New rules for offshore reads may hit rads at home

February 21, 2005

The American College of Radiology issued a new set of guidelines early this month to ensure that radiologists interpreting studies abroad meet the training and professional practice standards of their counterparts in the U.S. The policy could boomerang against small domestic teleradiology firms, however.

The American College of Radiology issued a new set of guidelines early this month to ensure that radiologists interpreting studies abroad meet the training and professional practice standards of their counterparts in the U.S. The policy could boomerang against small domestic teleradiology firms, however.

The ACR Task Force on International Teleradiology recommended that physicians reading studies outside of the U.S. should be licensed in the states where the studies originated, be credentialed and afforded privileges by the healthcare institutions contracting them, and carry liability insurance (J Am Coll Radiol 2005;2:121-125).

These guidelines may have little effect on sizable foreign teleradiology firms. Several companies already contracting with U.S. hospitals can invest the time and resources into getting these accreditations and assembling a legitimate group of U.S.-trained, board-certified, and insured physicians.

But some of those engaged or interested in the teleradiology business - single radiologists working out of their homes or very small firms - may be deterred by the high costs involved. Those who are able to follow suit may ultimately succumb to cutthroat competition, said Dr. Mike Maresca, president and founder of St. Lawrence Radiology, a nighthawk service based in Potsdam, NY.

"It's hard to get contracts, and the people you are going after are shopping for price and quality," Maresca said.

The ACR follows the lead of the Joint Commission on Accreditation of Healthcare Organizations. In the March 2003 issue of Briefings on Credentialing, JCAHO published an update on telemedicine standards that drew the lines between physicians directing patient care and those providing interpretation or consultative services at a distance. Like JCAHO, the ACR directed efforts at identifying potential issues compromising accepted standards of care in the U.S.

"What the ACR is doing is simply trying to protect the patients. They are going along with what JCAHO has already done," Maresca said.

For the most part, U.S.-based radiologists and teleradiology services express satisfaction and support for the ACR guidelines. But some have reservations. Many fear that quality assurance procedures as well as patient privacy standards will not be properly observed abroad, leaving the door open for abuse.

According to Mark Bakken, president and CEO of Radlinx Group, the ACR statement does not address key areas of concern, such as compliance overseas with the Health Insurance Portability and Accountability Act, accountability for malpractice, and the oversight of working environments thousands of miles away.

"Healthcare information requires a whole set of rules, and the enforcement of those rules is purely voluntary overseas. These guidelines do not address the liability perspective of those reading studies abroad," Bakken said.

Two bills sitting in Congress propose limiting the amount of personal information that can be provided to overseas contractors. If signed into law, legislation proposed by Sen. Hillary Rodham Clinton (D-NY) and Rep. Edward Markey (D-MA) would require patients to give consent for the use of overseas radiology readings.

For more information from the Diagnostic Imaging archives:

CMS eases billing requirements for offsite readers

IHE committee takes its message around the globe

Thrall weighs pros and cons of radiology outsourcing

Healthcare law will mean big changes in practice