Business
Radiologists weigh in on outsourcing of imaging work
■ The specialty group recommends that doctors working outside the country maintain the same licensing and credentialing standards as those within the United States.
By Tyler Chin — Posted June 14, 2004
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The American College of Radiology has acted to protect patient safety by approving guidelines on the practice of "offshore" interpretation of radiological images.
Under the guidelines, which are voluntary, ACR recommends that radiologists outside of the United States who interpret images should meet, exceed or be held to the same standards as their U.S. counterparts.
Those standards call for offshore radiologists to be licensed in the state where the image was originally obtained; be credentialed and maintain privileges at the health care facility where the image was obtained; have appropriate liability insurance for the state where the exam was obtained; and be responsible for the quality of the images being interpreted.
"We feel there should be some significant qualifications for the person overseas who is receiving these images for interpretation," said E. Stephen Amis Jr., MD, a radiologist in New York who is chair of ACR's board of chancellors.
Radiologists who can meet the criteria would include those who are members of innovative practice groups that send their own physicians abroad to take advantage of the time difference when providing after-hours coverage to hospital emergency departments, Dr. Amis said.
Rather than have radiologists work what is essentially the graveyard shift in the United States, for example, those groups can set up a teleradiology operation somewhere in Europe so that their physicians can work during the day and enjoy the experience of living in a foreign country. In this case, it's not true outsourcing so much as a quality-of-life issue for U.S.-based physicians.
Quality is key
ACR does not oppose any form of offshore interpretation of images as long as those performing the interpretation meet its criteria, Dr. Amis said.
"What [ACR members] are concerned about is someone with unknown training sitting in a sweatshop in Bangladesh, for example, with perhaps one American-trained radiologist overseeing them and signing off on all reports, or simply issuing a preliminary report upon which treatment can be based."
ACR does not know the degree to which offshore interpretation is occurring, Dr. Amis said. He added that offshoring is a relatively new practice that the medical society began hearing about within the last two years.
"Perhaps some of this has been to fill the need, particularly during nights, weekend, holidays and ER coverage," Dr. Amis said. "If you have a short-staffing situation, the first thing that's going to suffer is the call because you don't have enough people to spread out."
Interpretation of images isn't being done by just foreign radiologists. Some American companies also employ American-trained, board-certified radiologists living abroad to provide "nighthawk" services, ACR said.
Physicians, hospitals and insurers also are offshoring billing, transcription, coding, claims review and adjudication, and nurse call centers to workers in English-speaking countries, observers say. Those countries, including India and Australia, offer cheaper labor and in some cases, a larger pool of qualified and available workers than America, they say.