Night moves: tips for moving to global teleradiology

In the face of a radiologist shortage, many radiology operations, from small private-practice groups to large university centers, are relying on nighthawks to staff night shifts.

International "nighthawk" teleradiology is one solution, exploiting time zone differences to let U.S. radiologists work days and sleep nights, but it presents unique challenges.

Having a dedicated nighthawk helps by providing support at the time when the local radiologist least wants to be working, and it allows the group to focus on their daytime work, which is their primary interest and responsibility, said Dr. Arjun Kalyanpur, CEO and chief radiologist for Teleradiology Solutions.

While international nighthawk arrangements may benefit the practice, the radiologist, the emergency department, and the patient, they are not without issues. Reimbursement is one of them.

"Medicare prevents offshore final reads from being reimbursed," Kalyanpur said. "Short of sorting all cases immediately based on insurance provider, it is simpler for the nighthawk to
provide a preliminary report, which the in-house radiology group can scrutinize the next morning before issuing the final report."

Next-day review, while inherently unproductive, is not all bad. It allows the group to perform quality assurance, as well as to have the final word on a report, which is in the best interest of patient care.

Licensing is another issue. To provide international nighthawk services, the interpreting radiologist must be certified by the American Board of Radiology, be licensed in the
state in which the image originates, and have malpractice insurance to cover practice within the U.S.

"Some states now offer specific telemedicine licenses that are adequate for teleradiology coverage and somewhat easier to obtain than the regular state license," Kalyanpur said.

Once the radiologist is licensed in the state in which the group is located, the only delay is related to credentialing, which is often tedious and lengthy.

"Any group considering hiring a nighthawk service at short notice should ideally approach their medical staff office with a request for limited telemedicine privileges for the nighthawk, which allows institution of service rapidly," Kalyanpur said.

Kalyanpur also advised that the choice of a particular nighthawk provider should be determined by performance (as certified by current users) and by the credentials of the interpreting radiologists, and "not on racial biases or popular (mis)conceptions of what may or may not constitute a high-technology region geographically."

Several nighthawk operations currently exist, providing international services to U.S. radiology groups from Australia, Israel, India, and the U.K.