The practice of imaging self-referral doesn't produce much one-stop service

Health Affairs

Volumn 29, Issue 12, 2010, Pages 2237-2243

  Sunshine, Jonathan ^a   Bhargavan, Mythreyi ^a  

^a AMERICAN COLLEGE OF RADIOLOGY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; DIAGNOSTIC IMAGING; HUMAN; INSURANCE; MEDICARE; ORGANIZATION AND MANAGEMENT; PHYSICIAN SELF-REFERRAL; PREVENTIVE HEALTH SERVICE; UNITED STATES;

DIAGNOSTIC IMAGING; DIAGNOSTIC SERVICES; EFFICIENCY, ORGANIZATIONAL; HUMANS; INSURANCE CLAIM REVIEW; MEDICARE; PHYSICIAN SELF-REFERRAL; UNITED STATES;

EID: 79953773179     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2009.1081     Document Type: Article

References (30)

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13. To define which services are imaging, we used the standard Berenson- Eggers Type of Service classification. Centers for Medicare and Medicaid Services. Berenson-Eggers Type of Service (BETOS) codes [Internet].ltimore (MD): CMS; [cited 2009 Dec 2]. Available from: http://www .cms.gov/MedicareFeeforSvc PartsAB/Downloads/BETOSDesc Codes.pdf
14. Medicare's data system treats independent diagnostic testing facilities as a physician; the specialty of the actual physician in charge is unknown. We excluded from the analysis imaging performed in these facilities. Because Medicare rules generally preclude reimbursing radiologists for self-referring, we also excluded from the analysis their selfreferred imaging. Such imaging, approximately 2 percent of the total, had a particularly low rate of sameday service.
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17. To access the Appendix, click on the Appendix link in the box to the right of the article online.
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19. The best-known of the abuses is the so-called per click lease, in which a referring physician or practice contracts with an off-site imaging center to perform imaging at a fixed fee per imaging examination. According to the contract, the referrer leases the imaging equipment and personnel involved in each examination. The equipment and its off-site location is thereby deemed-for however many minutes the examination takes-to be part of the referrer's office and thus to fall within the in-office exemption.
20. US Department of Health and Human Services. Centers for Medicare and Medicaid Services, 42 CFR Parts 411, 412, 413, 422, and 489. Fed Regist [serial on the Internet]. 2008 Aug 19;73(161):48713-21, 48742-3 [cited 2010 Oct 27]. Available from: http://edocket.access.gpo.gov/ 2008/pdf/E8-17914.pdf
21. US Department of Health and Human Services. Centers for Medicare and Medicaid Services, 42 CFR Parts 405, 409, et al.. Fed Regist [serial on the Internet]. 2008 Nov 19;73 (224):69799-817, 69935-6 [cited 2010 Oct 27]. Available from: http:// edocket.access.gpo.gov/2008/pdf/ E8-26213.pdf
22. When imaging and an office visit take place on the same day, to distinguish this situation from actual one-stop service would require knowing whether the imaging had been scheduled when a previous visit took place. Claims do not include information about when the scheduling of an imaging took place. They provide only the dates of the imaging and office visits.
23. The "in-office ancillary services exemption" is found at 42 USC 1395 nn.
24. X-rays that are not chest or musculoskeletal x-rays are less than 2 percent of all self-referred in-office imaging (Exhibit 1). Thus, the desirability of excluding them from the exemption would probably be offset by the simplicity of an exemption for all x-rays.
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