Printer-friendly format

Today, many medical offices are equipped with their own in-office imagery equipment. Patients enjoy the perceived convenience of one stop medical care. Yet, is this truly the best medical practice? The issue has raised many concerns.

Through self-referral, physicians allow their patients to obtain in-office imaging procedures.

“Self-referral is where non-radiologist physicians acquire imaging equipment, MRI, PET and CT scanners, for their own offices and utilize those pieces of radiology equipment on their patients,” said Michael W. Langenberg, practice administrator of University Radiology in Knoxville.

Unfortunately, due to pre-authorization requirements, advanced imaging tests are rarely able to be approved and scheduled on the same day, even when performed in-office through self-referral. Additionally, in-office results often require more detailed imagery and additional tests in a hospital, which in turn duplicates the patient’s exposure to radiation.

Even though radiologists are still reading in-office scans, there are underlying issues. “The problem has come up in terms of the quality of the equipment that goes in an individual practitioner’s office verses that of the hospital,” said Langenberg.

In order to be competitive, hospitals obtain the very best quality high-end imaging equipment. For example, according to Langenberg, most hospital imaging is performed on a 64-slice computed tomography (CT) scanner, compared to single or dual slice CT imaging commonly being utilized today in many office self-referral settings.

“Your insurance premium and your reimbursement to the provider are going to be the exact same whether you get your scan on a two-slice scanner or a 64-slice scanner,” said Langenberg. In reality, patients may not even be aware of their option to initially request a more advanced test.

Radiology claims for non-radiology groups are becoming increasingly noticeable. The self-referral issue is currently a hot topic nationally in various major medical journals and the public media, which is creating interest among the Centers for Medicare and Medicaid Services (CMS), third party payers and state and federal lawmakers.

“The imaging volume that Medicare pays claims on has skyrocketed over the last 10 years, and when they break that down into a little bit more detail, they see that the fastest growing component of that growth is on self-referred imaging,” said Langenberg.

Self-referral also has a negative financial impact on hospitals. Losing imaging business to outside offices takes needed dollars away from hospitals, and other services suffer. “If all imaging leaves the hospitals to MD offices, it hurts the hospitals’ ability to provide other critical lifesaving and essential services,” said Langenberg.

Dr. David Levin, former head of radiology for Thomas Jefferson University Hospital, has done extensive research on the topic, and his findings regarding the increased usage of high-end imagery by non-radiologists have been published in numerous articles.

“I think that there’s no question that this whole self-referral business is growing pretty rapidly,” said Levin.

In a recent study, which utilized the Medicare data base, Levin and his research team investigated the in-office ownership or leasing of magnetic resonance imaging (MRI) scans by radiologists and non-radiologists nationwide and investigated the growth from 2000 to 2005.

“Among radiologists, that [growth] grew by 83 percent. Among non-radiologists, who either installed the MRI equipment in their offices or leased scanning slots, that growth was 254 percent in five years,” said Levin. “It’s true that radiologists still do the large majority of MRI scans, but if you just look at growth, it’s growing much more rapidly among non-radiologists.” Levin’s most recent findings will be published in an upcoming issue of the Journal of the American College of Radiology (JACR).

Although the Stark II Law currently prohibits physicians from referring patients to entities where they are owners, the in-office ancillary services exception has created a loophole. With a vested financial interest, self-referral has become very popular among non-radiologist physicians who own in-office imaging equipment. However, some states, including Maryland, currently have anti self-referral laws in place for ancillary services that prohibit non-radiologists from performing MRI and CT scans.

In certain circumstances, such as an x-ray, in-office imagery is a necessary part of a patient’s care. However, the federal government will likely rule on areas subject to abuse and over utilization.

“What you tend to see out of Tennessee, at least on the referral standpoint, is it tends to follow the federal lead,” said Mark A. Cunningham, head of the healthcare practice group at Chambliss, Bahner & Stophel, PC in Chattanooga. “I do think that within the next year, you’re really going to see some clarification on the government’s position on certain aspects of in-office imagery that are being done by physician practices, and it’s clear that the government has expressed some concerns about it.”

So-called turnkey no risk operations that market to physicians will probably also be investigated. “Physicians need to be on the lookout for turnkey relationships where a third party is coming in and effectively telling them that there’s no real financial risk for them, and that they’ll be able to make a profit,” said Cunningham. “If they are not really at risk under the scenario, in any meaningful way, then the government’s wondering what’s going on.”

Eventually, the government may have to intervene to determine what types of equipment can be utilized in physicians’ offices. “Where it used to be the cost factor was enough to keep physicians’ practices out of it, now it’s going to be an issue of whether or not there is going to be a legal prohibition as well,” said Cunningham.



February 2008

Tags:

None

Login and voice your opinion!

Do you know someone else who would like to see this?
Your Email:
Their Email:
Comment:	(Will be included with e-mail)