Wednesday, May 28, 2008

A Resolution from the American Misbegotten Association
"Fairness" in Medical Imaging Interpretation

If you look up misbegotten, you will find that it is a more acceptable synonym for something less savory.

Resolution 208, Fairness in Medical Imaging Interpretation, is to come before the AMA's House of Delegates shortly, and it is expected to pass. It is introduced by some of our very good friends:

American Society of Neuroimaging
American Association of Neurological Surgeons
Congress of Neurological Surgeons
American Medical Group Association
American College of Cardiology
American College of Gastroenterology
American Gastroenterological Association
American Society for Gastrointestinal Endoscopy

So, what do these illustrious physicians call "fair"? Here's the text of the bill and relevant AMA policy:

Whereas, Expenditures for advanced medical imaging services, such as CT, MRI and PET, have significantly increased in this decade, raising legitimate concerns over utilization rates; and

Whereas, These concerns have led payers, state legislatures, government agencies and radiology management companies to consider eliminating reimbursement for in-office imaging and image interpretation by non-radiologists without consideration of their training and certified competence to provide these services; and

Whereas, Available data do not suggest that increased imaging costs are necessarily attributable to in-office imaging services by most medical specialties involved in medical imaging and interpretation; therefore be it

RESOLVED, That our American Medical Association encourage and support the in-office utilization, medical direction and supervision of advanced imaging services by qualified or certified physicians whose utilization of these modalities is within the scope of their specialty practice in accordance with appropriateness guidelines, practice guidelines, technical standards and accreditation standards for the imaging modalities utilized as defined by their specific medical society (New HOD Policy); and be it further

RESOLVED, That our AMA actively oppose efforts by federal and state legislators, regulatory bodies, private payers, public payers and radiology business management companies to restrict the application of advanced imaging services for the diagnosis and treatment of patients when such services are provided as defined by specialty specific appropriateness guidelines, practice guidelines and technical standards for the imaging modalities utilized. (Directive to Take Action)

Fiscal Note: Implement accordingly at estimated staff cost of $6,509.

Received: 05/07/08

RELEVANT AMA POLICY

D-385.974 Freedom of Practice in Medical Imaging
Our AMA will: (1) encourage and support collaborative specialty development and review of any appropriateness criteria, practice guidelines, technical standards, and accreditation programs, particularly as Congress, federal agencies and third party payers consider their use as a condition of payment, and to use the AMA Code of Ethics as the guiding code of ethics in the development of such policy; (2) actively oppose efforts by private payers, hospitals, Congress, state legislatures, and the Administration to impose policies designed to control utilization and costs of medical services unless those policies can be proven to achieve cost savings and improve quality while not curtailing appropriate growth and without compromising patient access or quality of care; (3) actively oppose efforts to require patients to receive imaging services at imaging centers that are mandated to require specific medical specialty supervision and support patients receiving imaging services at facilities where appropriately trained medical specialists can perform and interpret imaging services regardless of medical specialty; and (4) actively oppose any attempts by federal and state legislators, regulatory bodies, hospitals, private and government payers, and others to restrict reimbursement for imaging procedures based on physician specialty, and continue to support the reimbursement of imaging procedures being performed and interpreted by physicians based on the proper indications for the procedure and the qualifications and training of the imaging specialists in that specific imaging technique regardless of their medical specialty. (Res. 228, A-05; Reaffirmed in lieu of Res. 901, I-05; Reaffirmation A-06; Reaffirmation I-06; Reaffirmed in lieu of Res. 125, A-07)
Excuse me, but what a bunch of CRAP! It has been proven time and time again that self-referral DOES show increased utilization. Beyond that, what our friends are asking for is a complete disregard for imaging standards as set by us, the imagers. Can anyone gue$$ what the motivation might be for all of thi$? $ure, you can. And tell me, is it "fair" for a clinician to be able to generate income by ordering unnecessary tests, bypassing any restraint? I don't think so.

If this resolution passes, I will drop my membership in the AMA, and I would urge everyone in Radiology to do so. Obviously we have no voice there anyway.

1 comment:

Ron A. Dawson said...

Dr. Harold,

You left out the most important thing. The self referrers making this new policy are NOT qualified to image and interpret images of patients. They never were qualified. They could not and did not qualify for a radiology residency. In my opinion, given my experience over the years dealing with these folks, they do not have the means to complete a radiology residency or pass the competency boards. The general public does not understand that their doctors medical training does not include imaging, and they their doctors do not know how to interpret their MRI's or CT's.

The self referrers' power is in numbers, not in IQ. Let the Wild West of Medicine commence!

So that the general reader does not think this is sour grapes, I assure you that this is about quality and professionalism. What is happening is dangerous. If you want the best and safest care for you or your family, demand that your imaging studies are performed outside of the doctors office. Make sure the study is under the supervision of a board certified radiologist. In the doctors office you are never assured who is performing the study or interpreting it. There is no quality control or oversight. Most likely you will be receiving an unnecessary exam for the sole purpose of making that doctor money.