MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Americans For Responsible Imaging' source. Mon, 15 Dec 2008 12:49:21 +0100 http://honestimaging.blogspot.com/2008/09/self-referral-and-bank-bailout.html The big topic of conversation everywhere these days is the $700 Billion bailout of Wall Street, which so far has yet to be approved by Congress. Whether you are for the rescue operation or not, you will still be able to see some uncanny parallels between the economic crisis and the imaging self-referral issue.The facts of self-referral are pretty simple. Because of the In-Office Exception of Stark II, doctors who own imaging equipment placed in their offices can order scans to their hearts' content, and collect technical fees thereof. Studies have demonstrated that giving out the keys to the cash-register leads to anywhere from two to eight times the number of scans being ordered. No one seems to be disputing that at all. The excess scans are costing you and me somewhere in the neighborhoo... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1844554 Wed, 01 Oct 2008 02:37:00 +0100 1844554 http://honestimaging.blogspot.com/2008/08/clear-vue-to-self-referral.html The self-referral mills in St. Louis were not alone in their approach to skirting the Stark Laws. According to ArkansasBusiness.com, there is another such operation in Lowell, Arkansas. In similar fashion, Fayetteville MRI, running a strip mall operation called Clearvue Medical Imaging, also depends on self-referral of its investors, and keeps it legal by avoiding Medicare and Medicaid patients. Arkansas Business got hold of a confidential memo, which. . . indicates that Fayetteville MRI – led by four northwest Arkansas doctors – is seeking 50 physicians to invest a total of $5,000. It anticipates annual profits that would quickly exceed $2 million from a controversial business plan that relies on self-referral. State and federal laws forbid self-referral to imaging centers that accept... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1733709 Tue, 26 Aug 2008 20:39:00 +0100 1733709 http://honestimaging.blogspot.com/2008/08/if-i-had-scanner.html Midi courtesty of http://www.brownielocks.com/With apologies to Peter, Paul, and MaryIf I had a scanner,I’d scan her in the morning,I’d scan her in the evening,As long as I can.I’d check her for tumors,I’d check her for infection,I’d scan her for the cash I’d getFrom Medicare and AetnaAs long as I can.If I had a PET/CT,I’d scan her in the morning,I’d scan her in the evening,As long as I can.I’d check her for tumors,I’d check her for infection,I’d scan her for the cash I’d getFrom Medicare and AetnaAs long as I can.If I had an MRI,I’d scan her in the morning,I’d scan her in the evening,As long as I can.I’d check her for tumors,I’d check her for infection,I’d scan her for the cash I’d getFrom Medicare and Aetna,As long as I can.I don’t have a scanner,I d... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1723345 Thu, 21 Aug 2008 17:34:00 +0100 1723345 http://honestimaging.blogspot.com/2008/08/changin-times.html We haven't seen a total reversal of self-referral yet, but there have been some victories here and there. The Times, They Are a Changin'. Slowly but surely.Remember the blatant self-referral clinics in St. Louis? There were four imaging centers that skirted the Stark Laws by not accepting federally-paid patients (Medicare, Medicaid, etc.) According to a follow-up article by Mary Jo Feldstein of the St. Louis Post-Dispatch, three of the four have closed down. No one knows why this happened at this point, but maybe patients got wise to what was happening to them, or just maybe someone developed a conscience. More likely, they were about to get into trouble over insurance money: Insurers are looking into whether the clinics violated a policy that requires physicians and facilities that care f... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1717072 Tue, 19 Aug 2008 20:19:00 +0100 1717072 http://honestimaging.blogspot.com/2008/07/gao-talks-amic-squawks.html The Government Accountability Office has just published a study with the lengthy title of "Rapid Spending Growth and Shift to Physician Offices Indicate Need for CMS to Consider Additional Management Practices." In brief, the GAO demonstrated what we already know, that in-office imaging is growing much faster than otherwise equivalent segments. Obviously, I'm not particularly surprised by this revelation. From Diagnostic Imaging's summary: Medicare spending for in-office imaging services increased from $6.9 billion in 2000 to more than $14 billion in 2006. The proportion of outpatient Medicare imaging performed in physician offices rose from 58% in 2000 to 64% in 2006. Spending on advanced imaging, such as CT, MRI, and nuclear medicine, rose 17% per year, substantially faster than spending... