Doctors Investing in Diagnostic Imaging Centers
Posted on: Monday, 1 December 2003, 06:00 CST
LOUISVILLE, Ky. (AP) -- Entrepreneurs around the country are teaming with physician investors to open diagnostic imaging centers that serve privately insured patients.
The investors often are in specialties other than radiology, which traditionally did most imaging. The practice is pitting radiologists against other doctors, and hospitals against freestanding centers, in a fight for health care dollars.
Ethicists say the physician investors, in many cases, violate the American Medical Association's code of ethics, which says physicians should - with some exceptions - avoid sending their patients to facilities in which they invest and where they do not provide direct care. The exceptions generally involve situations where a community otherwise wouldn't have adequate diagnostic facilities.
"I don't think it's right, and the AMA doesn't think it's right," Dr. Herbert Rakatansky, past chairman of the AMA Council on Ethical and Judicial Affairs, said of the practice.
But the AMA does not view monitoring compliance or enforcing the code to be its role, said Ross Frazier, an association spokesman in Chicago. That's the job of state physician licensing agencies, he said.
Kentucky is among a number of states that have incorporated the AMA code into state law. But the Kentucky Board of Medical Licensure has never disciplined a physician for violating the self-referral rule, The Courier-Journal of Louisville reported Monday.
Lloyd Vest, the board's general counsel, said he could not recall receiving a grievance involving the issue, and that the board cannot investigate on its own.
When lawyers for two physician groups last year asked the board for an advisory opinion on the legality of physicians referring patients to MRI centers they owned, the board's president sent a letter only referring the lawyers to the AMA code and the Kentucky Medical Practices Act.
Dr. Danny Clark of Somerset, the state board's president, said the letter did not take a position on whether the proposed centers would violate the ethics code and state law because the board did not have enough information about the specific situations and no grievance had been filed.
Dr. Edward Roberts, a Mount Sterling internal medicine specialist who is among those who sought the board's opinion, said his lawyer interpreted the board's letter as giving the doctors clearance to go ahead with an investment in an MRI center.
Roberts said the group solicited the opinion because "we wanted this to be on the up and up and not have any trouble."
Ethicists and radiologists say they are concerned that physicians who invest in diagnostic centers may order unnecessary scans, or direct patients to their facility, even if others are of higher quality.
A decade ago, Congress passed legislation aimed at ending the practice of physicians referring patients to diagnostic imaging centers they own.
But that law only prohibits physicians from referring federally funded Medicare and Medicaid patients to imaging centers in which they invest. It includes no such restrictions on patients with private health insurance.
The sharpness of MRI images depends on the power of the scanner. Machines in physician offices and "open" scanners for claustrophobic patients typically have less power than those in hospitals, but less powerful machines can be sufficient for certain types of scans, according to imaging experts.
Dr. E. Stephen Amis Jr., chairman of the board of chancellors of the American College of Radiology, said patients should ask whether an imaging facility is accredited.
"The question is, are the images going to be good, is the most qualified person going to read them, and is there going to be overutilization for fiscal gain," he said.
Amis added that his group is trying to get data from insurance companies on whether self-referral is increasing MRI use.
"I think it will show the trend is upward," he said.
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