Some have blamed in-office self-referral for imaging's fall from grace, alleging that overprescription of imaging exams for personal gain and the low-quality images that often result have tarnished the specialty's reputation. Now relief may come from an unlikely quarter: healthcare reform.
Tucked in among proposals for reimbursement cuts and sales taxes on medical equipment in the House of Representatives' Affordable Health Care for America Act is a "sunshine" provision that would require docs who bill Medicare for imaging exams done on their own patients to disclose any financial interest they have in conducting those exams. If the legislation goes through as currently written, beginning in March 2011, these physicians will have to report annually to Medicare on their ownership stake in imaging operations. The proposed legislation also calls for a study to evaluate the costs, extent of use, and impact on Medicare from such self-referrals. Of great interest to the imaging community, it specifically calls attention to providers of advanced diagnostic imaging and radiation oncology.
It's not blind luck that this provision was included in the House bill. The American College of Radiology has been fighting for legislation that would limit self-referrals for a long time. Successes in the late 1980s and early 1990s, commonly known as Stark I and II, named for Congressman Pete Stark (D-CA), directly attacked self-referral. Exceptions to these laws, however, have allowed the practice of self-referral to continue.
Until now, efforts to close loopholes in the Stark laws have fallen short. The college has had more success with state governments than on Capitol Hill, but even these successes have been hard fought and produced limited results. Often the best results have been achieved indirectly, through a (state) government-mandated quality assurance program applied to all imaging facilities, for example. Requirements for stringent record keeping on patient radiation exposure and use of metrics addressing image quality—such as contrast resolution, noise, and artifacts—have forced marginal imaging providers in New Jersey to get out of the business.
Private payers have also chimed in with restrictions that have shaken out underperforming self-referrers. Several Blues, for example, require of interpreters that they be accredited or have achieved a certain level of training, or can document their expertise.
The House bill on healthcare reform offers the best hope yet of reining in self-referral. The reach of healthcare reform would be national and uniform. And, as written by the House, it would target precisely the source of the imaging community's problems.
Given the less-than-positive aspects of the House healthcare reform legislation for radiology, its sunshine provision, at least, will provide a sugar coating for the bitter pill of reimbursement cuts and equipment taxes that will come with its passage.
|
Diagnostic Imaging. Self-referral provision may sugarcoat bitter pills in House reform
By Greg Freiherr |
November 19, 2009
Cardiologists boost imaging to compensate for lower DRA-related rates
HIMSS 2009
HIMSS 2009 promises to help guide administrators to prepare to meet an uncertain future for healthcare. It will provide a forum for discussion and a showcase of technologies developed to consider performance metrics and patient outcomes as well as gauge the means for documenting them. Diagnostic Imaging will capture this nexus of information and discussion through reports on key presentations and interviews with the makers of innovative information technologies.
--Greg Freiherr NewsfromHIMSS2009HIMSS Keynote: IT offers hope to solve impending healthcare crisis, says Greenspan
Diagnostic Imaging, April 8, 2009
Harsh economics dampen appetite for healthcare IT
Diagnostic Imaging, April 8, 2009 The weakened U.S. economy is slowing the pace of growth in healthcare IT, according to a survey conducted by HIMSS. Only a little more than half (55%) of the 304 respondents participating the 20th annual HIMSS Leadership Survey said their IT budgets would increase, compared to 78% last year. This year about 42% said their staffing levels would increase, down from 68% last year. HIMSS Video Blog: The challenge of interoperability
Diagnostic Imaging, April 8, 2009 It was designed as a showcase for the nexus of standards and IT, a testament to the ability of divergent systems to work together in a health information exchange. This “interoperability showcase,” an island on the HIMSS09 exhibit floor of kiosks, employed various clinical scenarios to demonstrate the potential of IT to deliver information that can make a crucial difference in the care of patients. HIMSS Day Four: PACS interfaces and financials get better, first responders enter the loop
Diagnostic Imaging, April 8, 2009 There’s no more natural way to convey information than speech and arguably no more difficult interface or a computer to capture. Agfa has come up with a couple new twists to help. Viztek takes a swing at tighter integration between PACS and EMRs, while IT specialists include first responders in the chain of medical communications and refine ways for providers to keep on top of their financials. Games HIMSS People Play: Marketing at the end of a pool cue
Diagnostic Imaging, April 8, 2009 Even if you’ve never been hustled at pool, you’ll appreciate the slick tricks at the Iatric HIMSS booth. Video Blog: Siemens exec wrestles with 'meaningful use'
Diagnostic Imaging, April 8, 2009 The Federal government is pushing medical practitioners toward the use of integrated electronic information systems. The hope is that these systems will improve the efficiency of medical care and reduce errors, thereby cutting costs and improving healthcare. Vioguard blasts germs off keyboards
Diagnostic Imaging, April 8, 2009 Hospital-associated infections are a growing concern for hospitals. Some 1.7 million people pick up infections each year while in hospitals. More than 99,000 die. While these infections may come from several sources, studies have shown that computer keyboards are a leading contributor. With the introduction of their first product, a self-sanitizing keyboard, Seattle-based Vioguard hopes to eliminate the keyboard as a vector of infection in hospitals. HIMSS Blog: Get ready for a fight over who owns electronic medical records
Diagnostic Imaging, April 8, 2009 In the boom leading up to sequencing of the human genome, genetics and legal experts debated the ownership of the data contained within the double helix. Now, as the U.S. readies for a surge into healthcare IT, a similar debate has broken out over EMRs. The outcome could be critical to making the best use of the huge amount of electronic medical information that the Obama Administration’s stimulus funding will create in the next few years. HIMSS Blog: Can robots give meaning to EMRs
Diagnostic Imaging, April 8, 2009 The debate over “meaningful use” has begun. At stake is nothing less than the success of President Obama’s initiative to turn paper into electronic medical records. AcceleRAD unveils easy access imaging portal
Diagnostic Imaging, April 8, 2009 Newly christened AccelaRAD unveiled at HIMSS 2009 a service that allows patients unprecedented control over their medical images. The service, called SeeMyRadiology.com, is designed to provide patients the opportunity to create personalized libraries of images in a centralized location. Using this service, patients own their digital medical images, choosing which ones to easily and securely share with whom, particularly physicians. |
VideosHIMSS Keynote: IT offers hope to solve impending healthcare crisis, says Greenspan Time is running out on Medicare, said economist Alan Greenspan in a keynote address to a capacity crowd at HIMSS09. View Video |