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1655367 Fri, 25 Jul 2008 18:56:00 +0100 1655367 http://honestimaging.blogspot.com/2008/07/today-show-mentions-self-referral.html A report featuring NBC Medical Reporter Dr. Nancy Snyderman was aired yesterday on the Today Show, which discussed mainly the amount of radiation one would receive from various tests. Self-referral was mentioned quite briefly in that patients were urged to ask their ordering doc if he or she has a financial interest in the scanning facililty. See the video HERE. While the ACR has done much to bring imaging self-referral to light, they sometimes take too much credit. In a piece about the Today Show report, Dr. Thrall of the ACR said: "ACR media and public relations efforts regarding quality imaging and the effect of financial incentives on imaging quality and cost are clearly having an effect."ACR media and public relations efforts regarding quality imaging and the effect of financial incen... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1655368 Fri, 25 Jul 2008 14:17:00 +0100 1655368 http://honestimaging.blogspot.com/2008/07/cheat-me-in-st-louis.html Just when I think imaging self-referral can't get worse, I find something like this. As reported in the Saint Louis Post-Dispatch, a lawyer named Kirk Bowman is managing four imaging mills in the St. Louis area. The business model is very simple: Here's how Bowman's clinics work: After being evaluated by a board of directors, physicians who want to join make an investment that varies by location, Bowman said. He declined to provide details.To remain investors, physicians must earn 75 "participation units" throughout the quarter. An MRI counts as three participation units. A CT scan counts as two. Then, the profits are split equally among the investors, he said. Physicians can miss the target for one quarter before being asked to relinquish their ownerships.Bowman said the referral requirem... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1630894 Wed, 16 Jul 2008 18:49:00 +0100 1630894 http://honestimaging.blogspot.com/2008/07/ge-is-worried-about-radiation.html Fellow blogger Doctor Dalai has a recent post about SPECT/CT scanners. It seems that General Electric is trying to get him to buy a machine that doesn't do as good a job of scanning, in his opinion, but they are pushing it as the scanner with the lowest dose to the patient: The following link is to an article regarding the possible link between multiple CTs and cancer risks, especially in children. Aiding us in our cause for our low-dose SPECT/CT Infinia Hawkeye 4 system. Maximum patient dose with the Infinia Hawkeye 4 is 2.5ma. Why more dose for Attenuation Correction and Anatomical Mapping in Nuclear Medicine environment?I had to laugh when I read this. You might remember my post about GE promoting the sale of scanners to self-referrers from last year. GE has an entire web-page devoted t... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1593702 Mon, 07 Jul 2008 23:56:00 +0100 1593702 http://honestimaging.blogspot.com/2008/07/self-referral-on-wikipedia.html A poster named Rolf-Rad on AuntMinnie.com has created a page on the Wikipedia about self-referral. It is very well written, and possibly could serve as a focal point for further discussions. Please view it and contribute more information. (Source: Americans For Responsible Imaging) Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1593703 Mon, 07 Jul 2008 23:54:00 +0100 1593703 http://honestimaging.blogspot.com/2008/05/resolution-from-american-misbegotten.html If you look up misbegotten, you will find that it is a more acceptable synonym for something less savory.Resolution 208, Fairness in Medical Imaging Interpretation, is to come before the AMA's House of Delegates shortly, and it is expected to pass. It is introduced by some of our very good friends: American Society of NeuroimagingAmerican Association of Neurological SurgeonsCongress of Neurological SurgeonsAmerican Medical Group AssociationAmerican College of CardiologyAmerican College of GastroenterologyAmerican Gastroenterological AssociationAmerican Society for Gastrointestinal EndoscopySo, what do these illustrious physicians call "fair"? Here's the text of the bill and relevant AMA policy:Whereas, Expenditures for advanced medical imaging services, such as CT, MRI and PET, have signif... