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Threshold Benchmarking for Radiology Report Turnaround Times in Payment Programs: Current Thoughts and Literature
N Kadom1, V Burugu2, Ms White3
1Professor of Radiology and Imaging Sciences, Emory University, Department of Radiology and Imaging Sciences, Atlanta, Georgia; Radiology Quality Programs Director, Emory Healthcare; ACR Metrics Committee Chair.
Purpose:
Report turnaround time (R-TAT) is widely used as a radiology quality metric and is increasingly considered for national benchmarking. Beginning in 2026, CMS will no longer accept continuous R-TAT reporting in the Merit-Based Incentive Payment System and instead recommends threshold-based benchmarks. This study evaluates how radiology practices have used R-TAT in quality improvement and examines the evidence supporting implementation of national threshold-based R-TAT measures.
Methods:
A systematic literature review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and included English-language studies published between 2000 and 2024 that reported radiology R-TAT defined as time from examination completion to report finalization. Two independent reviewers screened titles, abstracts, and full texts. Eligible studies were analyzed for practice setting and intervention type. Descriptive statistics were generated, and a narrative review discusses risks and feasibility of threshold-based benchmarking.
Results:
Of 1,722 screened records, 13 studies met inclusion criteria. Most originated from US academic practices (92%) and evaluated technology adoption (46%), targeted improvement projects (31%), or operational changes (23%). All studies relied on local pre- and postintervention comparisons; none reported use of the ACR General Radiology Improvement Database TAT registry for benchmarking. Reported improvements in R-TAT were context specific and heterogeneous. The narrative review identified important concerns regarding clinical risk, unintended consequences, and measurement validity associated with unadjusted threshold-based R-TAT metrics.
Conclusion:
R-TAT is a useful internal performance indicator for evaluating workflow and operational interventions. However, existing evidence does not support adoption of uniform national threshold-based R-TAT benchmarks without adjustment for case complexity, modality, practice setting, and workflow factors. Continuous R-TAT measures remain better suited for local quality improvement, and future policy implementation should incorporate balancing measures to ensure patient-centered, high-quality radiologic care.
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