This opens up an ethical minefield, which is mostly controlled by the self-referring clinicians themselves. They are the ones who determine which patients deserve a scan and which do not. These are "their patients" after all, and who are we to second-guess their judgement? If a patient walks in with a headache, should they not be scanned to rule out a subdural? Well??? Bottom line here is that the clinicians win the appropriateness argument, since in a real sense, they set the rules for it.
We have reviewed the article in Health Affairs on equipment leasing and are hopeful that the author will release the underlying study data so that her peers can replicate her analysis. Since its inception, the Access to Medical Imaging Coalition (AMIC) has worked with policymakers with the goal of ensuring appropriate utilization of medical imaging services. Unfortunately, the Health Affairs article does not offer any data on the appropriateness of the imaging procedures it analyzes -- which is the key to crafting responsible and sustainable policies on access to medical imaging services.
Without having access to the author's data, it is impossible to know if the conclusions she has drawn are reflective of the facts. However, if the arrangements described in the Health Affairs article are in violation of federal or state law, those violations of the law should be prosecuted.
AMIC looks forward to continuing to work with the Congress to enact a reasonable Medicare imaging policy that preserves and strengthens beneficiary access to the right imaging procedure at the right time.
But wait. This logic can be turned on its head and thrown right back at them.
We know without any real doubt that those with imaging equipment in their offices order more scans than those who don't self-refer. This is pretty much a given. Let's say that they order twice as many studies, which is really underestimating the problem, but that's OK for the moment. AND, let's assume that all of those scans are appropriate. We wouldn't want to question the judgement of our friends, now would we? With me so far? Now, we turn back to the behavior of those who DON'T have scanners in their offices. They are ordering at One-HALF the rate of their colleagues. Therefore, if the self-referrers are ordering appropriately, the non-self-referrers are jilting their patients, not utilizing the life-saving services available right down the street at their local hospital.
The truth cannot fall both ways, can it? Either the self-referrers are ordering inapproriately, most likely due to the fact that they will make a profit doing so, or the non-self-referrers are restricting their ordering inappropriately. One group is harming their patients, and I'll leave it to you to figure out which one that is.