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1475059 Wed, 28 May 2008 14:34:00 +0100 1475059 http://honestimaging.blogspot.com/2008/05/chat-with-internist.html I was reviewing a case with an internal medicine physician who happens to be a good friend of mine. We were talking about a patient that needed a CT, and I said, almost without thinking, "At least you don't have a scanner in your office."This started a discussion of the relative merits of in-office scanning and self-referral. My friend was unaware of the statistics that we all know so well: self-referring docs order from two to eight times as many scans as those who don't self-refer, and they generate $16 Billion in extra expenditures annually.My friend is honest as the day is long, and quite non-judgemental. He had no harsh words for his colleagues who are dabbling in the scanning business. But he was very clear as to why he thought they were doing so. As an internist, he is very much awa... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1472317 Tue, 27 May 2008 19:48:00 +0100 1472317 http://honestimaging.blogspot.com/2008/05/uro-trash.html A doctor calling himself Krom on Auntminnie.com found this article from the Urology Times, "the leading news source for Urologists". The web-page is titled, "Ancillary income: What's possible, and what's legal?" Here's the opening paragraph: In an age of declining reimbursements for traditional physician services—eyeball to eyeball with our patients or standing at the operating table—many physicians are looking for replacement sources of income to keep their small businesses healthy. This has been difficult or even impossible in the past because of government regulation or legislation (self-referral and anti-kickback statutes) concerning physician ownership of businesses ancillary to the provision of direct patient care.The authors interviewed a urologist named Pat Hezmall, M.D. from U... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1451695 Mon, 19 May 2008 13:40:00 +0100 1451695 http://honestimaging.blogspot.com/2008/05/sad-commentary.html An anonymous reader from a small town in the west sent this comment:I am a radiologist in a western community of 50k, with both a hospital and outpatient practice. The cardiologists have a CTThe family practice group has a CTThe neurosurgeons have a CTThe oncologist has a CT, soon to be a PET CTThe neurosurgeons have a MRIThe neurologist has a MRIThe orthopedists have a MRThe family practice group has a MRThis is in addition to the imaging center 50% owned by the rads and hospital with 1 CT and 2 MRs. There are also 2 CTs in the hospital. So, a town of 50k has 7 CTs and 6 MRs. There never was an issue with waits for imaging in our community. If a doctor asked for a study today, we made sure that it got done, today. We call results when asked, and have turn around time for written reports m... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1419621 Mon, 05 May 2008 00:09:00 +0100 1419621 http://honestimaging.blogspot.com/2008/04/inappropriate-appropriateness-argument.html Dr. Ron in the last post has done away with the convenience argument, as far as I'm concerned. But don't worry, our friends the self-referrers have more justifications up their sleeves. Even Tim Trysla, head of AMIC, voiced the "Appropriateness" argument when discussing an article by Dr. Jean Mitchell: We have reviewed the article in Health Affairs on equipment leasing and are hopeful that the author will release the underlying study data so that her peers can replicate her analysis. Since its inception, the Access to Medical Imaging Coalition (AMIC) has worked with policymakers with the goal of ensuring appropriate utilization of medical imaging services. Unfortunately, the Health Affairs article does not offer any data on the appropriateness of the imaging procedures it analyzes -- which... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1409636 Wed, 30 Apr 2008 13:24:00 +0100 1409636 http://honestimaging.blogspot.com/2008/04/is-something-that-is-convenient-always.html A reader named Ron put a comment on the last post, and it is so well-written, I thought it deserved full exposure.Is something that is convenient always good for you?Imaging studies are used to confirm a diagnosis and these studies should only be done after a full evaluation by a physician, never before. I find it inconceivable that any physician office could provide an in office imaging service immediately after the physician evaluation without wait. I’m willing to say that there will be either a considerable wait, or a reschedule to come back at a later time to the self referring physician’s office for the exam. If no wait for the exam, I'm sure there will be a wait for the results.If this was all about convenience, then the same self referring doctors that offer in office imaging wo... