Patient-Centered Imaging in Urology –State Activity Alert

From the AUA National Office

This is an alert to our members in targeted states (CA, FL, IL, IN, MA, MD, MN, NJ, OH and TX) that the American College of Radiology (ACR) is moving to the state level to begin to bring their fight against patient-centered health care by seeking avenues to prevent competent physicians from doing their job. In-office imaging provides the fastest, most convenient, and often the most reliable results—results that are routinely used by treating physicians in providing ongoing patient care. The use of office-based imaging allows for quicker diagnosis and prompt treatment.

Currently, there are several forms that these changes may take the form of, so it is important to monitor the following areas:
· Change in the Self-Referral or “Stark” Laws
· The Budget, different medically related programs like Medicaid or general health care appropriations or through tax related means
· Changes in health insurance laws
· Certificate of Need if your state has this law

Changes may not be limited to just the above methods, ACR can use other avenues so it will be critical that you remain vigilant.

The performance of diagnostic and therapeutic imaging by a patient’s physician ensures that a physician familiar with the patient’s clinical condition and medical history performs the services.

According to the American College of Radiology’s (ACR) own interpretation of 2001 Medicare data, 91% and 83% of Medicare claims for CT and MRI, respectively, were performed by radiologists. According to MedPAC, the advisory body to Congress, diagnostic imaging utilization increased by 9.4% between 2001 and 2002; however, MRI and CT increased at a substantially higher rate—about 15% for CT and almost 20% for MRI.

A prohibition on in-office diagnostic testing would reduce patient access to timely, convenient testing, and disrupt the important continuity of care. According to the ACR, there is currently a shortage of radiologists, and in certain parts of the country there are already long waiting periods for critical imaging studies, such as mammography. Restricting in-office testing could substantially aggravate the problem, resulting is significant delays and reduced quality of care. In addition, Medicare beneficiaries pay substantially more when imaging services are provided in hospital outpatient settings instead of physicians’ offices. According to MedPAC, in 2002 the Medicare coinsurance rate for hospital outpatient imaging services was 53%. Coinsurance for these services in physicians’ offices is limited to 20%.

For these reasons, the AUA urges states to view any proposal promising simple solutions to increased diagnostic imaging costs with great skepticism. While increased costs are a concern to physicians and patients alike, restricting patients’ access to timely and accurate diagnoses by their own physicians is not the answer. Please contact your state medical society and keep in touch with your state legislators on this very important issue.

If you have any questions, please contact Brian Reuwer at 410-689-3745 or by email at breuwer@auanet.org.

If there are any further problems, please contact the CUA by email at info@cuanet.org or by phone at 714-550-9155.