There was wide variation among disciplines, though. For instance, emergency room radiologists had a baseline preliminary report-to-final signing time of nine hours, on average; after the pay-for-performance program started, it fell to an average of two hours. But for neurovascular radiologists, the baseline time was nearly three days. (It fell to about half a day after the study.)

Neuroradiologists, interventional and otherwise, were also the only discipline allowed to continue to have a 24-hour, and not an eight-hour window, a year after the program started. Their exams tend to be extremely complex, multi-hour affairs, Boland said.

But the differences among disciplines probably are not only owed to procedural complexity. It also has to do with the culture of the departments, Boland suggests. Chest radiologists and gastrointestinal radiologists have similar workloads, Boland and his co-authors argue. Yet chest radiologists had an after-program preliminary-to-final report time of around one hour, on average, whereas gastrointestinal rads took nearly five times as long.

Boland, who works in the GI department, credits the difference to culture. Cultural change can also help explain one of the study's most curious findings--that the greatest change was seen after the program ended when radiologists were no longer rewarded for bringing their turnaround times down.

What exactly brought this about, the researchers don't know, but perhaps "simply discussing the importance of an expedited [radiologist report turn-around times] to the radiologists in a more formalized and consistent manner (as was the case in this study) may have influenced some radiologists to be more attentive and diligent in signing their reports from a preliminary to a finalized status," the researchers wrote.

"The other piece is that now we've set up the expectation from referring physicians," Boland said, many of whom got used to reports being available the same day. "They start looking for the reports online, and if it doesn't come out, they start bugging us."

While the findings might not apply outside of an academic teaching hospital to private imaging centers - where competing radiologists often use their fast turnaround times as a sales point - it does hint that pay-for-performance schemes can be more about awareness-raising than anything else.

"There's a lot of psychology going on here," Boland said. "It's not completely understandable why and how it happened, and I think some of these things are tangible and some are intangible."

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