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1405299 Mon, 28 Apr 2008 21:40:00 +0100 1405299 http://honestimaging.blogspot.com/2008/04/self-referring-physicians-order-more.html Jean M. Mitchell, PhD, a professor of public policy at Georgetown University, has written extensively about self-referral, and I have discussed one of her earlier articles in a previous message. Dr. Mitchell has published another article in the journal Medical Care, titled, "Utilization Trends for Advanced Imaging Procedures: Evidence From Individuals With Private Insurance Coverage in California." Apparently mining further information from the data utilized in the earlier article, she concludes: "Use of highly reimbursed advanced imaging, a major driver of higher health care costs, should be based on clear clinical practice guidelines to ensure appropriate use." This conclusion seems to be pointed at Tim Trysla's criticism of her earlier article, wherein the AMIC leader questioned her res... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1401315 Sat, 26 Apr 2008 12:23:00 +0100 1401315 http://honestimaging.blogspot.com/2008/04/nema-code-of-ethics.html NEMA, the National Electronic Manufacturers Association, is an organization of technology companies that includes most of the manufacturers of medical imaging equipment. Their "Cope of Ethics" is a long document outlining the sorts of interactions their members should and should not have with health care professionals and institutions in the business of selling things to them. The underlying principle is: Members shall encourage ethical business practices and socially responsible industry conduct and shall not use any unlawful inducement in order to sell, lease, recommend, or arrange for the sale, lease, or prescription of, their products. Most of the rest of the document talks about things they can sponsor in the realm of training and so on, and things they can't do, such as take a client... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1385661 Sun, 20 Apr 2008 00:06:00 +0100 1385661 http://honestimaging.blogspot.com/2008/04/politics-of-greed.html Eradicator, over on AuntMinnie.com, found an incredible article in ImagingBiz.com, written by Curtis Kauffman-Pickelle, who is "a strategic business consultant to more than 30 imaging centers and radiology practices and CEO of the Imaging Center Institute." Obviously, Mr. Kauffman-Pickelle knows his way around the outpatient imaging world. He decries the "pollution" of this sector by the "dark attraction of greed": What is difficult to control, however (and extremely difficult to train salespeople to penetrate), is the political referral that clearly falls within the category of an expected quid pro quo: I will send you my scans if you give me something in return. Kauffman-Pickelle goes on to describe the ways in which unscrupulous operators will go around the law and regulations trying to... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1385360 Sat, 19 Apr 2008 15:26:00 +0100 1385360 http://honestimaging.blogspot.com/2008/04/there-are-some-ethical-docs-out-there.html You might think from reading this blog, as well as any other media source, that many doctors are greedy S.O.B.'s, trying to make an extra buck anywhere they can. While that might be true in some cases, there is a growing movement away from such avaricious behavior. Gina Kolata, writing in the New York Times today, notes a trend of doctors rejecting pay from industry. It seems that several very prominent physicians have sworn off the dole from pharmaceutical companies and the like. The scientists say their decisions were private and made with mixed emotions. In at least one case, the choice resulted in significant financial sacrifice. While the investigators say they do not want to appear superior to their colleagues, they also express relief. At last, they say, when they offer a heartfelt ... