Health Law Changes Rules For Docs With In-House Imaging Machines

Here are excerpts from a Kaiser Health News article:

….Under the new health care overhaul law, doctors who refer Medicare and Medicaid patients to in-house imaging machines must disclose in writing that they own the equipment. They’ll also have to tell their patients they can get the services elsewhere, and provide a list of 10 alternative sites within 25 miles. The rule takes effect next year.

An increase in spending, then a drop

Adrienne Dresevic, a lawyer with the Health Law Partners firm, based in New York City and Southfield, Mich., says the new disclosure requirement underscores concerns among some lawmakers about physicians who refer patients to in-house imaging machines. “This is just the beginning” of efforts to tighten self-referral rules.

Medicare spending on imaging services paid to doctors rose sharply in the past 10 years — to $13.7 billion in 2006 from $6.6 billion in 2000, according to the Centers for Medicare and Medicaid Services. Spending declined to $12.1 billion in 2009, after Congress cut reimbursement rates. But the number of advanced imaging tests has continued to increase, albeit at a slower rate, according to agency data. The agency does not break out data for imaging services provided under the in-office exemption.

Exception raises radiologists’ ire

Since the early ’90s, doctors have generally been barred by federal law from referring patients for certain services —including imaging and lab tests — to entities in which they have a financial interest. But that law exempts doctors who provide such services in their offices. Lawmakers figured it would be more convenient for patients if the doctors could get an in-house X-ray to make a diagnosis.

Over the past several years, cardiologists, orthopedic surgeons, urologists and other specialists have used the exception to buy increasingly high-tech and expensive imaging equipment for their offices.

Some doctors have leased time on machines at existing imaging centers, arguing that the centers were part of their office practices and thus exempt from the self-referral law, according to the Medicare Payment Advisory Commission, which advises Congress on Medicare issues. This trend has infuriated radiologists, who are expert at reading images and find themselves competing with other specialists who are opting to move or keep their tests in-house.


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One Response to "Health Law Changes Rules For Docs With In-House Imaging Machines"

  1. tiponeill says:

    Just the tip of the private insurance iceberg. I used to work for commercial medical laboratories and you wouldn’t believe the kickback and “salesmanship” that goes on behind the scenes so that when a doctor sends you to a lab for a blood test, he hands you a form for a specific lab, or he draws the samples in the office and decides for himself what lab to use.

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