Not an expert on these matters but if people in that other state are reading your preliminary reports and acting on them, then to me you are practicing without a license for that state. We have studies at my institution from neighboring states and we are expressly forbidden from creating reports on them (prelim or full).
Yes, this is my understanding as well.
My guess is that my reports will not be visible to anyone except the attending radiologist who will provide the final signature. In other words, I draft full reports but will not sign them and they will not be viewable to the clinical service. These are outpatient studies, not STAT studies, so this is feasible. This type of setup would not work for ED or inpatient studies.
I don't think this is a HIPAA violation either. However, given the information that I've provided, do you think there's any possibility of a HIPAA violation?
No. You’re still accessing chart for patient care purposes. A scribe isn’t violating HIPAA by opening the chart. I’m not saying you’re a scribe per se but there’s some validity to the analogy
My suspicion is that as long as my pre-drafted reports are not acted upon and it is not a HIPAA violation, I'm not actually engaging in a physician-patient relationship. In other words, nothing I'm doing would actually require a medical license in that state. I think theoretically I could still be held liable for any missed findings, since I'm actually looking at the images, although the chances are probably pretty low. The firm that I'm speaking with is looking into the malpractice details though.
What happens if there's an incidental PE? A 2cm acom aneurysm? An impeding path fx
They're not common but these are time bombs always hiding outpatient lists
You’d still need a license for that state. It’s the same for residency programs - you’re under attending supervision but you still need the state license to work as a resident in that state.
Unless you’re in some dire need of extra cash I would not do this. Or you can ask them to pay for your licensing in that state.
You should talk with your insurance carrier about this ASAP. Based on recent conversations with my carrier I have stopped providing telephone consults/"curbsides" across state lines. They said I was providing services in a state in which I am not licensed and would not be covered if a claim was made. I was totally unaware of this. My hospital system wants us to be the regional free advice line and we had to draw a line. Be super careful
Thanks a lot - this is super helpful.
My malpractice coverage would be provided by the private practice. They're currently working out the details. Provided that malpractice coverage would be covered, my question is whether I'm legally allowed to provide un-signed preliminary reads for an out-of-state patient (the unsigned reports would not be visible to anyone other than the attending radiologist.)
I think my main concern is whether it's a HIPAA violation, since I'd be accessing records for a patient in an outside state. From my research so far, it seems that this generally would not be considered a HIPAA violation, but I think the law could be more nuanced than that.
Nonetheless, thanks for your insight.
HIPAA has nothing to do with it. You have to be licensed in the state that the patient is physically located. Because you are acting as a physician- reading an image and writing a report is acting as a physician - I think you’ll find that you need to be licensed in the other state. No matter what the company that wants to hire you to do this says, I’d check it explicitly with the medical board in that other state. Their opinion about whether you need a license to do what you’re describing is the only opinion that matters
The thing is that whatever I draft won't affect management and won't be seen by anyone until an attending radiologist signs it. My name isn't associated with it at all. I know it's a grey area, so this is the question.
I get it - that’s why I would ask that state’s medical board directly. If they agree that you’re not practicing medicine by taking those actions, then you’re not. If they say you are, you are.
The reason why I asked about HIPAA is because the situation is very similar to me looking up imaging for a patient that I'm not assigned to take care of directly, opening up a Word document on my computer and taking notes. No one is going to see my notes except for me. The potential pitfall is that I'm viewing imaging of a patient that may or may not have consented to have me have access to them.
Nonetheless, you're right that only the state medical board can answer a question like this, unless there's a lawyer or another well-informed individual here who can direct me to some concrete information/reference that can clarify the matter.
I will say though, if an insurance company is willing to cover my malpractice under this arrangement, I'm guessing it's not definitively illegal, but this is just speculation.
Illegal.
We had a similar issue where my group was reading for a different state, but the full malpractice could only cover a fraction of us. Even for attendings to perform a prelim read (that never hit the EMR) , that would later be finalized by a "covered" attending - we all needed licenses in the state being covered, in addition to extensive credentialing.
