Forum Airs Views on Accreditation of Physicians Offering Office-based Imaging

Patients will lose access to timely, high-quality medical care if Congress limits reimbursement for imaging services to physicians who meet accreditation or certification requirements.

That was among the points made by AAFP Board Chair Michael Fleming, M.D., of Shreveport, La., and his colleagues during an April 5 congressional health forum, "Improving Patient Care and Medical Outcomes: The Role of Office-Based Imaging." The forum drew legislative staff from the U.S. House of Representatives and Senate, including the House Ways and Means Health Subcommittee and the Senate Finance Committee. Research presented there refuted reports that questioned the quality of office-based imaging services performed by physicians other than radiologists and that claimed the services drove Medicare costs up.

Definitive data, not costs, should be the foundation for any limitation of imaging, said Fleming. Moreover, if imaging were limited to radiologists, a very large part of the population would be denied access to high-quality imaging service, said Fleming.

He spoke during discussion that followed formal presentations by members of the Coalition for Patient-Centered Imaging. The Academy and 19 other specialty organizations formed the coalition to protect patient access to in-office diagnostic imaging services by physicians other than radiologists.

At issue is whether Congress should direct HHS to set accreditation and certification standards for physicians who bill Medicare for providing and interpreting diagnostic images. Coalition members contend accreditation and certification requirements would virtually eliminate office-based imaging. The results: Patients would lose access to timely diagnostic tests that could prevent expensive, invasive procedures, and the unnecessary procedures and delayed treatment would drive health care costs up. Moreover, limiting imaging services to radiologists would worsen the impact of the current shortage in radiology services.

Office-based imaging "is a factor in the reduction of the number of more costly and riskier diagnostic procedures," according to the research results presented to forum participants by the Lewin Group, a health care policy research and consulting firm based in Falls Church, Va. "Shifts in site of service from hospitals to physicians' offices account for a significant share of the growth in imaging services," said the results.

However, annual growth in claims for office-based imaging per 1,000 Medicare beneficiaries between 1999 and 2001 and between 2001 and 2003 "remained fairly stable at approximately 11 percent," the study found.

The Medicare Payment Advisory Commission would disagree. In MedPAC Recommendations on Imaging Services, (PDF file: 10 pages/113KB. More help with PDF files.) testimony given to the House Ways and Means Health Subcommittee March 17, MedPAC Executive Director Mark Miller said all physician services grew by 22 percent between 1999 and 2003, while imaging services grew by 45 percent.

"In dollar terms, Medicare spending for imaging services paid under the physician fee schedule grew over 60 percent, from $5.7 billion in 1999 to $9.3 billion in 2003," Miller said in his testimony. "Of the $1.6 billion increase in fee schedule imaging spending from 2001 to 2003, only $300 million was offset by the decrease in imaging provided in hospital outpatient departments."

Miller called on Congress to provide statutory authority to HHS to develop national standards in imaging services. Those standards, he said, should not use the physician's specialty to determine whether he or she can bill for imaging services.

Private accreditation organizations such as the American College of Radiology, the American Institute for Ultrasound Medicine or the Intersocietal Accreditation Commission already have standards, said Miller.

Therein lies part of the coalition's concern: Such organizations may develop standards that are so restrictive only radiologists would meet their criteria.