Self-Referral in California

The conflict of interest posed by self-referral has been an issue for radiology for quite a while. Organized radiology has attempted multiple times to raise awareness of self-referral both at the state and federal levels. Efforts have been thwarted by most of the rest of medicine aligned against any limitations. The gold standard remains the Maryland legislation which bans the practice.

Self-referral legislative consideration has once again come to the fore. The latest Congressional Budget Office score estimates a $3.4 billion savings if the In Office Ancillary Service Exclusion (IOASE) loophole is closed. The Government Accounting Office has recently produced relatively scathing reports of self-referral abuses with advanced imaging services, pathology and GI. A report on physical therapy is due soon.

Now, California is considering self-referral legislation. Senate Bill 1215 would remove the exception for advanced imaging, anatomic pathology, radiation therapy and physical therapy.

Both the California Radiological Association and the American College of Radiology support the legislation. Several large trade unions, health care payers and other stakeholders are also behind the bill. This is still an uphill battle. Most other physicians and many other special interests are lining up to defeat the effort.

Eliminating the IOASE could be considered as a “pay for” in the SGR permanent reform debate that should take place at the end of this year. The politics seem to make it improbable.

As always, we will keep you informed.

Howard B. Fleishon, MD, MMM, FACR

On the Right Track

McGintyImgAs reimbursement for imaging (like many other physician services) under the current fee-for-service system has been cut over and over again, your Economics Commission has heard the message loud and clear that we need to help members find a way forward. The somewhat overused phrase “volume to value” does provide an overarching principle, but we need to find concrete ways to help radiologists continue to help their patients, practice the specialty they love and feed their families. The cultural change that we need to make as a profession is embodied in the Imaging 3.0 campaign. The specific payment models for the future are more elusive.

On Monday, April 14, we convened a meeting of policy experts, radiology thought leaders and, most importantly, radiologists who are leading change in their own practices, to review our activities to date on developing new payment models. Our goals were several fold and we learned a lot.

It turns out that most specialty groups are struggling to figure out the best way to succeed in the new world of bundled payments and ACOs and we may, in fact, be ahead of many as evidenced by the calls the Neiman Health Policy Institute has been getting from other professional organizations asking for ideas. We were reminded that while change may be mandated centrally, it is happening most effectively at the local level. And the more we can tap into our collective experience, the better. We recognized, yet again, that we work with incredibly smart and dedicated business managers and administrators and that our team effort will be critical for our success.

We’ll be reporting more specifically on the results of our discussions in the near future, but in a nutshell: we are on the right track, there’s no magic bullet we haven’t thought of and our Imaging 3.0 commitment to our patients and our profession will be our strength.

Author – Geraldine B. McGinty, MD, MBA, FACR


Radiology and Medicare Physician Payment Information Made Public

I confess to having a competitive streak. I was very glad however, when CMS released the data on what they paid individual physicians for 2012, that radiologists were not at the top of the league table. We were way down the list behind Internal Medicine, Ophthalmology and Cardiology. Not that I am not supportive of fair reimbursement for the high value services we provide; far from it, but I’m happy to let the spotlight shine elsewhere for a while. For too long radiologists have been accused of being part of the problem. Our recent success in getting clinical decision support enacted for advanced imaging as part of the SGR patch places us firmly in the value camp and it’s a good place to be.

We are looking more closely at the data however and have requested clarification from CMS on how they derived it. It will be important for our patients to understand the fact that our services are billed and paid for using the TC/PC construct which, depending on practice type, can significantly change the revenue a particular physician receives. Getting paid for doing an imaging service means that you have to pay for the resources needed to perform it: the $2 million MR unit, the highly trained technologist etc. As the ophthalmologists and oncologists who were interviewed yesterday pointed out, revenue does not equate to take home salary.

We’ll be keeping you posted in this story as it rolls out and as we dig into the data. For the moment, our focus remains firmly on the value that we know we deliver to our patients

Author – Geraldine B. McGinty, MD, MBA, FACR