Health insurers and medical-imaging policy - A work in progress

New England Journal of Medicine

Volumn 360, Issue 10, 2009, Pages 1030-1037

  Iglehart, John K ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CLINICAL DECISION MAKING; COMPUTER ASSISTED TOMOGRAPHY; COST UTILITY ANALYSIS; DIAGNOSTIC IMAGING; ECHOGRAPHY; HEALTH CARE COST; HEALTH CARE ORGANIZATION; HEALTH CARE PLANNING; HEALTH CARE POLICY; HEALTH INSURANCE; HOSPITAL DEPARTMENT; HUMAN; MEDICAL EDUCATION; MEDICARE; NUCLEAR MAGNETIC RESONANCE IMAGING; OUTPATIENT CARE; POSITRON EMISSION TOMOGRAPHY; PRACTICE GUIDELINE; PRIORITY JOURNAL; RADIOGRAPHY; ECONOMICS; GOVERNMENT; LEGAL ASPECT; REIMBURSEMENT; UNITED STATES; UTILIZATION REVIEW;

CENTERS FOR MEDICARE AND MEDICAID SERVICES (U.S.); DIAGNOSTIC IMAGING; HEALTH EXPENDITURES; HEALTH POLICY; HUMANS; INSURANCE, HEALTH; MEDICARE; REIMBURSEMENT MECHANISMS; UNITED STATES;

EID: 61849144428     PISSN: 00284793     EISSN: 15334406     Source Type: Journal    
DOI: 10.1056/NEJMhpr0808703     Document Type: Article

References (38)

