AMA votes to stand against imaging services clampdown

Chicago -- Increasing evidence that lawmakers, regulators and insurers are set on reining in spending on medical imaging has prompted the American Medical Association to take a stand, but not all physicians are happy about the new position.

Delegates at the AMA Annual Meeting in June passed a resolution calling on the Association to oppose efforts by any payer to control utilization of any medical service unless policy-makers can prove that the move will improve quality without interfering with patient access. The new policy also directs the group to reject any proposal to restrict payment for imaging services based on physician specialty and to review with specialty groups any criteria on patient care that may emerge from public debate.

Rising federal costs in this area have set off alarms in Congress and at the Centers for Medicare & Medicaid Services, which are looking to control the spending and determine whether growing use of these tests is necessary. CMS estimated in a recent report that Medicare expenditures for advanced scans, such as magnetic resonance imaging, rose more than 25% between 2003 and 2004, more than twice the increase from the previous year.

Many physicians testified that any attempts by Congress and private payers to curb spending on imaging services and restrict the tests to credentialed specialists would be an assault on what they view as appropriate freedom of practice when ordering x-rays, sonograms and other scans.

"We know that payers are targeting high-growth physician services, often with little understanding of why growth is actually occurring," said Suma Thomas, MD, a cardiologist and alternate delegate from Bethesda, Md.

Growth may stem from practice guidelines that call for more diagnostic testing to head off potential medical problems, some delegates said. Also, decreasing imaging equipment prices mean that more physicians can conduct the tests in their offices.

Specialty groups that introduced the measure include the American College of Surgeons, the American Academy of Neurology and the American College of Cardiology. Members of that coalition warned that insurers are already aggressively targeting imaging spending in some states.

Pittsburgh-based Highmark BlueCross BlueShield, for instance, launched a program late last year to recredential network physicians who perform imaging services and require preauthorization. Doctors have already seen the ill effects, said Richard Schott, MD, a cardiologist and delegate from Wallingford, Pa.

"We have ... serious issues with access created by limitations on our ability to practice," he said. "This creates quality problems for our patients."

Radiologists go their own way

The American College of Radiology disagrees with the AMA's move. The college is pushing for federal standards that would make more stringent requirements for ordering scans and would limit diagnosis to radiologists and other credentialed specialists who have had rigorous training. This would improve quality of care for patients and slow uncontrolled growth in the imaging sector, the group says.

"It should be the goal of the medical community to provide the best possible care to patients, and this philosophy should extend to diagnostic imaging services," said James Borgstede, MD, chair of the ACR board of chancellors.

The Medicare Payment Advisory Commission, which makes reimbursement recommendations to Congress, has said that lawmakers and CMS should make stronger imaging standards a prerequisite for billing Medicare. The American College of Radiology supports the move and is lobbying Congress to act, said Dr. Borgstede, a radiologist in Colorado Springs, Colo.

Dr. Schott, a proponent of the AMA's new policy, said that attempts by radiologists or other medical groups to support Congress or insurers in their quest to clamp down on imaging spending would hurt all physicians who want to administer the services.

"There's nothing at all to be gained by members of the House of Medicine going outside the house to legislators and third-party payers in a divided fashion," he said. "Whenever that happens, we all lose."