Legislation passed by Congress in July 2008 (House Resolution 6331) to defer a 10.6% reduction in Medicare fees to physicians also contained language intended to curtail the performance of “advanced” imaging procedures by unqualified physicians in nonhospital settings.
When the legislative language is implemented in 2012, any freestanding imaging center will have to meet federal standards, and the physicians operating the center will have to demonstrate training or experience that qualifies them to perform computed tomographic, magnetic resonance imaging, and isotope scans, including positron emission tomography, and to operate the necessary equipment. The basic x-ray, fluoroscopic, and ultrasound procedures, already defined by Congress as radiology, are not included in the new requirements. Nor is there any change in image-guided treatment performance, which is excluded from the federal definition of radiology.
Although the implementation of the law should curb the immediate expansion of other physicians’ undertaking imaging procedures and getting paid by Medicare, the federal agency is directed to work with professional societies in determining the standards to be applied to imaging centers and their physician operators. Thus, the final language of the regulations will have the effect of defining medical imaging as an integral part of cardiology, orthopedics, neurology, urology, and even pediatrics and any other specialty that chooses to establish standards acceptable to the Medicare program.
That section of the new law was promoted by the American College of Radiology (ACR) with the cooperation of the American College of Cardiology and the National Electrical Manufacturers Association, representing major manufacturers of imaging equipment. Because the main thrust of medical lobbying was to avoid cutting all Medicare physician fees, there was no opposition to the imaging provisions from the American Medical Association or the specialty societies whose members will be affected by the requirement.
The legislation specifies criteria for medical organizations that will seek to become accrediting agencies, language defining the technical qualifications of imaging centers, and language specifying the qualifications of physicians serving as medical directors or supervising physicians. The section relating to physician qualifications may well have an impact on radiology training programs and possibly on the functions of the American Board of Radiology.
Some of the language relating to the standards was suggested by the ACR and reflects the ACR’s role in developing criteria for mammography, which became legal requirements under the Mammography Quality Standards Act of 1992, and subsequent voluntary standards for facilities performing other types of imaging. Thus, the ACR should qualify as an accrediting agency. The technical standards also reflect existing state requirements for all medical x-ray facilities. And the physician requirements can allow and/or require other disciplines to meet the radiology standards or else develop their own criteria to meet the federal objectives.
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Reference
- 1. Amis E.S., Butler P.F., Applegate K.E., et. al.: American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol 2007; 4: pp. 272-284.