1. Demmerle C, Glaudemans J. Diagnostic imaging: spending trends and the increasing use of appropriateness criteria and accreditation. Washington, DC: Avalere, 2008.
2. Iglehart JK. The new era of medical imaging-progress and pitfalls. N Engl J Med 2006;354:2822-8.
3. Report to Congressional requesters: Medicare Part B imaging services: rapid spending growth and shift to physician offices indicate need for CMS to consider additional management practices. Washington, DC: Government Accountability Office, June 2008. (GAO-08-452.)
4. Winter A, Stensland J. Introduction to expert panel on new research on use of imaging services: presentation to Medicare Payment Advisory Commission, Washington, DC, September 5, 2008.
5. Organisation for Economic Cooperation and Development Health Data 2008. Accessed February 13, 2009, at http://www.oecd.org/els/health/data.)
6. Baker LC, Atlas SW, Afendulis CC. Expanded use of imaging technology and the challenge of measuring value. Health Aff (Millwood) 2008;27:1467-78.
7. Report to the Congress: Medicare payment policy. Washington, DC: Medicare Payment Advisory Commission, 2007.
8. Office of the Inspector General. Provider relationships and the use of magnetic resonance under the Medicare Physician Fee Schedule. Washington, DC: Department of Health and Human Services, 2008. (OEI-01-06-00261.)
9. Mitchell JM. The prevalence of physician self-referral arrangements after Stark II: evidence from advanced diagnostic imaging. Health Aff (Millwood) 2007(3);w415-w424.
10. Casalino LP. Physician self-referral and physician-owned specialty facilities: the Synthesis Project. Princeton, NJ: Robert Wood Johnson Foundation, 2008.
11. Levin DC, Rao VM, Parker L, Frangos AJ, Sunshine JH. Ownership or leasing of MRI facilities by nonradiologist physicians is a rapidly growing trend. J Am Coll Radiol 2008;5:105-9.
12. Levin DC, Rao VJ, Kaye A. Turf wars in radiology: recent actions against self-referral by state governments, commercial payers, and Medicare -hope is on the horizon. J Am Coll Radiol 2008;5:972-7.
13. Gazelle GS, Halpern EF, Ryan HS, Tramontano AC. Utilization of diagnostic medical imaging: comparison of radiologist referral versus same-specialty referral. Radiology 2007;245:517-22.
14. Pham HH, Devers KJ, May JH, Berenson R. Financial pressures spur physician entrepreneurialism. Health Aff (Millwood) 2004;23(2):70-81.
15. Tynan A, Berenson RA, Christianson JB. Health plans target advanced imaging services. Issue brief no. 118. Washington, DC: Center for Studying Health System Change, 2008.
16. Abelson R. An M.R.I. machine for every doctor? Someone has to pay. New York Times. March 13, 2004.
17. Bach P. Paying doctors to ignore patients. New York Times. July 24, 2008.
18. Armstrong D. MRI and CT centers offer doctors way to profit on scans. Wall Street Journal. May 2, 2005:A1.
19. Zimmerman M. Medicare: referring physicians' ownership of laboratories and imaging centers. Testimony of Michael Zimmerman, General Accounting Office, June 8, 1989, before the House Energy and Commerce Subcommittee on Health and the Environment.
20. Shikles JL. Physicians who invest in imaging centers refer more patients for more costly services. Testimony of Janet L. Shikles, General Accounting Office, April 20, 1993, before the House Ways and Means Subcommittee on Health.
21. Report to the Chairman, House Ways and Means Subcommittee on Health. Medicare: referrals to physician-owned imaging facilities warrant HCFA's scrutiny. Washington, DC: General Accounting Office, 1994. (GAO/HEHS/95-2.)
22. Medicare: trends in fees, utilization, and expenditures for imaging services before and after implementation of the Deficit Reduction Act of 2005. Washington, DC: Government Accountability Office, 2008. (GAO-08-1102R.)
23. Congressional Budget Office. Factors underlying the growth in Medicare's spending for physician services, 2007. (Accessed February 13, 2009, ats www.cbo.gov/publications/by subject.cfm?cat=9.)
24. Iglehart JK. Medicare showdown. N Engl J Med 2008;359: 556-8.
25. Ensuring quality through appropriate use of diagnostic imaging. Washington, DC: America's Health Insurance Plans, 2008.
26. Appleby J. The case of CT angiography: how Americans view and embrace new technology. Health Aff (Millwood) 2008;27: 1515-21.
27. Smith-Bindman R, Miglioretti DL, Larson EB. Rising use of diagnostic medical imaging in a large integrated health system. Health Aff (Millwood) 2008;27:1491-502.
28. Winter A, Ray N. Paying accurately for imaging services in Medicare. Health Aff Millwood) 2008;27:1479-90.
29. Tunis SR, Pearson SD. Coverage options for promising technologies: Medicare's 'coverage with evidence development.' Health Aff (Millwood) 2006;25:1218-30.
30. Redberg RF, Walsh J. Pay now, benefits may follow-the case of cardiac computed tomographic angiography. N Engl J Med 2008;359:2309-11.
31. Proposed decision memo for computed tomographic angiography (CAG-00385N). Baltimore: Centers for Medicare & Medicaid Services, 2007. (Accessed February 13, 2009, at http://www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp? from2=viewdraftdecisionmemo.asp&id=206&.)
32. Decision memo for computed tomographic angiography (CAG-00385N). In: Medicare national coverage determinations manual. Sect. 220.IF. Baltimore: Centers for Medicare & Medicaid Services, March 12, 2008. (CMS Publication 100-03). (Accessed February 13, 2009, at http://www.cms.hhs.gov/mcd/ viewdecisionmemo.asp?id=206.)
33. Redberg RF. Evidence, appropriateness, and technology asessment in cardiology: a case study of computed tomography. Health Aff (Millwood) 2007;26:86-95.
34. Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008;359:2324-36.
35. Brenner DJ, Hall EJ. Computed tomography- an increasing source of radiation exposure. N Engl J Med 2007;357:2277-84.
36. Pear R. Drug industry, having long smiled on G.O.P., now splits donations equally. New York Times. October 18, 2008:A18.
37. Douglas PS. Improving imaging: our professional imperative. J Am Coll Cardiol 2006;48:2152-5.
38. Hackbarth G, Reischauer R, Mutti A. Collective accountability for medical care - toward bundled Medicare payments. N Engl J Med 2008;359:3-5.