Ideas for Hospitals, Centers, and Practices
Teleradiology: Credentialing Is the Gateway to Quality
Michael Melville
Teleradiology is one of the fastest-growing areas in health care. Several years ago, a study by radiology experts predicted that up to 20% of the country’s image interpretation business would soon be provided via teleradiology.
There are many reasons for the current boom. Teleradiology can help a facility’s bottom line, as off-site overnight reading services are significantly less expensive than night radiologists. Teleradiology can also improve patient care, as it provides access to subspecialists. It can help address the current radiologist shortage: The American College of Radiology (ACR) estimates that the number of radiological scans is growing three times faster than the current available pool of radiologists. This shortage is attributed to aging populations and increased use of imaging in trauma situations.
However, teleradiology does present its own unique set of challenges. When it comes to teleradiology quality control, speed and accuracy are top priorities; however, credentialing needs to be an equal part of the QC equation.
The Centers for Medicare and Medicaid Services maintains that teleradiologists, even providing preliminary reads, are providing a “medical level of care” and must be individually credentialed and privileged through the medical staff process and approved by the board of directors. Meanwhile, ACR guidelines dictate that teleradiologists be licensed in the transmitting and receiving states, and credentialed in the sending facility.
Naturally, the credentialing process is a very complicated and time-consuming issue for any facility. The process can involve a review of the applicant’s current licensure and specific relevant training, data from professional practice reviews, peer or faculty recommendations, and review of the practitioner’s performance within an organization. It can typically take anywhere from 1 to 3 months to obtain responses from past employers or schools with essential credentialing information. Also, the practice in the United States is to issue licenses at a state level, unlike many countries that give doctors nationwide licenses.
What further complicates matters is that many facilities still rely on outdated, time-consuming, and potentially inaccurate approaches. In fact, it’s estimated that nearly 70% of those performing front-line credentialing are using some type of manual (paper) or home-grown (Excel, Access) system. Pencil-and-paper credentialing approaches can make it difficult to hire the most qualified staff since more sophisticated competitors will complete the credentialing process quicker and more accurately, and thus hire the best providers faster.
Automating payor/provider enrollment is an equally important element of the credentialing process. Radiology practices are reimbursed for services offered by caregivers who are licensed to provide care in a particular state, and who maintain relationships with appropriate payors. This is a particularly important issue for radiology practices utilizing teleradiology, as care is often provided across state lines. This element can make verifying relationships with payors a complicated and time-consuming issue for radiology practices.
When radiology practices are unable to confirm a relationship with a payor, they frequently provide radiology services for free since the payor is unwilling to reimburse for services completed before the provider was approved. Each year, health care providers are forced to write off millions of dollars in billings on account of delays in the approval process.
Automated credentialing suites can solve these problems by permitting instant management of the enrollment process. Automated programs proficiently manage the process, beginning by distributing e-mails requesting the necessary licensing information.
Automated Solutions
So what can facilities do to address these credentialing challenges? One solution is automated credentialing suites, which can permit instant management of the credentialing process. Rather than having to manually track each caregiver and communicate personally with their past employers and educators, automated programs can monitor when each caregiver must be recredentialed and distribute e-mails requesting the required credentialing or licensing information. Automated credentialing packages can also provide instant access to national physician databases where employment and education information is stored.
One of the benefits of automated credentialing is time savings, since this type of management can be completed in a fraction of the time it takes by hand. Meanwhile, the financial advantages are just as significant. By completing the process months sooner, facilities save thousands in administrative costs since they no longer distribute credentialing requests by hand and follow up individually.
There are several different credentialing programs available, each of which provides different features and different levels of service. This variety of choice gives providers an opportunity to find the program and vendor that best meets their needs.
Today, the predominant topic in the health care industry is “quality.” And while there are many different factors that contribute to quality of care, the most important is the caregiver. It?s not possible for health care organizations to ensure they are providing the highest quality of care unless that care is given by the most talented, experienced, and qualified professionals.
By making their credentialing efforts more effective and efficient, those facilities utilizing teleradiology can assure that care is being provided by the most qualified and experienced professionals.
—Michael Melville
Michael Melville is the president of the IntelliSoft Group. He can be reached at .
Med Students Triaging Off-Hour Imaging Requests Is a Win-Win
Scott Kennedy, MD
On November 2005, at the Yale University School of Medicine, the Emergency Department Radiology Triage Program was established with the primary goal of improving the efficiency of off-hour diagnostic imaging studies performed and interpreted by on-call diagnostic radiology staff. The idea of using medical students to triage calls coming into the radiology reading room was expected to benefit the radiologists, since it allowed them to focus on the accurate interpretation of imaging studies without disruption from the nonstop flow of calls that is the norm for a busy emergency department in a major academic medical center. A survey of current and former medical students who participated in the triage program was conducted by Scott Kennedy, MD, et al (AJR. 2010;194:1027?1033) to determine the additional educational value and career impact of such a program on the medical students who were hired to handle the calls.
The study captured the medical students’ demographic information, as well as answers to specific questions regarding their participation in the triage program, career plans, satisfaction with the program, and suggestions for improvement. It was interesting to note that of the 26 survey respondents, 17 were obtaining a second degree, in addition to their MD, while in the program. And an additional four respondents were taking an extra year of study without pursuing an additional degree. When asked to comment on this finding, Kennedy stated, “? a lot of the people who were doing the program were attracted to it because they were doing additional degrees and had extra time to participate in a program. If they were doing a PhD for 7 to 8 years, they could have a steady job where they could increase their clinical skills and also have something to do with their remaining years at school.”
With respect to influencing career choices, 20 of the 26 respondents described the program as being of at least moderate help to their medical careers, indicating that they learned useful clinical skills while a member. Of the 25 respondents who were applying to or enrolled in residency programs, eight were applying to or enrolled in diagnostic radiology, which was the highest percentage of any specialty. The study authors suggest that establishing a program such as theirs in medical schools “possibly attracts students interested in a career in diagnostic radiology, contributes to previously uninterested students’ pursuing the field of diagnostic radiology, or, at the very least, helps students become better informed about their decision to choose a certain specialty.”
The most surprising finding was that the most important factor rated by participants in their decision to join the program was financial. Monetary compensation ranked higher than the value of gaining experience and knowledge for a career in diagnostic radiology or another specialty. The study authors concluded that one could “not ignore the strength of monetary compensation in our ability to have sufficient numbers of students in the program to fill all of our triage shifts.”
The study compared the annual cost of the program, around $57,200 per year, to that of hiring two health care professionals with strong clinical backgrounds, such as physician assistants, whose annual salaries, including benefits, would be over $200,000 cumulative to fill this role. They concluded that with the obvious time-saving benefits of the program for diagnostic radiologists, as well as the education and professional development of medical students, the cost savings of using medical students are significant.
When the survey asked former and current participants of the Emergency Department Radiology Triage Program for suggestions for improvement, they requested higher wages for weekend/holiday shifts and for more senior members of the program, an equitable shift scheduling system, a more rigorous orientation, and more detailed training materials.
Kennedy explained that since the publication of this study, a number of these suggestions have been put into place at the Yale University program and have been incorporated into the infrastructure of a similar program that will be adopted at the New York Presbyterian/Cornell Medical Center starting July 1 of this year.
“It seems to not only have worked at Yale University but it seems to be attractive to other academic medical centers. It allows radiologists to be focused on their work. It seems to be a really good idea because not only are you compensating others for helping out the radiologists; you are educating students along the way. So it’s a win-win situation for medical students and hospitals,” he said.
—Carol Dawson
