As we close in on 2009 physicians find themselves continuing to look to see where the next shoe will drop and how it will effect how they practice medicine and care for patients. It seems like almost daily some new regulation comes from CMS or Congress. Recently there has been the DRA and another 10% reduction in Medicare reimbursements that was thankfully tabled. Physicians Imaging Solutions works closely with physicians of all specialties and we have seen first hand how rising malpractice rates, declining reimbursements and burdensome regulations have continued to squeeze physicians into an ever shrinking box. This has forced physicians to see many more patients during a day, do additional testing and make sure every “I” is dotted and “T” is crossed. This has also made it a necessity for physicians to look to ancillary services in order to keep their practices open and serve their patients. Some misguided groups and individuals call this greed, but constant cuts and frivolous lawsuits have made this a necessity. Physicians spend years and years training and working unbelievable hours as interns and residents in order to practice medicine. Why begrudge them for being successful when they get there? 

 

Well, in yet another move to shrink their options, there is a growing movement to stop non-radiology physicians from using medical imaging within their practices. The American College of Radiology (ACR) and its supporting lobbying groups such as The Association for Quality Imaging (AQI) are hammering CMS and Congress to all but eliminate this option to physicians. Their reasons are that physicians can’t control themselves and over-utilize imaging, MRI and CT especially, and that they are not concerned with quality.  

 

We have all heard the old saying, “Stats are for losers”. Anyone can take data such as rising utilization of medical imaging and twist it anyway he or she wants to prove a point, and that is what these groups are doing in an attempt to say rising utilization is directly and solely attributable to physicians owning these modalities and having them in their practices. Could it be that, as these modalities become more sophisticated and enhanced they become the main method for Neurologists, Cardiologists, Orthopaedists and others to determine a diagnosis? Could it be that unless we see TORT reform these physicians need concrete data to show their reasons for treatment in order to protect themselves? 

As Physicians Imaging Solutions has worked closely with many of these practices we have never witnessed abuse and any more utilization than what was done prior to bringing imaging into the practice. To make a blanket statement that physicians will over-utilize imaging if they have it in their practice is to slander every physician for being greedy and uncaring to patients’ needs. Besides, many patients today almost demand imaging and feel under-diagnosed if they don’t receive an MRI, CT or X-Ray. 

 

As far as quality is concerned, there should be no greater source of quality assessment than the ACR. These are the radiologists who read the studies and have been trained to see the minute details that separate the good images from the bad ones. Every facility Physicians Imaging Solutions is involved in is ACR accredited and many of those are in physician practices. To say that the ones in physician practices are not of the highest standards of quality is to say that the ACR is not a good judge of quality, and that is just not so.  If a site is accredited with the ACR, whether it is in a hospital, an imaging center owned by radiologists, or in a non-radiologist physician office, it is of high quality. So why do groups like AQI try to make the case to CMS and Congress that there is a lack of quality in physician owned imaging centers? They argue that there needs to be uniform standards. There already is; the ACR. I believe that it is a turf war between radiologists and their peers in the non-radiologist world, and groups like AQI are the paid infantry. Here is a quote by AQI that pertains to the recent ruling by CMS concerning physician ownership in medical imaging.  This should make all physicians wake up and finally speak out in a collective voice.

 

 

It is interesting that this group’s reasoning for pushing its agenda is that  non-radiologist physicians do NOT stand for safe, quality diagnostic imaging for their patients. REALLY?

 

If something is repeated long enough and loud enough it becomes the truth. Unfortunately, the forces aligned on the side of eliminating the physician’s choice of how to best serve his or her patients have been yelling in a unified voice for sometime now. Their message is being heard and accepted. Physicians, especially those in the specialties of Orthopaedics, Neurology, and Cardiology have been fragmented, unresponsive and apathetic to their rights to choose how to practice. Unless they begin to speak equally loud and with the same repetitiveness, they are truly in danger of losing yet another battle without ever firing a shot. 

 

Paul Revere