient care and undermines the security of all medical staff: now radiologists-next, someone else.

There is another perspective on the analysis of proposed CMS regulations as described in your article CMS plan could take a bite out of teleradiology night reads, published July 29.

The analysis of the regulations correctly states that motivated teleradiology companies will work hard to get their radiologists privileges at a hospital where it has contracted to provide extensive services. It also notes that hurdles to privileging might have the perverse effect of invoking resistance on the parts of hospitals when an incumbent radiology group seeks to obtain outsourced services.

But there is a problem with hospitals accepting the credentials of others (The Joint Commission, teleradiology companies, or other hospitals). That approach bypasses normal medical staff oversight. This is inimical to patient care and undermines the security of all medical staff: now radiologists-next, someone else.

At a time when there appears to be a reckless attitude on the part of shortsighted hospital CEOs and their boards of directors toward radiology service providers, many consultants and well-known radiologists are appropriately advising radiology practices to make medical staffs their allies. The benefits of these efforts are compounded because the medical staff has a strong role in credentialing.

Removing the local oversight of credentialing weakens what are potentially the only allies that patients and radiologists might have.

I submit that the benefits of medical staff involvement outweigh the potential disincentives to introducing teleradiology when a radiology practice seeks them out. In fact, the ACR has a policy that states, “The American College of Radiology regards care by onsite radiologists preferable to teleradiology, the latter being most useful as a supplement to onsite care for purposes such as subspecialty consultation and to provide coverage for underserved areas where the physical presence of a radiologist is not feasible.”

A decision to introduce outsourced providers to a hospital should be taken very seriously, and hurdles are appropriate.


Dr. Kaye chairs the radiology department at Bridgeport Hospital, Yale New Haven Health System, in Bridgeport, CT.