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1373337 Tue, 15 Apr 2008 18:49:00 +0100 1373337 http://honestimaging.blogspot.com/2008/04/cardiologist-gets-it.html You never know what you will find when you Google "Self-Referral". The list generally includes numerous discussions of Stark laws and CMS rulings. Today, I stumbled across this very insightful piece from Anthony N. DeMaria, MD, MACC, Editor-in-Chief, Journal of the American College of Cardiology. This would be someone pretty well respected among cardiologists, yes? At first, Dr. DeMaria pays the usual lip-service to self-referral: That the increase in medical imaging procedures raises the issue of self-referral should be no surprise. Several studies have demonstrated that diagnostic imaging services are rendered with greater frequency and at greater cost when performed by non-radiologists using equipment in their offices (2). In fact, data suggest that the bulk of the increased use of imag... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1355959 Mon, 07 Apr 2008 16:53:00 +0100 1355959 http://honestimaging.blogspot.com/2008/04/welcome-aunt-minnie-readers.html Looks like someone named eradicator found this blog, and let everyone on Aunt Minnie know about it. Thanks for the promo!Please read through the posts and see if they make sense to you. I would really like to hear your comments and suggestions as to how we can fight against the problem of imaging self-referral.Harold(I'm not going to say much about who I am for obvious reasons. I'm just a guy that thinks self-referral has to stop. That's all.) (Source: Americans For Responsible Imaging) Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1353852 Sun, 06 Apr 2008 15:39:00 +0100 1353852 http://honestimaging.blogspot.com/2008/03/decline-and-fall-of-radiology-and-how.html In a recent JACR, Richard B. Gunderman, MD, PhD, Andrew J. Koerber IV, BS, MS make some interesting comparisons between the decline and fall of radiology, and the historical downward spiral of the Roman Empire. They base their discussion on Edward Gibbon’s The History of the Decline and Fall of the Roman Empire.Rome was the greatest empire that had been seen to it's day, and some would say it still holds this distinction. I'm not going to review all of its accomplishments, but they were legion. So what happened? Gibbon noted several factors. The reason most often cited is the pressure from outside, the Huns and Goths, and other shabby folks, who ultimately destroyed the city of Rome itself. The authors of the JACR article liken this to the external problems radiology faces such as uncoop... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1289250 Sun, 09 Mar 2008 16:50:00 +0100 1289250 http://honestimaging.blogspot.com/2008/03/talk-to-congress.html AuntMinnie.com recently reviewed a speech given at the RBMA meeting in February, 2008 by Douglas Smith, founder and president of Barrington Lakes Group, a healthcare consulting firm in Barrington, IL. Mr. Smith made some suggestions that are right in line with what I've been saying myself. Elected officials often don't differentiate between different imaging entities -- radiologist-, corporate-, or referring physician-owned -- but focus instead on imaging's spike in the percentage of total medical services, Smith said."The radiology profession is not well understood in the halls of Congress," Smith said. "Many Congress people don't realize that overutilization is something that is done to radiologists, not something they do."Policy makers have moved to clamp down on costs with legislation ... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1280628 Wed, 05 Mar 2008 17:42:00 +0100 1280628 http://honestimaging.blogspot.com/2008/02/modest-proposal.html Jonathan Swift's tongue-in-cheek treatise, "A Modest Proposal" was anything but modest. I'll leave it to you to read the original, but suffice it to say that his "solution" to the problem of hunger in Ireland was entirely unacceptable to say the least.I've been ranting for some time now about the problem of imaging self-referral, and for all the good I'm doing, I might as well be talking to myself. While CMS seems to slowly trudge toward doing the right thing, it will probably take years before they accomplish anything. In the meantime, we see self-referring docs gutting the system, almost literally "eating their young" in the process.But what to do? CMS seems to grasp the problem. Sort of. Occasionally. Congress doesn't get it at all, and gets conflicting information in the form of the AC... