Establishing M.D. imaging credentials tops ACR tasks

Faced with possible Medicare payment cuts, the American College of Radiology will lobby Congress for legislation that would require Medicare to define physician qualifications for performing diagnostic imaging.

Congressional approval of a "designated physician imager" will be the ACR's top legislative priority of 2005, according to Dr. James Borgstede, chair of the society's board of chancellors. The college will support legislation limiting Medicare reimbursement for CT, MR, and PET procedures to medical facilities and physicians meeting specific quality control and educational criteria. The move could save Medicare $3 billion annually.

The ACR will promote DPIs as a way for Medicare to slow escalating diagnostic imaging costs without cutting reimbursement rates, Borgstede said. Increasing at 15% per year since 1999, diagnostic imaging is the fastest growing category of physician services covered by Medicare, according to the Medicare Physician Payment Advisory Commission.

DPIs would save money by making it harder for nonradiologists to qualify for Medicare payment. Nonradiologists' promotion of office-based medical imaging, which is exempt from federal law banning physician self-referral, is fueling higher Medicare utilization, he said. The ACR government relations committee decided to push for DPIs after learning that the Republican Congress would be unwilling to close the loophole. The college's proposal excludes imaging modalities that are already widely used in office practice, such as general radiography, nuclear cardiology, and sonography.

The ACR moved forward with the lobbying plan with the understanding that mandatory federal accreditation for CT, MR, and PET would be essential to the DPI concept, according to Borgstede.

Implementation would probably involve the Centers for Medicare and Medicaid Services. It would set minimum educational, reading volume, and continuing medical education requirements for physicians seeking DPI certification. Equipment performance, quality control programming, and the use of registered technologists would probably also be regulated.

"This will be a level playing field," Borgstede said. "If physicians are

willing to meet standards for these three modalities, they can perform imaging."

Nonradiologists with extensive imaging experience don't seem to feel threatened. Dr. Gerald M. Pohost, a cardiologist and chief of cardiovascular medicine at the University of Southern California, sees potential advantages in the plan.

"People need to be qualified to perform interpretations. If they are not qualified, they need training that allows them to make appropriate diagnoses," he said.

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2/1/05, Issue # 2702, page 12.