Two States Fight Imaging Self-Referral

Some states appear to understand the problem of self-referral, and are willing to do something about it. Let's hear it for Maryland and West Virginia, who seem to be at the forefront of the battle.

As reported in amednews.com, a Maryland court has upheld a rule banning non-radiologists from self-referring for in-office imaging.

The court battle ensued when a group of 14 medical practices challenged the board last December. The plaintiffs -- comprising orthopedic surgeons, urologists and emergency physicians -- are part of the Maryland Patient Care and Access Coalition, which was formed to advocate for the issues at stake in the case. The doctors say state authorities misread the law and several exemptions within it that allow in-office referrals for ancillary services, including imaging tests.

The court noted, however, that the statute's definition of ancillary services "specifically excludes MRI and CT scans for all doctors except radiologists" -- a delineation that "forecloses the two other exceptions."

But don't think the self-referrers will take this lying down:

Baltimore orthopedic surgeon Andrew N. Pollack, MD, said quality of care and patient convenience are improved when physicians have immediate access to the diagnostic testing.

"[Physicians] can get the information they need in evaluating the patient, whereas radiologists as third parties do not have the same background on the patient's condition," said Dr. Pollack, past president of the Maryland Orthopaedic Assn. and member of the American Academy of Orthopaedic Surgeons, which filed a friend-of-the-court brief in the case.

I thought radiologists were physicians. Here is what they have to say:

"Despite the intentions [of Maryland's self-referral law] to disarm this inherent conflict of interest, overutilization still exists, causing the cost of health to rise dramatically and exposing patients to unnecessary medical procedures," states the Maryland Radiological Society in a friend-of-the-court brief. The American College of Radiology supported the state chapter. Both groups declined to comment.

The radiologists also argue that they are better trained to interpret imaging than non-radiologists. The medical board in its opinion cited examples showing patients rarely benefit from getting tests on the same day of an appointment or at the same location as the referring physician.

The Charleston, West Virginia, Gazette, from December 9, has a somewhat similar story:

West Virginia doctors won’t be putting expensive diagnostic imaging equipment in their offices anytime soon.

Gov. Joe Manchin has rejected a state Health Care Authority-approved plan to let physician offices buy and install CT scanners, saying the proposal didn’t ensure that doctors would accept low-income patients unable to pay for digital X-ray services.

“He wanted to make sure that everyone who has these operates on a level playing field,’’ said Manchin spokeswoman Lara Ramsburg. “Otherwise, you’re giving an unfair advantage to one group over the other.’’

Hospitals are required to provide CT scanning services to all patients, including those without insurance and those covered by Medicaid.

“If the governor is sending this back to the authority to look at Medicaid, the uninsured and underinsured, that’s something that will be beneficial to patients,” said Joe Letnaunchyn, president of the West Virginia Hospital Association. “This will start to address the issue of a level playing field. Hospitals are providing care 24/7 to all patients.”

. . .Hospital executives say the proposal to allow doctors to have CT scanners will siphon away business, costing them tens of millions of dollars a year. CT scanning is one of the few profitable services that hospitals provide.

Again the self-referrers bleat the same refrain:

Doctors argue that more imaging machines would save lives, allowing them to diagnose diseases earlier.

And make them more money, but I guess that doesn't sound as good to their patients and the public.

The tide is turning, folks.