New imaging disclosure requirements could mean opportunity for radiologists

Starting January 1st, referring physicians who provide in-office imaging services must provide their patients with a list of other options in their area. This is a new regulation under the Patient Protection and Affordable Care Act affecting practices under the in-office ancillary exception of the Stark law.

So, how does this new requirement affect radiology professionals?

Most diagnostic imaging centers and radiology groups won’t be directly impacted, said Thomas W. Greeson, a partner at the Falls Church, Va., office of healthcare group Reed Smith LLP. But there will be some radiology groups subject to the requirement, he said, such as interventional radiologists who are acting as treating physicians.

However, it’s probably a good time to make sure your practice is on that list of alternative imaging providers given to patients. This new regulation could be a marketing opportunity for radiology practices to reach out to primary-care providers and others, making sure they are included and the referring practice has their latest contact information.

Many radiology groups already have relationships with those practices, providing supervision and interpretation services, Greeson noted, but “they are going to want to be on the list.”

Here’s a review of the new regulation:

Physicians who bill for MRI, CT, and PET scans should develop procedures and forms notifying patients that they may obtain the imaging service somewhere else. The provider must give patients a list of at least five suppliers (which can include hospitals) within a 25-mile radius of the office. The disclosure must be provided every time a referral happens.

CMS "just wants to make sure patients know they have options for providers they can see, and that providers are giving patients those options and not just referring to themselves,” said Heather B. Deixler, an associate with Davis Wright Tremaine LLP.

The notices don’t need to be signed or included in the medical record, but Deixler said it’s a good idea to document that the disclosure was given. “We suggest doing a checklist in the medical record, and check it off so that you know it happened.”

Meanwhile, a new study shows just how many practices own advanced imaging equipment. According to the Center for Studying Health System Change, one in six physicians in 2008 reported their practice owned such equipment. Here’s a breakdown of the study of 2,750 physicians in community-based, physician-owned practices:

• 22.7 percent owned/leased equipment for X-rays
• 17.4 percent for advanced imaging
• 25.2 percent for lab services
• 28.9 percent for non-invasive procedures
• 11.4 percent for invasive procedures
• 13.2 percent owned/leased three or more types of equipment

Among those owning advanced imaging equipment, 30.0 percent were surgeons and 10.6 percent were primary-care physicians treating adults. Non-procedure-based specialists, such as neurologists, accounted for 13. 5 percent, and procedure-based specialists such as cardiologists represented 15.7 percent, the study found. The study was funded by the Robert Wood Johnson Foundation.