Part B Insider (Multispecialty) Coding Alert

In-office imaging adds to convenience, improves outcomes, say doctors

If Medicare imposes standards on providers who interpret diagnostic imaging scans, it will reduce patient convenience without improving clinical outcomes or saving money, according to the Coalition for Patient-Centered Imaging.

In March, the Medicare Payment Advisory Commission encouraged Congress to impose qualifications on doctors who interpret scans. MedPAC also proposed tightening rules against physicians having a financial interest in the imaging centers to which they send patients.

But in an April 5 Capitol Hill briefing, the Coalition warned that MedPAC's proposals would add yet another layer of expensive and unnecessary bureaucracy on top of the training and standards medical specialties already require. And new Medicare standards could mean that only radiologists would be allowed to interpret imaging tests.

Physician and other medical groups formed the Coalition to promote the use of in-office imaging by physicians other than radiologists. The Coalition says in-office imaging provides patients with quick, first-rate treatment, helps prevent separate trips to a hospital outpatient department or radiology center and substitutes for more invasive procedures such as catheterization or exploratory surgery.

MedPAC executive director Mark Miller insisted the Commission's standards wouldn't restrict imaging interpretation to radiologists in a March 17 testimony before the House Ways and Means Health Subcommittee. But the Coalition says it sees an unfortunate precedent in the private insurance market, where radiologists have "hammered on" plans, resulting in imaging rules that effectively bar non-radiologists.

"The implication has been that, if a radiologist does it, then it must be appropriate," said William Gee, an urologist who also teaches at the University of Kentucky School of Medicine.

MedPAC says physician imaging costs per Medicare beneficiary grew 10.1 percent from 1999 to 2002 and 8.6 percent from 2002 to 2003 - roughly double the cost increase in all physician services.