Providers

QUESTIONS & ANSWERS FOR PHYSICIANS

Q. What is Premerus? How does Premerus improve diagnostic accuracy? How is Premerus different from other teleradiology companies?

A. Premerus is a quality initiative designed to improve patient outcomes through utilizing diagnostic imaging subspecialist to deliver precise and accurate interpretations to referring physicians. It consists of a platform that directs high-tech images only to subspecialists with additional qualifications to interpret images of those particular body systems or modalities. The governing principle of Premerus is that the more experience a diagnostician has for a specific condition, the more likely he/she will deliver an accurate diagnosis. Although Premerus may utilize “teleradiology” to ensure that a qualified subspecialist is reading a particular study, it is the only comprehensive, imaging-specific, quality management program in the industry. We have a rigorous peer review process as well as a thorough feedback loop for quality assurance and continuous improvement

Q. Is there really a problem with misdiagnosis?

A. Studies indicate misdiagnosis is prevalent:

Autopsy studies have uncovered frequent clinical errors and misdiagnoses, with error rates as high as 47%. 1
A study of autopsies of patients in the intensive care setting, published in the Mayo Clinic Proceedings, comparing clinical diagnoses with postmortem diagnoses revealed that in 26% of cases a diagnosis was missed clinically. In most of these cases, knowledge of the true diagnoses might have resulted in a change in the patient’s therapy and prolonged survival. The researchers concluded that “The number of missed major diagnoses remains high, and despite the introduction of more modern diagnostic techniques and of intensive and invasive monitoring, the number of missed major diagnoses has not essentially changed in the past 20 to 30 years” 2

Medical imaging has become a vital component in modern diagnosis. There have been multiple articles published over the past several years discussing radiologic errors. Most of these described failure to detect abnormalities in 25-32% of cases where disease was present and falsely diagnosing diseases in 1.6-2% of cases that were actually normal. 3

Q. How has Premerus addressed the issue of misdiagnosis?

A. To measure impact, Premerus conducted a study comparing the medical interpretations of general radiologists to subspecialty radiologists. The study consisted of 160 patients from a single health plan in 2 states who underwent MR and/or CT imaging. Cases were distributed to subspecialists based on their expertise; they were provided with the original clinical history and images, but not the original interpretation results. Interestingly, 44% of the original and subsequent subspecialists’ reports were found to be non-concordant. Examination of insurance claim data for these non-concordant cases, along with clinical outcomes data gathered from patient records identified unnecessary procedures and erroneous treatments that were the result of these original interpretations.

Q. Does Premerus have a Peer Review/QA Process in place?

A. For additional questions about the Peer Review/QA Process, please contact Premerus at
(866-600-3016).

Q. Where does Premerus obtain its subspecialist radiologists known as “Certified Premerus Experts”?

A. Premerus welcomes all qualified subspecialist radiologists to apply to be a Certified Premerus Expert. As we expand Premerus, we are seeking qualified subspecialist radiologists in the local markets to join our network. Local subspecialists participation is very important to the success of the program. Our goal is to ensure that all studies are read by the appropriate subspecialist. In order to accomplish this, when a local subspecialist is not available, we will send images via teleradiology to other Certified Premerus Experts in the network.

Q. What are the criteria for a radiologist to be accepted as a reader for Premerus? What is the credentialing process?

A. Premerus has worked with nationally recognized prominent diagnostic imaging subspecialists in the industry to develop standards that ensure the Certified Premerus Experts on our team are of the highest caliber and quality. The standards are located on Premerus.com (add link). The credentialing process for Certified Premerus Experts begins with our credentialing department reviewing the application using the Premerus standards as a benchmark and then validating degrees, fellowships, licenses, malpractice records, and CMEs. If a candidate passes the initial credentialing review, he/she will be administered the practical test for his/her particular subspecialty. Upon passing this test, there will be a final interview with Premerus clinical personnel. All Certified Premerus Experts, regardless of their primary practice setting or affiliation with any group must meet the Premerus standards.

Diagnostic imaging is an ever-evolving field and as a result of this, the Premerus credentialing process may require occasional adjustments to address these changes.

Q. Who are the Premerus experts that are judging the CPEs?

A. The Premerus Medical Director and members of the Credentialing Committee will evaluate each candidate’s application and their practical test case interpretations. This committee includes distinguished diagnostic imaging subspecialists.

Q. How will Radiologists be tested?

A. We have collaborated with diagnostic imaging subspecialists who focus their practice in the areas of Neuroradiology, Body, Musculoskeletal, Cardiac and Breast Imaging (respectively) to provide case examples that will evaluate the knowledge and judgment of the candidates and clearly demonstrate expertise in these subspecialty areas. The practical examination case images are provided to the candidate. After reviewing the case images, the candidate will provide a transcribed diagnostic report for evaluation by the credentialing committee.

Q. What if a physician fails the test and would like to take it again?

A. There is a waiting period of six (6) months before a candidate may apply to take the test again. Premerus will only allow three attempts at passing the practical examination.

Q. Can I take the test with a colleague or ask for help from others to complete the test?

A. No. All Certified Premerus Expert applicants must review and complete the test on his/her own, signing an attestation to that effect. The test may not be copied or shared with others. All applicants are required to complete a non-disclosure agreement prior to Premerus administering the test to him/her.

Q. What role can a “general” radiologist play in Premerus?

A. There are some general radiologists who, through their experience, are effectively practicing as subspecialists due to the focus or interest they have in a particular area and the large volume of cases they have read. Accordingly, we encourage general radiologists who meet all other Premerus Radiologist Standards other than a fellowship to apply. Some subspecialties (Neuroradiology, Pediatrics, Nuclear Medicine and Vascular/Interventional) will require a CAQ.

Q. How do radiologists benefit by joining Premerus?

A. It will enable subspecialists to focus on and hone their skills within their subspecialty. In addition, Premerus will increase the volume of cases directed to subspecialists. Premerus will also promote a nationwide collegial network of subspecialty readers who will benefit from effortless collaboration on difficult or rare cases.

Q. Can a physician qualify to be an expert in more than one subspecialist category?

A. Yes, but no more than two (2). Some radiologists with extensive experience in more than one category will qualify for multiple areas of subspecialization.