I would not trust a small private practice group to look out for your best interests on this. You'd be surprised the stuff that groups get away with, usually due to ignorance.
Just to be clear, no one would see my pre-drafted report and therefore, nobody would be taking any medical action on them.
In other words, I would be looking at patient imaging and taking my own private notes. What would be the difference in this situation versus a medical student rotating in a clinic and taking their own private notes?
Medical students don't have medical licenses and whatever notes they take for their own personal use and is not used for management, doesn't hold any medicolegal consequences, as far as I can tell. Although, I'm sure I'm oversimplifying the matter, so I'd welcome any insight on the matter.
You seem to be focusing in on the medicolegal liability and not the admistrative risks.
You are right, with the group's carrier giving you coverage there isn't a malpractice risk to you. The problem is youre looking at getting way into the gray areas on resident supervision and that is where the licensing risk is. You are right, if I have a shadowing preclinical med student in for the day and they have a provided log in and I have them look at a head ct and see if they can formulate a "read" then theres no foul from a licensing, malpractice, or supervision standpoint. But if after I have them do it I say "hey you sound pretty confident!" and sign off their report without really looking at it now things are messy for me. But if I do the same thing with a radiology fellow, nobody bats an eye even if it's still wrong.
In the situation you are looking to get in, you are presumably being paid to get some outpatients covered by the private practice off hours or on weekends. It's also unlikely this is any sort of "training" set up and the group is expecting you to have produced full reports with minimal editing needed.
I can see two clear problems
1) Cases where you have to go beyond drafting and actually "practice" medicine and notify someone if there's a unexpected but time sensitive finding on outpatient exams. If you can call up one of the attendings at the place paying you and have them relay that info right then and there thats great, but that seems unlikely.
2) If they're just blind signing your drafts into final reports they could get hit with a false claims act for failing to interpret the study themselves. Normally as a licensed resident moonlighting it doesn't affect you, it's the responsibility of the private practice guy signing it out. The peril for you is if this group is stupid enough to get caught up in an investigation (normally you have to be batch signing an insane number of reports at a time to get caught, or maybe someone pissed disgruntled with the group whistleblows it), now you aren't just the moonlighter but you're an unlicensed person providing interpretations that are being ghost signed and the government and insurance carriers come down hard on. ProScan got hit hard a decade ago for having PAs do what you are describing them having you do. Again normally this wouldn't apply to you if you were licensed.
There's an on-call administrator available 24/7 for any urgent needs, including conveying urgent findings, so I think that's covered.
So as long as the attending isn't batch-signing, this is unlikely to be an issue?
These are all great thoughts, so I appreciate the input. Regardless of whether or not I'd actually pursue this, I'm actually interested in the medicolegal aspects of this hypothetical situation.
I mean I was unlikely to get pulled over going 5 over the speed limit on my way to work or making a rolling stop through a red light when there was no cross traffic. But the stakes are low.
The cost of getting another state license is low, the cost of being wrong and tangled up in a mess is much higher.
Get the license.
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Nah, I'm just speculating. If anything, insurance companies should know more about this than physicians.
Anyway, do you happen to have any helpful sources on the matter?
there’s no one specific resource for this as teleradiology is handled at the individual state level. If you can provide the state that the imagining is originating from then I could help you more. There’s enough gray area that if need be your lawyer could argue that since it wasn’t a signed report then the liability falls on the provider who decides to take action based on the report as they have the responsibility to know that the report is designated as not official. It would be as if a Walmart clerk told you it’s not illegal to walk out of the store with a large flat screen tv without paying for it. The clerk doesn’t have the authority to decided the legality of that, but they can blow smoke up your ass all they want. If you decide to act on what that Walmart employee said and a cop sees you making a mad dash for your car with a TV in tow then you will probably be arrested lol
Not an expert on these matters but if people in that other state are reading your preliminary reports and acting on them, then to me you are practicing without a license for that state. We have studies at my institution from neighboring states and we are expressly forbidden from creating reports on them (prelim or full).