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1252398 Sat, 23 Feb 2008 19:30:00 +0100 1252398 http://honestimaging.blogspot.com/2008/02/heres-where-were-going.html From ChinaView comes an interesting tidbit:China to control procurement of high-cost medical devices www.chinaview.cn 2008-02-14 16:18:03 BEIJING, Feb. 14 (Xinhua) -- The Ministry of Health has reportedly tightened controls on purchases of high-priced "Group A" medical devices, which cost more than 5 million yuan (about 710,000 U.S. dollars), saying that such equipment could contribute to rising medical expenses. The ministry and the National Development and Reform Commission will jointly develop a procurement plan for such items as X-ray machines and PET-CT scanners, according to the Beijing News.The ministry said that these devices involved high operating costs and complex technologies.The ministry said that it would ask experts to evaluate the purchase of such equipment before giving ... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1231757 Thu, 14 Feb 2008 20:31:00 +0100 1231757 http://honestimaging.blogspot.com/2008/01/certifying-your-self-referral-ct.html If you want to legitimatize your self-referral operation, just create a society or a commission. The ICACTL, or the "Intersocietal Commission for the Accreditation of Computed Tomography Laboratories" fills the bill. Their mission statement reads, "The ICACTL is dedicated to promoting quality computed tomography diagnostic testing in the delivery of health care by providing a peer review process of laboratory accreditation." So I guess if they bless an operation, it guarantees quality. Sure it does. Who sponsors this thing anyway? I don't see any radiology societies in there:American Academy of NeurologyAmerican Academy of Otolaryngology American Association of Physicists in Medicine American College of CardiologyAmerican Society of EchocardiographyAmerican Society of Nuclear CardiologySoc... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1191289 Thu, 31 Jan 2008 17:10:00 +0100 1191289 http://honestimaging.blogspot.com/2008/01/buine-of-medicine.html Here are two articles about doctors profiting from their patients. In both, the doctors appear to be basing their treatment decisions on how much money they can make, rather than what is best for the patient.The first is from the New York Times, and discusses how an artificial disk for the spine called Prodisk made it through all the testing that these things need: In a study of nearly 240 patients with lower back pain, the doctors said that the Prodisc, an artificial spinal disk, had worked much better than conventional surgery in which patients’ vertebrae were fused.“As a surgeon, it is gratifying to see patients recover function more quickly than after fusion and return to their normal activities more easily,” Dr. Jack E. Zigler, a well-known spine specialist and one of the study�... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1188496 Wed, 30 Jan 2008 19:25:00 +0100 1188496 http://honestimaging.blogspot.com/2008/01/new-way-to-profit-from-imaging-and-self.html It isn't enough that self-referrers profit from their actions; now, you have the opportunity to invest in their bad behavior and make some money yourself!From the website, http://www.directmedicalinvesting.com:The demand for PET scans has grown 46% per year since 2004 Analysts project that nearly 2 million more patients will require scans this year Growth means additional demand creating a unique investment opportunity AndEarn a monthly distribution as a partner in a full service, state-of-the-art medical facility, equipped with the most sophisticated and effective scanning diagnostic tools available today.Private investments are great alternative to today's stock market. This cutting-edge diagnostic technology is capable of providing a crystal-ball-like look into your medical future. Thes... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1158115 Thu, 17 Jan 2008 15:55:00 +0100 1158115 http://honestimaging.blogspot.com/2008/01/pied-off-urologists.html The American Urological Association have an "Imaging Resource Center" to justify their imaging self-referral. Here is a partial list. Pick a topic and see how they posture and pander to keep the cash flowing:AUA Positions, Letters and Talking Points Patient-centered Imaging in Urology—The Facts on In-office Diagnostic TestsResponse to Highmark’s Diagnostic Imaging StandardsImaging Talking Points for AUA Members- Self-referral Talking Points for PhysiciansConsensus Statement on Urologic Ultrasound UtilizationRecommendations for Urologic Office UltrasoundCoalition for Patient-Centered Imaging (CPCI)Comments on MedPAC’s Proposed Recommendations on Imaging Utilization: January 6, 2005CPCI Testifies to Ways & Means Subcommittee on March 17, 2005 (press release) I shouldn't be surprise... