The lazy days of summer have brought forth a stunning resolution that forecasts a gathering storm on the imaging technology front. Correction: make that a tsunami.

In June, the American Medical Association passed Resolution 235. The resolution first reaffirmed the society’s position on physician self-referral and then committed and funded the association to battle any state or federal attempts to repeal the in-office ancillary exception to physician self-referral laws, “including the way they apply to imaging services.”

In recommending that the resolution be passed, the AMA’s reference committee stated that there existed no credible evidence that self-referral for imaging services results in unnecessary care or poor quality. In fact, the committee heard much testimony attesting to the fact that in-office imaging results in better quality and continuity of care, as well as patient convenience and reduced cost. The committee cited “overwhelming” support for this measure.

From whence did this resolution come? It was introduced by professional societies representing cardiologists, urologists, neurosurgeons, gastroenterologists, orthopedic surgeons, and OB-GYNs, plus the American Medical Group Association.

It is entrepreneurial, not illegal, to want to collect the technical fees for imaging services ordered, and who can blame the specialties listed abovesome of which pay some of the highest medical liability premiumsfor wishing to collect those technical fees. And yes, surely patients find it convenient to be imaged on the spot, should they require this. But plenty of data exists to support the fact that utilization rises when there is imaging technology on-site. Does anyone really believe that over-utilization is not a factor here? Take, for instance, the OB-GYN, and surely no specialty is more beleaguered than that one. Seventeen years ago, I underwent one, maybe two ultrasounds during my entire pregnancy. An informal poll of the two pregnant women in my office revealed that they each had considerably more than that: nine and 10…and counting.

Concern about medical liability may be a factor in this as well as other imaging modality utilization increases. But is all of this imaging medically necessary? Given the benefit of the doubt that improving the quality of care is the primary motivation here, where are the mammography units in the offices of the OB-GYNs? The AMA clearly is protecting the business interests of its members, but what of radiology? Where was radiology when the AMA sought the elusive evidence that in-office imaging promotes overutilization and decreased quality?

In preparing for a more – not less – competitive environment, radiology practices and departments must continue to add value, be it in improved turnaround, better access to appointment times and radiologists, state-of-the-art technology, continuing education, and new service lines, including innovative partnerships with other specialties.

By its very nature, a tsunami is unstoppable. Many of you already are engaged in multiple forms of collaboration with some of your major referrers. But it would be a grave mistake to throw in the towel and abdicate to the “orderers” on the subject of imaging appropriateness. Radiologists are the imaging experts, and in order to remain so, the voice of radiology must be heard loud and clear on this subject at every opportunity.

Cheryl Proval
[email protected]