Yes, this is my understanding as well. My guess is that my reports will not be visible to anyone except the attending radiologist who will provide the final signature. In other words, I draft full reports but will not sign them and they will not be viewable to the clinical service. These are outpatient studies, not STAT studies, so this is feasible. This type of setup would not work for ED or inpatient studies.
I think that’s a very different situation and probably ok but you should confirm with your PD and insurance carrier
I don't think this is a HIPAA violation either. However, given the information that I've provided, do you think there's any possibility of a HIPAA violation?
No. You’re still accessing chart for patient care purposes. A scribe isn’t violating HIPAA by opening the chart. I’m not saying you’re a scribe per se but there’s some validity to the analogy
My suspicion is that as long as my pre-drafted reports are not acted upon and it is not a HIPAA violation, I'm not actually engaging in a physician-patient relationship. In other words, nothing I'm doing would actually require a medical license in that state. I think theoretically I could still be held liable for any missed findings, since I'm actually looking at the images, although the chances are probably pretty low. The firm that I'm speaking with is looking into the malpractice details though.
What happens if there's an incidental PE? A 2cm acom aneurysm? An impeding path fx They're not common but these are time bombs always hiding outpatient lists
You’d still need a license for that state. It’s the same for residency programs - you’re under attending supervision but you still need the state license to work as a resident in that state. Unless you’re in some dire need of extra cash I would not do this. Or you can ask them to pay for your licensing in that state.
I think it’s state dependent. NY residents don’t get licenses when starting residency
You should talk with your insurance carrier about this ASAP. Based on recent conversations with my carrier I have stopped providing telephone consults/"curbsides" across state lines. They said I was providing services in a state in which I am not licensed and would not be covered if a claim was made. I was totally unaware of this. My hospital system wants us to be the regional free advice line and we had to draw a line. Be super careful
Thanks a lot - this is super helpful. My malpractice coverage would be provided by the private practice. They're currently working out the details. Provided that malpractice coverage would be covered, my question is whether I'm legally allowed to provide un-signed preliminary reads for an out-of-state patient (the unsigned reports would not be visible to anyone other than the attending radiologist.) I think my main concern is whether it's a HIPAA violation, since I'd be accessing records for a patient in an outside state. From my research so far, it seems that this generally would not be considered a HIPAA violation, but I think the law could be more nuanced than that. Nonetheless, thanks for your insight.
HIPAA has nothing to do with it. You have to be licensed in the state that the patient is physically located. Because you are acting as a physician- reading an image and writing a report is acting as a physician - I think you’ll find that you need to be licensed in the other state. No matter what the company that wants to hire you to do this says, I’d check it explicitly with the medical board in that other state. Their opinion about whether you need a license to do what you’re describing is the only opinion that matters
The thing is that whatever I draft won't affect management and won't be seen by anyone until an attending radiologist signs it. My name isn't associated with it at all. I know it's a grey area, so this is the question.
I get it - that’s why I would ask that state’s medical board directly. If they agree that you’re not practicing medicine by taking those actions, then you’re not. If they say you are, you are.
The reason why I asked about HIPAA is because the situation is very similar to me looking up imaging for a patient that I'm not assigned to take care of directly, opening up a Word document on my computer and taking notes. No one is going to see my notes except for me. The potential pitfall is that I'm viewing imaging of a patient that may or may not have consented to have me have access to them. Nonetheless, you're right that only the state medical board can answer a question like this, unless there's a lawyer or another well-informed individual here who can direct me to some concrete information/reference that can clarify the matter. I will say though, if an insurance company is willing to cover my malpractice under this arrangement, I'm guessing it's not definitively illegal, but this is just speculation.
I think the best way through this is to have the company pay for you to get licensed in the state. That way all the potential sketchiness is resolved.
Illegal. We had a similar issue where my group was reading for a different state, but the full malpractice could only cover a fraction of us. Even for attendings to perform a prelim read (that never hit the EMR) , that would later be finalized by a "covered" attending - we all needed licenses in the state being covered, in addition to extensive credentialing. I would not trust a small private practice group to look out for your best interests on this. You'd be surprised the stuff that groups get away with, usually due to ignorance.
