Radiology provides better Veteran care
“After two years of imaging, he was cancer free and we were part of his journey.”
Source: Abraham Essenmacher Battle Creek VA Public Affairs
MENLO PARK, CA — According to a recent report from the VA’s Office of the Inspector General, staffing shortages and an overreliance by VA facilities on interpreting non-priority cases is causing extensive delays in National Teleradiology Program services, leaving veterans and providers in limbo.
Located at the Palo Alto, CA, VA Healthcare System, the National Teleradiology Program (NTP) employs about 100 VA radiologists supplemented by about 200 fee-based providers and operates 24 hours a day, year-round. NTP radiologists interpret CT scans, X-rays, MRIs, ultrasounds and other imaging studies electronically sent to them from VA facilities who need a quick response that their on-site radiologists would not be able to provide.
NTP results are judged on both timeliness and accuracy, and a report of a misread imaging result by an NTP radiologist in April 2024 triggered the OIG investigation. While the investigation uncovered little regarding misread tests, it documented numerous complaints of delayed results and a growing challenge for NTP when it comes to turnaround times.
OIG investigators reviewed 288 patient safety reports from Oct. 1, 2023, to Feb. 23, 2025, and found an overall trend in increased delays in interpretation. NTP’s timeline benchmarks are 1 hour for stat imaging and 48 hours for routine imagining. In FY 2024, the program processed 1.08 million stat studies, hitting the benchmark 78.9% of the time. It processed 363,830 routine studies, hitting the benchmark 69.3% of the time.
“A facility emergency department provider told the OIG that delays [in the return of interpretation reports] have a significant impact on patient flow, expressing that imaging plays a significant role in determining whether a patient requires hospital admission or can be discharged,” the OIG report stated. “In a discussion of performance monitors, an NTP leader expressed to the OIG that ordering providers ‘don’t care about averages, they care about outliers.’”
In summer 2024, NTP staffing levels could not keep up with demand. In response, NTP leaders cut the volume of routine studies they accepted from facilities by 15% and no longer interpreted stat studies during weekday business hours. They attempted to address the delays by hiring more radiologists and letting facilities know they needed to establish contingency plans for when NTP wasn’t available.
However, those efforts were hindered by forces outside of NTP’s control, OIG investigators noted.
“NTP’s chief of clinical operations described a ‘huge national shortage’ of radiologists impacting the recruitment and retention of NTP radiologists,” the report stated. “[Further complicating retention efforts were] uncertainties regarding hiring freezes and workplace flexibilities in early 2025, resulting in the loss of 10 full-time, and roughly 20 fee basis, radiologist applicants.”
Pay limits also were cited as a difficulty, with there being a federally mandated ceiling on how much NTP can offer a radiologist.
VA facilities across the country are facing similar difficulties. As staffing shortages worsen, demand grows for NTP’s services, putting greater strain on the system and further increasing turnaround times.
Investigators found that a poor understanding by some facilities of how and when the NTP should be used is also contributing to the overload.
“Facility staff have varied knowledge of the terms and processes specified in [the memorandum of understanding (MOU) between NTP and VA facilities],” the investigators wrote. “As a result, facility staff send routine imaging orders labeled incorrectly as stat and send requests to the NTP outside agreed-upon hours, creating an increase in NTP’s workload.”
According to NTP leaders, this lack of understanding can be partially blamed on high turnover at VA facilities, with new staff constantly coming onboard who have no familiarity with NTP.
The MOU requires facilities to have a contingency plan in place for when NTP is unavailable. While one facility interviewed by OIG reported having a VISN-contracted teleradiology service on standby, others came up against the same national staffing shortage that caused the problem in the first place. And some radiology technologists told investigators they were unaware if their facility even had a contingency plan at all.
OIG recommended that VHA make filling vacant radiologist posts nationwide a priority and investigate additional methods to recruit and retain NTP teleradiologists.