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1147228 Sun, 13 Jan 2008 14:36:00 +0100 1147228 http://honestimaging.blogspot.com/2007/12/hcfa-decries-self-referral-circa-1999.html Googling "self-referral" brings up many interesting articles. Here are some exerpts from the testimony of Kathy Buto, who was then Deputy Director, HCFA Center for Health Plans & Providers U.S. Department of Health and Human Services, before the House Ways & Means Health Subcommittee on May 13, 1999:Chairman Thomas, Congressman Stark, distinguished Subcommittee members, thank you for inviting us to discuss limits on physician self-referrals for Medicare and Medicaid beneficiaries. These limits were enacted into law, with leadership from this Subcommittee, to prevent increased program costs and potential harm to beneficiaries from unnecessary tests and treatments. They are based on numerous studies showing that physicians made far more referrals when they had a financial interest in... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1113276 Sun, 23 Dec 2007 00:49:00 +0100 1113276 http://honestimaging.blogspot.com/2007/12/why-radiologists-should-avoid-imaging.html Radiologists who read studies for self-referrers try to explain away their behavior with excuses like these:"They will buy the scanners anyway, so we might as well read for them, and thereby not anger them and lose other business.""The patients deserve the best reads that only we can provide.""If we don't read for them someone else will..."Here's the answer from an anonymous source who makes a great deal of sense:The answer is that you can never justify doing something wrong because somebody else will if you don't. That condition is always true and always will be true, and could be used to rationalize any nefarious act. This type of logic didn't hold water at Nurenberg and still doesn't.You can't live your life according to what other people might do. You can only control what you do and f... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1111744 Fri, 21 Dec 2007 17:47:00 +0100 1111744 http://honestimaging.blogspot.com/2007/12/ge-promotes-in-office-imaging.html This little ad on GE's website really says it all. Let me quote:Expand your practice with in-office CT More continuity. More convenience. More ways for your practice to succeed.There are compelling reasons to add CT imaging to your practice.First and foremost? Enhanced patient care. The ability to identify a potential problem and then confirm or rule it out with a CT exam conducted in your own office – perhaps on the same day – improves the convenience, timeliness and continuity of care your patients receive.In-office CT also provides a highly credible and effective means of differentiating your practice from others in your market. It places you on the leading edge of patient care and may engender positive word-of-mouth that has the potential to increase your revenue opportunities sign... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1098750 Mon, 17 Dec 2007 02:40:00 +0100 1098750 http://honestimaging.blogspot.com/2007/12/excuses-for-self-referral.html Those who practice imaging self-referral always have an excuse for their actions. Here are some of the most common, along with some possible rebuttals.1. Having imaging in the office is sooooooo convenient for my patients. Just ask them and they will tell you how much they appreciate it. They don't mind that I own the equipment. The vast majority of self-referring clinicians schedule imaging at different time than the patient's clinical appointment. Thus, the patient has to make two trips anyway. How is that more convenient? Those places that do schedule the imaging on top of a clinical appointment run in a "just in time" fashion that puts undue stress on whoever is reading the study to get the interpretation out fast, which can lead to mistakes. Does this "convenience" outweigh the danger... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1097607 Sun, 16 Dec 2007 14:33:00 +0100 1097607 http://honestimaging.blogspot.com/2007/12/two-states-fight-imaging-self-referral.html Some states appear to understand the problem of self-referral, and are willing to do something about it. Let's hear it for Maryland and West Virginia, who seem to be at the forefront of the battle.As reported in amednews.com, a Maryland court has upheld a rule banning non-radiologists from self-referring for in-office imaging. The court battle ensued when a group of 14 medical practices challenged the board last December. The plaintiffs -- comprising orthopedic surgeons, urologists and emergency physicians -- are part of the Maryland Patient Care and Access Coalition, which was formed to advocate for the issues at stake in the case. The doctors say state authorities misread the law and several exemptions within it that allow in-office referrals for ancillary services, including imaging tes... