Emergency Radiology: An Underappreciated Source of Liability Risk.

PURPOSE: While several studies analyze radiology malpractice lawsuits, none specifically examines the site of service. The purpose of this study is to estimate the relative likelihood of a lawsuit arising from a radiology study performed in emergency (ED), inpatient (IP) and outpatient (OP) settings. METHODS: Referrals from a malpractice review consulting company over a six year period were compared to the 2016 Medicare Part B file and stratified by site of service. The proportion of exams for each site of service was estimated, and using absolute differences in proportions and odds ratios (ORs), differences in the place of service were calculated. RESULTS: The Cleareview cohort contained 25 (17%) IP, 56 (38%) OP, and 68 (46%) ED exams. In 2016, Medicare assigned benefits for 27,009,053 (20%) IP, 84,075,848 (62%) OP and 23,964,794 (18%) ED exams. The ORs (Cleareview: Medicare) of the ED to IP, OP, and IP+OP were 3.07 (95% CI: 1.56-6.03), 4.26 (95% CI: 2.76-6.59), 3.89 (95% CI: 2.60-5.83), respectively. By contrast, the OR for IP:OP between Cleareview and Medicare was not significantly different than 1 (OR: 1.39, 95% CI: 0.68-2.83, P = .38). DISCUSSION: Radiological studies performed in the ED accounted for a disproportionate number of liability claims against radiologists. Further study is warranted to confirm this finding with a more robust data set.

The Patient Protection and Affordable Care Act in a nutshell.

The Patient Protection and Affordable Care Act (PPACA) is comprehensive reform and by virtue of its comprehensiveness can be cumbersome to read and understand. This short piece is a succinct and irreverent glance at PPACA. The piece starts with a question and ends with the same question: Will PPACA break the iron triangle?

The adoption of low-osmolar contrast agents in the United States: historical analysis of health policy and clinical practice.

OBJECTIVE: In this historical analysis of low- and high-osmolar contrast agents, we outline the reasons for the price depreciation, speculate on motivation for universal adoption by many radiologists despite suboptimal reimbursement, and cast light on important shortcomings of economic analyses in the realm of health policy. CONCLUSION: Early economic analyses regarding low-osmolar contrast agents concluded that universal adoption was not cost-effective. Over time, the price differential between low- and high-osmolar agents narrowed, yet reimbursement patterns lagged behind the narrowing price differential.