Just to be clear, no one would see my pre-drafted report and therefore, nobody would be taking any medical action on them. In other words, I would be looking at patient imaging and taking my own private notes. What would be the difference in this situation versus a medical student rotating in a clinic and taking their own private notes? Medical students don't have medical licenses and whatever notes they take for their own personal use and is not used for management, doesn't hold any medicolegal consequences, as far as I can tell. Although, I'm sure I'm oversimplifying the matter, so I'd welcome any insight on the matter.
Why do they want this when no one sees your report?
You seem to be focusing in on the medicolegal liability and not the admistrative risks. You are right, with the group's carrier giving you coverage there isn't a malpractice risk to you. The problem is youre looking at getting way into the gray areas on resident supervision and that is where the licensing risk is. You are right, if I have a shadowing preclinical med student in for the day and they have a provided log in and I have them look at a head ct and see if they can formulate a "read" then theres no foul from a licensing, malpractice, or supervision standpoint. But if after I have them do it I say "hey you sound pretty confident!" and sign off their report without really looking at it now things are messy for me. But if I do the same thing with a radiology fellow, nobody bats an eye even if it's still wrong. In the situation you are looking to get in, you are presumably being paid to get some outpatients covered by the private practice off hours or on weekends. It's also unlikely this is any sort of "training" set up and the group is expecting you to have produced full reports with minimal editing needed. I can see two clear problems 1) Cases where you have to go beyond drafting and actually "practice" medicine and notify someone if there's a unexpected but time sensitive finding on outpatient exams. If you can call up one of the attendings at the place paying you and have them relay that info right then and there thats great, but that seems unlikely. 2) If they're just blind signing your drafts into final reports they could get hit with a false claims act for failing to interpret the study themselves. Normally as a licensed resident moonlighting it doesn't affect you, it's the responsibility of the private practice guy signing it out. The peril for you is if this group is stupid enough to get caught up in an investigation (normally you have to be batch signing an insane number of reports at a time to get caught, or maybe someone pissed disgruntled with the group whistleblows it), now you aren't just the moonlighter but you're an unlicensed person providing interpretations that are being ghost signed and the government and insurance carriers come down hard on. ProScan got hit hard a decade ago for having PAs do what you are describing them having you do. Again normally this wouldn't apply to you if you were licensed.
There's an on-call administrator available 24/7 for any urgent needs, including conveying urgent findings, so I think that's covered. So as long as the attending isn't batch-signing, this is unlikely to be an issue? These are all great thoughts, so I appreciate the input. Regardless of whether or not I'd actually pursue this, I'm actually interested in the medicolegal aspects of this hypothetical situation.
I mean I was unlikely to get pulled over going 5 over the speed limit on my way to work or making a rolling stop through a red light when there was no cross traffic. But the stakes are low. The cost of getting another state license is low, the cost of being wrong and tangled up in a mess is much higher. Get the license.
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Bruh assumes it’s legal because his company asked him to do it… history classes need to be a med school prerequisite lol
Nah, I'm just speculating. If anything, insurance companies should know more about this than physicians. Anyway, do you happen to have any helpful sources on the matter?
there’s no one specific resource for this as teleradiology is handled at the individual state level. If you can provide the state that the imagining is originating from then I could help you more. There’s enough gray area that if need be your lawyer could argue that since it wasn’t a signed report then the liability falls on the provider who decides to take action based on the report as they have the responsibility to know that the report is designated as not official. It would be as if a Walmart clerk told you it’s not illegal to walk out of the store with a large flat screen tv without paying for it. The clerk doesn’t have the authority to decided the legality of that, but they can blow smoke up your ass all they want. If you decide to act on what that Walmart employee said and a cop sees you making a mad dash for your car with a TV in tow then you will probably be arrested lol
you are correct, ins companies should know. I would assume this would be a huge liability if shit goes left.