Your question is interesting in light of recent HCFA rulings on payment
for radiologic services. As you are aware, most institutions provide
attending level radiology coverage only during the ususal workday hours.
At St. Chris the radiology attendings stay until 8 pm and from 8 am to 8
pm we get a "wet reading" on 75 to 80 percent of our plain radiographs.
After hours the emergency medicine attendings and the pediatric and
emergency medicine residents read the films. Several recent articles in
the EM literrature suggest that in a setting such as this, clinically
significant mis-readings by the EM attendings and residents occur <2% of
BUT, now HCFA gas said that (for medicare patients) it will only pay for
one reading and that reading has to be the one that influences the
immediate management decision. Furthermore, the attending radiologists
cannot bill for readings done by their residents after hours unless they
also read the film. This may mean that the radiology group has more
incentive to get tele-radiology capability in their homes than in their
Your choices would seem to be either allow the EM group to do its own
reading with radiology over readings at fixed intervals or to go with the
tele-radiology option. (Having tele-radiology capability might also allow
your radiologists to consult with other hospitals and, of course, bill
for that service.
The URL for the PED-EM-L Web Page is: