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  • Outpatient contrast coverage

    Posted by vatsa on March 21, 2023 at 5:36 pm

    I just wanted to see if there has been any discussion on Aunt Minnie about the ACR policy update regarding contrast coverage.


    Full disclosure: I wrote an article in JACR with the help of a mentor Harry Jha about 2 years ago entitled Competing Risks: Death from Contrast Versus Fatal Car Crash. As you might guess from the title it was a critique of the policy of requiring radiologists to be on site at outpatient centers for contrast.

    About 6 months after the article was published the ACR updated its policy to allow non radiologists to cover contrast. I do not claim any credit for myself or Dr. Jha since we were given none.

    My point is, who does this policy change make a difference for? I have worked in different settings. If you are at a huge outpatient center with numerous scanners and perhaps do procedures at those sites then there is no reason for you to change what youre doing.

    But if youre being pulled from the hospital or from a home work station to drive to outpatient sites where your only role is contrast coverage and the volume is low, please use this info to improve your jobs and lives.

    Whether Medicare needs to acknowledge this ACR policy change in order to allow radiologists out of this idiotic system I am not sure of. But I think if enough people are affected and care about this issue we could free ourselves of this pointless role. We are no better at saving lives from allergic reactions than a nurse or a doctor who actually sees patients. We are better used in hospitals (ever heard the phrase the doctors doctor)? Or if not needed in the hospital we are better off at home, saving the world from more unnecessary pollution and saving ourselves time and the risks of unnecessary driving.

    So, if anybody at Medicare or insurance companies or on hospital administration says we still need to be at these places, lets stand up and fix this. If you are still required at these sites in your job for no reason other than contrast coverage, then we know that is only because the world is run by morons. But if they get enough reminders from rational people they will eventually do their jobs and make the correct decision.

    Unknown Member replied 1 year, 4 months ago 3 Members · 4 Replies
  • 4 Replies
  • medvidr

    March 21, 2023 at 8:00 pm

    We are struggling to provide coverage at a remote center and can’t hire anybody to sit in that spot. If we were allowed to read it remotely and not have her to cover contrast, it would fix so many problems.

    Isn’t there a thing that CMS allowed during COVID for remote and telly medicine coverage for contrast? Even allowed a nurse or nurse practitioner to do it?

    • medvidr

      March 21, 2023 at 8:02 pm


      We look into this, but apparently state law trumps federal law in these cases.

      • toumeray

        March 21, 2023 at 9:50 pm

        The statement is a bit vague in terms of where/ how the supervision and monitoring occur. They talk about direct supervision but do not explicitly say they must be on site or in the same general location as the patient. They must be immediately available to furnish assistance and direction. Could this mean over the phone direction?

        The second change in regards to providers ie nonrads supervising this stuff makes sense. Radiology nurse or an NP/PA seems fine for this role and one of the logical entries for them.

        The third point is regarding the person in the room or control room, that they need to be able to recognize adverse reactions and call for help if needed (or if they cannot themselves provide the help). Which I am assuming is the tech.

        Theoretically, one could interpret this as an RN (radiology or not) providing remote direct supervision ie remotely available to a lone tech in an outpatient facility with no other medical staff around. That end result frankly does seem dangerous to me. But I could be misinterpreting the statement and possible outcome of it.

      • Unknown Member

        Deleted User
        March 21, 2023 at 10:00 pm

        [b]1.[/b]  this is only for Medicare patients.  Most patients for MRI do not need contrast. Those that do – we would schedule them all on one or two days a week – at a time when we could get Radiology residents to cover, usually evenings 5-8pm.  Also, we would pile on these patients – for example we could get 4-5 patients per hour with just contrast studies, so in essence we would need coverage for maybe 2-3 hrs.  We added one Saturday per month for 2 hours just for contrast inections for Medicare patients.  Also, if something was stat – we could to a noncontrast study MRI or CT initially, and have the patient return for the contrast portion later if necessary.

        [b]2.[/b]  This does not apply for non-Medicare patients.  We’d also [b]funnel[/b] these patient at certain days of the week and times and have RN, PA, or NP handle those injections. At night – we’d get  residents to do the injections.