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H.R. 2962, The Integrity in Medicare Advanced Diagnostic Imaging Act of 2009 (13 comments ↓)
H.R. 2962 would amend title XVIII of the Social Security Act to exclude certain advanced diagnostic imaging services from the in-office ancillary services exception to the prohibition on physician self-referral.
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Texas Rad Tech
July 2, 2009, 4:33pm (report abuse)I agree with this bill. I have worked in physician offices and have seen too many patients being done because the physician needed the income. When a physician owns the equipment, there is too much temptation to order procedures to increase the revenue in the practice. My health insurance premiums keep going up so physicians with imaging equipment can drive a new Mercedes.
Wilhelm
July 6, 2009, 12:05pm (report abuse)Instead, they should all physicians to jointly invest in equipment, thereby sharing the costs and reducing the motivation to do unnecessary scans. Right now that is prohibited which is ridiculous.
Sandra Mazzeo
July 9, 2009, 3:31pm (report abuse)I agree with this bill and feel that it should be expanded to include all Radiation Therapy procedures as well. I have been working in a hospital for 30 years and have watched physicians take the best paying patients to their private offices. Now hospitals are facing terrible financial crisis and closing. Of late is the proliferation of free standing, physician owned prostate centers due to a stark law loop hole that allows for inoffice ancillary billing for these services.This is just wrong. Radiation therapy is not an incident too service. It is very technical in nature and highly specialized and should only be provided in facilities who understand what is involved. Cancer can should not be provided to patients solely to pad physician pockets. I hope this bill is passed and protect the citizens or our hospitals will not be available in the future.
Rad. Oncologist
July 9, 2009, 7:02pm (report abuse)This Bill is very important, and critical to cost control with regard to Medicare expenditures. Urologists are exploiting the in-office ancillary services exemption to offer IMRT in their own offices for their own patients. Utilization of IMRT has skyrocketed as a result (revenue to urologists: $50,000 per patient). Simple solution: close the loophole!
Seen the "Deals"
July 19, 2009, 3:39pm (report abuse)To Wilhelm: The joint ventures between physicians are just as much of a incentive to refer. Many of them exist without seeing government patients. I have seen flat out 'point' systems with quotas for a month / quarter that are directly tied to the number of referrals. The fact is that docs look at imaging as a revenue source and it is tough to separate the money from the medicine. When there is a link, all they have to do is send a patient for a test to see the benefit. MRI is especially bad because there is no radiation for them to be concerned about....it also pays well with enough volume.
Dosimetrist
July 23, 2009, 1:45am (report abuse)I work in a Rad Onc Center with a urologist IMRT joint venture 2 doors down the street. What people fail to realize is that the "low hanging fruit", high reimbursement procedures and patients help support care for the really sick and those with bad insurance or no insurance.
While our docs continue to treat cancer appropriately, the hired gun down the street will do as he is told and treat everyone whether they are a proper candidate or not as long as they are have insurance. Reform the fraud and abuse first, then fix the rest of the system.
Calif Imaging Center Manager
July 23, 2009, 1:12pm (report abuse)I too support this bill. As a manger of a full service outpatient imaging center it was amazing to see our volumes plummet when a large orthopedic group put in their own MRI – but even more amazing was that their monthly volumes more than doubled once they owned their own scanner. The statistics reflecting the out-of-control increases in the utilization of high-tech imaging (CT, MRI, PET/CT) are surely horribly skewed by the “in-office exemption”. Washington needs to act on this.
SKSM
July 28, 2009, 11:14pm (report abuse)The above comment is untrue. Studies show that there was NO increase in MRI's. This Bill is promoted strictly by Radiologists wanting to preserve their own dollars.
Radiologist
August 1, 2009, 3:40pm (report abuse)Sometimes patients are well served by having imaging in the hands of non radiologist specialists. IMO, orthopedic patients are well served when their treating physician can obtain and view plain films in their office and make on the spot treatment decisions. OB-Gyn patients may be well served when pelvic ultrasound can be performed in their doctor’s office, if technologist is certified, and interpreting physician appropriately trained and credentialed.
However,can think of NO cases where a not rad should own in-office CT, MRI or PET unit and self refer. At $1+ mill,referring doc can't help being influenced by the need to see return on investment that large. Pts are not well served by the strong incentive to utilize that machine. These are complex exams, not always easy to interpret, yielding a large amount of information on various organ systems.
Taxpayer
August 8, 2009, 12:33pm (report abuse)I completely support this bill. I work in pathology field and I see first hand the greed of urologists and gastroenterologists that only care about making money on pathology. This bill should be expanded to include pathology services as well. Why should hard working American citizens have to pay additional taxes to support inappropriate physician profits. There has been a government study that showed a huge increase in radiology procedures as a result of the Stark exception. There have been studies of urologists that also showed a dramatic increase of pathology billings when the physician started to bill for pathology in their office. Many Americans are now out of work, yet CMS is allowing physicians to continue to bilk the system. Enough already.
Head and Neck Surgeon
August 12, 2009, 9:41am (report abuse)Physicians have been offering the convenience of in office radiologic evaluation of their patients since the advent of xrays over a century ago. The issue which is not understood by most and clouded in these ill conceived bills is that those xray studies have been replaced by equally efficient CT scanners which deliver a fraction of the radiation dose of traditional xrays. In many medical fields, traditional xrays are no longer the standard of care. The convenience of evaluating the patient and getting the radiologic study immediately is ingrained in American medicine. The answer to our health care crisis is not more socialization and rules. The issue of in office advanced radiologic studies has been addressed by market factors where there are strict guidelines for obtaining these studies, and physician practices have negotiated with private payers for compensation for them. Taking away the ability of physicians to efficiently diagnose and treat patients is a step backwards.
Patient
August 20, 2009, 5:07pm (report abuse)All this bill will do is cause me to have to see more doctors and go to more centers. I will go to my ortho who will diagnose me for a scan. Rather than having it done onsite, I will then have to take another day off of work schedule another appoitment and go to another center. Where is the coordination?
head em up moove them out
August 24, 2009, 12:51pm (report abuse)So they will line up at the nearest ER, stand in line for CT (indicated for tumor, aneurysm,hemorrhage). EDs are already packed with non emergent health care.