Radiologist Overreads of Intraoperative Radiographs- Value or Waste?

Abstract Background All aspects of the arthroplasty pathway must be scrutinized to maximize value and eliminate unnecessary cost. Radiology providers’ contracts with hospitals often call for readings of all radiographs. This policy has little effect on patient care when intraoperative radiographs are taken and used to make real time decisions. In order to determine the value of radiologist overreads, we asked three questions: what was the delay between the time an intraoperative radiograph was taken and time the report was generated, were the overreads accurate, and what is the associated cost? Methods 200 hip and knee radiograph reports generated over six months during 391 cases were reviewed. The time the report was dictated was compared to the time taken and time of surgery completion. To determine accuracy, each overread was rated as accurate or inaccurate. The cost of the overread was determined by multiplying the number of radiographs times the radiology fee less the technical fee. Results Median delay between taking the radiograph and filing the report was 45 minutes(Range:0-9778). Only 31.5% were filed prior to completion of the procedure. 18.0% (36/200) were considered inaccurate despite lenient criteria. The reading fee for hip radiographs was $52.00, and for knee radiographs was $38.00, representing a total cost of $10,182 in our select series. This cost projects to $43,614 annually at our facility. Conclusion Radiology overreads of intraoperative radiographs have no effect on real time decision making. In the era of value-based care, payors should stop paying for overreads and reimburse providers who actually read the films intraoperatively.