Value of Second-Opinion Interpretation of Outside-Facility Breast Imaging Studies to a Radiology Department and Cancer Center |
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| Affiliation: | 1. Breast Imaging Section, Department of Radiology, ChristianaCare Helen F. Graham Cancer Center and Research Institute, Newark, Delaware;2. Breast Imaging Section, Department of Radiology, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania;3. Biostatistics Facility, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania;1. Resident, Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University, Stanford, California;2. Resident, Division of Vascular and Interventional Radiology, Department of Radiology, Duke University, Durham, North Carolina;3. Medical student, Chicago Medical School, North Chicago, Illinois;4. Resident, Case Western Reserve University School of Medicine, Cleveland, Ohio;5. Associate Chair of Clinical Performance Improvement, Division of Vascular and Interventional Radiology, Department of Radiology, Stanford University, Stanford, California;1. Assistant Professor, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana;2. Clinical Research Coordinator, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana;3. Professor, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana;1. Member, Board of Advisors, Baobab Studios, Redwood City, California;2. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland;3. Division Chief, Diagnostic Division, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland;4. Associate Division Chief, Diagnostic Division, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland;1. Michigan Medicine, Ann Arbor, Michigan;2. University of Massachusetts Memorial Medical Center, Worcester, Massachusetts;1. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;2. Radiology Quality and Patient Safety Officer, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts;3. Vice Chair for Quality, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;4. Associate Chair for Enterprise Informatics/IT, Department of Radiology, Massachusetts General Hospital, Harvard Medical School Boston, Massachusetts |
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| Abstract: | PurposeThe aim of this study was to estimate the physician work effort for formal written breast radiology second-opinion reports of imaging performed at outside facilities, to compare this effort with a per-report credit system, and to estimate the downstream value of subsequent services provided by the radiology department and institution at a National Comprehensive Cancer Network–designated comprehensive cancer center.MethodsA retrospective review was conducted of consecutive reports for “outside film review” from July 1, 2015, to June 30, 2018. The number and types of breast imaging studies reinterpreted for each individual patient request were tabulated for requests for a 3-month sample from each year. Physician effort was estimated on the basis of the primary interpretation CMS fee schedule for work relative value units (wRVUs) for the study-specific Current Procedural Terminology (CPT) code and study type. This effort was compared with the interpreting radiologist credit of 0.44 wRVUs per report. Subsequent imaging and evaluation and management encounters generated by these second-opinion patient requests were tracked through June 30, 2019.ResultsFor the 3-year period reviewed, 2,513 unique patient requests were identified, averaging 837 per fiscal year. For January to March of 2016, 2017, and 2018, 645 unique patient reports were identified. For these reports, 2,216 studies were reinterpreted, with an estimated physician effort of 2,660 wRVUs compared with 284 wRVUs on the basis of per-report credit. The range of annualized wRVUs for all outside studies interpreted and credited per specific CPT code was 3,135 to 3,804 (mean, 3,547). However, the institutional relative value unit credit received for fiscal years 2015, 2016, and 2017, on the basis of the number of patient requests, was only 385, 375, and 345 wRVUs, respectively.ConclusionsThis study demonstrates the substantial work effort necessary to provide formal second-opinion interpretations for breast imaging studies at a National Comprehensive Cancer Network cancer center. The authors believe that these data support billing for the study-specific CPT code and crediting the radiologist with the full wRVUs for each study reinterpreted. |
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| Keywords: | Breast imaging second opinion relative value unit |
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