Should Radiologists Get Paid for Reading Prior Studies?

July 24, 2013

Obtaining prior studies benefits the patient, but takes extra resources. Radiologists should be incentivized to obtain priors and make comparisons. Do you agree?

Picture this scenario: You are reading a mammogram and your technologist tells you that the patient doesn’t have her prior studies and we are waiting to obtain them from an outside institution.

Or your technologist left a note on your desk stating that a prior brain MRI was uploaded in the system for you to compare to the study you read last week. 

These situations are not uncommon to radiologists and often are a nuisance given the increasing demands placed on us in the current healthcare environment of reading more cases to offset the decreasing reimbursements.

For most of these cases, I have little recollection of the findings I initially described (as it has been days or weeks since seeing the study) and I spend almost the same amount of time re-reading the case to be able to make a comparison to the prior study. This situation is particularly common in breast imaging. 

A few times a day I read mammograms on patients who had screening mammograms performed somewhere else. For many of these patients we usually obtain prior studies after calling the imaging centers where the patient had them done. In about a third of these cases, we cannot obtain their prior studies either due to patients not remembering where they had the studies performed or if the imaging center is no longer in existence. 

Should patients or radiologists have incentives to obtain prior studies?

In terms of breast imaging, I personally find that waiting to compare outside studies is more work for me than just working the patient up as if the study was a baseline for the patient. However, this is not the best practice as it can lead to increased radiation exposure and costs. Many of these patients often get additional diagnostic mammograms or ultrasounds. The benefit of getting priors is multi-factorial as it reduces radiation, decreases costs of more tests or biopsies, and reduces the emotional toll that patients have to go through when evaluating breast lesions.

Given the benefits of obtaining prior studies for the patient and often the additional resources it takes to obtain and review them, CMS and private insurers should provide an incentive for radiologists to obtain priors and make comparisons.

Do you agree?