AAOS Bulletin - August, 2005

AAOS convinces AMA to oppose restrictions on imaging

By Robert H. Haralson III, MD, MBA

At its Annual Meeting in June, the American Medical Association’s (AMA) House of Delegates considered several resolutions on a range of issues from pay for performance to direct-to-consumer advertising. One of the issues important to orthopaedists that the AMA considered was the increasing trend to place restrictions on the use of diagnostic imaging.

The House of Delegates voted overwhelmingly to oppose any attempts to prevent non-radiologists from providing diagnostic imaging services. The AMA delegates took this position after the AAOS, along with several other national specialty societies, lobbied hard for AMA action on this issue.

A united front

As battle lines are drawn, in both the states and on the federal level, to stop non-radiologists from using imaging equipment, the AAOS and its coalition partners considered AMA support vital to show policymakers that most physicians are united on this issue. Already, several private insurers and some states have begun to restrict the use of MRIs and other imaging equipment to radiologists. The AAOS and its coalition partners believe that such restrictions hurt patient care and are not justified, given the training and experience of orthopaedists and many other specialists in diagnostic imaging.

The new AMA policy calls for the Association to oppose efforts by payers and government officials to control utilization of any medical service unless it can be shown that such efforts would save money without hurting patient access and the quality of care.

It also requires the AMA to oppose payment restrictions for imaging services based on the specialty of the physician providing those services.

AAOS efforts

On the federal level, the AAOS helped create and is actively involved with the Coalition for Patient Centered Imaging. This group of more than 20 physician organizations is committed to educating policymakers about the importance of in-office imaging services. The coalition has been countering the American College of Radiology’s (ACR) efforts to prevent non-radiologists from providing these services.

The AAOS also has provided state orthopaedic societies with detailed analyses of the issue, strategies and supporting data for opposing the efforts by radiologists on the state level. A few states already have laws prohibiting non-radiologists from providing magnetic resonance imaging (MRI) and other high end diagnostic services. At least two states—Connecticut and Rhode Island—require physicians to be accredited by the ACR to use MRIs in their offices. Such accreditation is difficult for non-radiologists to obtain. Moreover, the ACR does not provide accreditation for extremity MRIs.

The AAOS is committed to protecting the rights of orthopaedists to provide appropriate diagnostic imaging in their offices. We will continue to work with our coalition partners on the federal level and with our state orthopaedic societies to ensure that this vital component of good orthopaedic care is maintained.

Robert H. Haralson III, MD, MBA, is AAOS executive director of medical affairs. He can be reached at haralson@aaos.org

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