When Your Quality Is Questioned: Answers From Frank Seidelmann, DO

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Recent media coverage of a radiologist’s accusations of inaccuracy against Radisphere National Radiology Group, Cleveland, Ohio, returns the question of quality to the forefront of discussion in the radiology community. ImagingBiz spoke with Frank Seidelmann, DO, chief innovation officer and clinical director of neuroradiology for Radisphere, both about the accusations and about how quality can be quantified, defended, and improved across the profession.

ImagingBiz: Accusations were leveled against Radisphere by a locum tenens radiologist you contracted with at a California hospital. What is your response?

FranklinSeidelmann: I think this is best described by the phrase, bad news travels fast, good news doesn’t travel at all. We take quality assurance (QA) and peer review very seriously; we’re one of the few organizations that has a full time QA/peer-review staff. As radiologists, we undertake daily double-blinded reviews, which most radiology groups don’t do. It’s extremely time consuming, but we take it very seriously.

What is ironic is that just 60 days ago, we had a discussion, in this publication, of our rigorous QA procedures, and how it takes quite a few resources to provide those to clients. This peer-review process was in place at this hospital; it was very successful at identifying discrepancies that we found, on our own, through our randomized, blinded process, and it also included follow-ups on discrepancies identified by referring physicians. Those results show our initial rates at this hospital are well below what we believe to be industry norms.

It also shows that any local radiology group is vulnerable to these types of unsubstantiated charges, so we all need to be vigilant in adherence to documented quality policies in all of our practices. At Radisphere, we’re constantly making sure our product is of the highest quality. Our radiologists are measured and tracked on quality, and we’re transparent about it with our clients; we report back to them on a monthly and quarterly basis. We’re often asked how our numbers compare with those from the prior group, and we discover that there are no numbers from the prior group.

ImagingBiz: Since these allegations were made in the press, what recourse do you have?

Seidelmann: For patient- and hospital-confidentiality reasons, this really does not merit any public response. What is clear is that no formal complaint by this radiologist had ever been brought to the proper channels at the hospital prior to this article, and it is also clear that we have the full support of senior administration there. When you have this sort of public claim, you really dig in—even beyond our normal QA process—to investigate this thoroughly, and we cannot substantiate the statements that were made in any way. We can confidently say, after our thorough review, that our QA rates are outstanding, and no patients have been harmed.

ImagingBiz: Not much has been written on error rates in the peer-reviewed radiology literature. How do you know with what to compare yourselves? What are the industry norms?

Seidelmann: That’s the problem: there are limited research and articles out there on industry benchmarks. There are actually lots of studies, however, on interobserver rates of discrepancies for specific modalities (and body parts), the most documented modality is mammography. Discrepancy rates for different modalities and exams can be anywhere from 5% to 30%—or even higher, for more complex studies.

What really have not been clearly shown (or even researched, from what I can see) are the average discrepancy rates for radiologists for all modalities and all exams, because that is the model of general-radiology practice that most community hospitals are using today. There are two reasons for this: First, there is a general fear of public disclosure of discrepancies due to medicolegal concerns. Second, most studies are done at academic medical centers and do not reflect general practice across all modalities that a general radiologist has to read.

One thing we’ve found is that modality distributions in community hospitals are really pretty consistent: around 48% radiography, 20% CT, 12% ultrasound, 5% MRI, and so on. Meanwhile, extremely high discordance rates—up to 46%—have been shown between a general radiologist versus a subspecialist in CT and MRI studies. That’s why our approach is to emphasize subspecialization through our national group, and to use that expertise in as