“Many of our radiologists refuse to explicitly note the presence of atherosclerosis, reporting rather “age-appropriate vasculature.” And no amount of discussion seems to make a difference. What should we do?”
Get new radiologists.
Fire them, now.
That’s what we did, though not for the reasons noted above.
Note that I’m not talking about reading out findings that aren’t there, I’m talking about reading out the findings in the most specific manner appropriate.
Which, BTW, is explicitly what CMS says it is paying for when it compensates radiologists to make that read.
When we found the radiologists we were working with didn’t meet our expectations, we found new ones. We contracted with a tele-radiologist group that put patient service above all—even price.
It was like dancing on air.
For most of you reading this blog, that’s not possible, so hire yourself.
You’re a licensed clinician. You know how to read x-rays.
If you’re radiologist colleagues won’t work with you for some reason, read the x-rays yourself.
If you see atherosclerosis, note in on an addendum to the office visit where it was ordered and submit the code.
I highly recommend that the changes be obvious though—subtle or questionable over-reads could lead to charges of self-dealing. But if atherosclerosis is obviously present, there’s no reason why you can’t make the call.
Then ask to meet with both the medical and administrative director of the radiologist group. And here’s what you tell them:
“You may notice from this point on that I’m intentionally directing as many of my patients away from your group as I can. The difficulty with collaboration we’re having has raised concerns in my mind about other quality issues. If your physicians are unwilling to follow the explicit regulations as well as the personal preferences of their referring physicians in this simple situation, what else might they do about more serious issues? My patients expect their studies to be performed in a collegial environment. So, I am making every effort to direct my patient flow elsewhere and I wanted you to know why.”
Then, to the best of your ability, do so.
And don’t look back.
The specialists who learn to collaborate, they will thrive.
The others—will not.