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1085518 Tue, 11 Dec 2007 02:14:00 +0100 1085518 http://honestimaging.blogspot.com/2007/12/stark-not-happy-with-his-laws.html There is a pretty good interview in Forbes with Congressman Fortney Pete Stark, who wrote the Stark laws about self-referral. He is disappointed that all he did was make doctors jump through the loophole in the law to keep self-referring. The Congressman had his doubts at the time: "I didn't think there was such a big deal. So the doctors wanted to make some extra money..." But then a study in Florida showed how much these self-referral arrangements were being abused. Some doctors would send every patient in for an X-ray at facilities they owned.While the law's intent was good, the law banning these businesses might have done more harm than good, he says now: "It gave every shyster and promoter a loophole." A whole industry of Stark-compliant businesses was born--not unlike the sector devo... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=1068626 Tue, 04 Dec 2007 01:58:00 +0100 1068626 http://honestimaging.blogspot.com/2007/04/radiologist-speaks-out.html Doctor Dalai found an article in the radiology journal JACR that really rakes self-referring doctors over the coals. I can't get the article, since I'm not a member of ACR, but Dalai seems to have read it through and through, and outlines it nicely. Please read Dalai's writeup for the full story. To make it short, a radiologist named Murray Reicher has had it with self referral, and he goes as far as to call it "unethical". He suggests using the phrase "No machine fee for self-dealing in medical imaging" as an understandable mantra for the masses. I suspect we will be seeing many more such articles. As Dalai puts it, this is the "first shot" in the war against self-referral. (Source: Americans For Responsible Imaging) Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=545460 Mon, 16 Apr 2007 02:11:00 +0100 545460 http://honestimaging.blogspot.com/2006/09/americans-for-honest-imaging.html Have you had a CAT scan in your doctor's office? How about an MRI or a PET? Did your doctor talk you out of going to the hospital for your test? Have you had multiple scans in your doctor's office?Some doctors who own imaging equipment in their offices are abusing the American Healthcare system, extracting up to $16 Billion per year in unnecessary scanning revenue. Studies show that doctors who profit from scaning in their offices order from two to eight times as many exams as they would otherwise. This practice is hurting all of us by sending healthcare costs and insurance premiums spiraling out of control.You can make a difference. Insist on having your study done in a hospital or an independent imaging center, where no one profits from self-referral. It's your life, your body, and your ... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=462339 Sun, 24 Sep 2006 23:51:00 +0100 462339 http://honestimaging.blogspot.com/2006/09/intels-barrett-blames-broken-health.html You don't think the American Healthcare system is in trouble? Read this from the chairman of Intel. It isn't very pretty. Here is some of what he said:"Every job that can be moved out of the United States will be moved out ... because of health care costs,'' which averaged more than $6,000 per person in 2004, Barrett said..."The (health care) system is out of control, it's unstable, it's basically bankrupt, it gets worse each year and all we do is tinker around the edges when what we need are major fixes,'' Barrett said, adding that health care costs make it increasingly difficult for U.S. companies to compete with rivals abroad.Barrett was more interested in seeing computerized stuff in hospitals than in stopping unnecessary scanning, but the problem is still obvious. Something has to be ... Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=462337 Fri, 22 Sep 2006 16:22:00 +0100 462337 http://honestimaging.blogspot.com/2006/09/good-article.html Here is a very good article on the subject of self-referral:http://www.imagingeconomics.com/issues/articles/2004-11_01.aspAll you have to do is "Google" the words "imaging" and "self-referral" and you will find many more! (Source: Americans For Responsible Imaging) Americans For Responsible Imaging blogs http://www.medworm.com/rss/comments.php?id=462338 Fri, 22 Sep 2006 03:37:00 +0100 462338