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Maryland Court Upholds Self-Referral Ban

January 28, 2011
Written by: , Filed in: Diagnostic Imaging, Medical Ethics, Practice Management
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Maryland’s highest court has upheld a state law that prohibits orthopedic surgeons—and, by extension, most nonradiologists—from referring patients for CT, MRI, and radiation therapy carried out by machines in their own offices.

The 1993 law, generally considered tougher than any other self-referral law in the nation, including the federal Stark laws, has been wrangled over in court for years. The decision by the Maryland Court of Appeals, announced Monday, presumably settles the issue in the state. Or at least shifts it from the courtroom to the floor of the General Assembly.

Predictably, radiologists cheered and orthopedic surgeons booed. Radiologists say, with some empirical justification, that self-referral by doctors for imaging on machines they own or control leads to financially wasteful and possibly harmful (because of unnecessary radiation exposure) overuse of imaging.

Supporters of self-referral say it’s more convenient for the patient, can ensure access to advanced imaging in rural or other underserved areas, and allows specialists to comprehensively manage their patients’ care.

Neither side likes to talk publicly about its own financial self-interest—although, let’s face it, that’s one of the main reasons this has become such a battleground issue.

“The Maryland law is a model to which other states should look—to maintain quality, curtail inappropriate utilization, and ensure that health-care dollars are spent effectively,” said John Patti, MD, chair of the American College of Radiology Board of Chancellors. He was quoted by DiagnosticImaging.com.

John J. Callaghan, MD, president of the American Academy of Orthopaedic Surgeons, saw it differently. “Significant technological advances have been made in our field so that patients can receive timely and accessible screenings from the comfort of their doctor’s office,” he told DOTmed News. “This ruling could have a dramatic effect on the treatment and quality of care of  Maryland patients.”

In other news involving money:

  • Kaiser Health News and Politico report that the American Medical Association, the American Hospital Association, the Pharmaceutical Research and Manufacturers of America, and other heavyweights are lobbying vigorously against the Independent Payment Advisory Board. The board, part of the Patient Protection and Affordable Care Act, is designed to cap the growth of Medicare spending—too enthusiastically, the health-industry groups fear. It’s scheduled to start work in 2015. Some members of Congress don’t like it either. Even some Democrats think it usurps congressional authority. California Democratic Representative Pete Stark, a health-care heavyweight himself, last year called it “dangerous.”
  • On Tuesday, the Wall Street Journal filed suit in an attempt to gain access to a database that shows how much money individual doctors receive from Medicare. The Journal wants the information for its reporting on Medicare fraud and abuse. What a potential uproar that could cause. Forget Wikileaks; watch out for medileaks.

Related seminar: National Diagnostic Imaging Symposium™

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