Under the healthcare overhaul law, a rule requires doctors who refer Medicare and Medicaid patients to in-house imaging machines to disclose that they own the equipment and give their patients a list of 10 alternative sites within a 25 mile radius where they could get imaging done. The provision, which takes effect next year, is designed to tighten self referral rules in the face of a sharp rise in Medicare spending on imaging services paid to doctors, Kaiser Health News reports.
That spending surged to $13.7 billion in 2006 from $6.6 billion in 2000. After Congress cut reimbursement rates, spending fell to $12.1 billion in 2009. But the number of advanced imaging tests continues to rise.
Proponents of in-house scanning say that doctors should be allowed to order advanced diagnostic imaging tests, MRIs, CT or PET scans, because they can work more closely with technicians and get their patients quick results. John Finkenberg, a San Diego orthopedic surgeon, told Kaiser Health News that the MRI, which he and his partners bought for $1 million, is the perfect diagnostic tool for them. "We can't afford to miss a diagnosis for our patient and for our malpractice costs."
Critics say self-referrals should be banned because they lead to excessive testing and higher Medicare spending.
Since the 1990s, federal law has usually barred doctors from referring patients for services, including imaging and lab tests, where they could benefit financially. But if the doctors provide those services in their offices, they are exempted, because lawmakers decided it would be more convenient for patients if doctors got in-house X-rays to make the diagnosis.
Because it's not easy to compare imaging costs and people tend "to defer to the white coat," some say the law may have little effect in the short term.
To learn more:
- read the Kaiser Health News/USA Today story
Related Articles:
Imaging coalition says White House supports radiology benefit managers
GAO to study link between physician self-referral, Medicare imaging costs
Study: Radiologists losing control of imaging industry
GAO report recommends imaging cost controls