Resident Physician Stanford Hospitals & Clinics, United States
Purpose: Imaging examinations initially performed at outside institutions often receive secondary interpretations, given their overall positive value to patients, providers (1–17), and the identity of radiologists (18–20). Reviews by in-house subspecialists allow for case discussions in real time, standardization of reports, and can reduce reimaging. The increase in Medicare reimbursements for rereads also suggests increased recognition of its value (21). Despite its prevalence, the practice of secondary interpretation requires further examination in order to become standard-of-care and be reimbursed as such. In this primer, we review these aspects and provide directions for future investigations.
Methods/Materials: This primer will first review medicolegal, financial, and ethical concepts, which include equitable utilization of resources, patient versus physician benefit, and reimbursement. This will be followed by a nuanced insight into Rosenkrantz et al.’s review of secondary interpretations and its cited publications(11), focusing on their limitations such as exclusion criteria and bias. More recent studies of this practice will be identified and similarly examined. The relationship between the introduced concepts and our findings will be explored. Solutions addressing these limitations will be suggested as ideas for future investigations.
Results: Potential improvements for future studies include developing prospective studies, improving patient selection, standardizing collected information, appropriately obtaining reference standards, and performing cost-benefit analyses. Mixed qualitative-quantitative methods can be utilized to gauge provider attitudes across specialties. A potential direction for future research includes developing selection criteria for reinterpreting primary imaging examinations. Criteria may include the type of institution providing primary and secondary interpretation, subspecialty, body system and etiology of diagnosis, and imaging modality.
Conclusions: Routine secondary interpretation of outside imaging has clinical value, but further research is needed to guide policy decisions and establish this practice as an optimized, patient-centric, and cost-effective standard of care.
