Rep. Anthony Weiner (D-NY) and Bruce Braley (D-IA) introduced an imaging amendment last week in the House Energy Commerce (E&C) Committee that would eliminate the ability of physicians to provide advanced diagnostic imaging services in their offices beginning in 2013. Bad idea. We all know that its passage would increase inefficiencies and present significant barriers to appropriate screenings and treatments. Support for this amendment -- mainly from radiologists -- is about money and not what’s best for patients. With the E&C Committee resuming talks on HR 3200 later today, this means that the Weiner amendment also could be discussed as early as today.

But, we’re fighting this bad strategy by organizing an effort with 23 other medical professional societies who sent a letter to Rep. Henry Waxman (D-CA), chair of the E&C Committee, opposing the amendment. We also talked to Majority Leader Hoyer about it. ACC staff and leaders also continue to meet regularly with Congressional staff about the benefits of appropriate use criteria and clinical guidelines to ensure that the right tests are delivered at the right time to the right patients. Appropriate use criteria and guidelines can reduce costs and limit unwarranted imaging, while at the same time ensure that patients that need it have access to appropriate care. The ACC also supports mandatory imaging laboratory accreditation to improve the quality of imaging. It’s time to use science and evidence to eliminate unnecessary tests, rather than price controls and turf wars that can only limit access to services to patients on the lower end of the economic spectrum.

In other imaging news, the ACC is working with the Access to Medical Imaging coalition (AMIC) and our partner cardiovascular societies to fight the changes in equipment utilization rates that are in both House and Senate reform bills. Stay tuned for more information. 

*** Image from Flickr (MacRonin47). ***

Recently, I told you about “More Fisticuffs with X-ray Doctors.” A radiologic advocacy group posted an inflammatory response to a recent National Council on Radiation Protection report entitled “Increased Average Radiation Exposure of the U.S. Population Requires Perspective and Caution.” The commentary was a pure economic and political piece which proposed non-radiologists who self-refer are responsible for egregious cost increases, inappropriate care, and the increased radiation risks of the U.S. population! ACC submitted a factual, evidenced based rebuttal, authored by President Doug Weaver and ACC Imaging Council Chair Kim Williams for posting on the NCRP site. They promptly took down the offensive radiology piece; but they didn’t put ours up! This is a victory of sorts, given that the NCRP board is mainly radiology oriented. We will release ours as a press release if we see this appear anywhere else. We also contacted the NCRP staff, and I believe they understand that we mean business here. More coverage of this issue is now available on CVN.

Note -- despite this unfortunate incident, the ACC and the ACR will continue to stay on the high road together, and work to use “appropriate use criteria” and science to reduce unnecessary imaging and radiation exposure.

A nasty brouhaha has developed over an inflammatory posting by a radiologic advocacy group on the website of the National Council on Radiation Protection (and measurement) in response to the NCRP report entitled “Increased Average Radiation Exposure of the US Populations Requires Perspective and Caution.” The NCRP report is pretty balanced.

However, the follow up press release and commentary by two academic radiologists (Gerard White, F.A.C.R., and John Boone, F.A.C.R.) is a pure economic and political piece which proposes non-radiologists who self-refer (the article presumes radiologists do not) are responsible for egregious cost increases, inappropriate care, and the increased radiation risks of the US population! 

Radiologists engage in as much if not FAR MORE self referral for dubious reasons, so this release is very unfortunate indeed, and must be responded to very firmly. We have prepared a response, which I encourage you to read.

A search of the literature on “self-referral” on MedLine reveals a huge preponderance of references related radiologists self-ordering (e.g. self-referral) CTs. Lately, for example, huge increases of CT of the abdomen to r/o aneurysm following unrelated studies have been noted, associated with questionable risk factors. There’s plenty of damning literature there for radiologists. Plus, reliable third party sources estimate that of CT radiation exposure, 96% is applied by radiologists, compared with 0.6% by cardiologists. There are some alarming things about potentially unnecessary medical radiation exposure in the NCRP report that bear careful consideration. But it’s not like radiology is uninvolved.

I called my counterpart at ACR on this, and I believe he was genuinely concerned this has occurred. ACR and ACC leaders have been working together to take the high road on changing our past dysfunctional dynamic toward working together on appropriate use criteria (AUC), multi-modality AUC, joint proposed registry quality improvement projects, and other positive efforts.

That’s why this kind of seriously skewed commentary is damaging ultimately to both ACR and ACC. We must respond to the inaccuracies and egregious accusations in this document, but hopefully we can contain it to the NCRP site and correcting the information for those who have accessed it.

This is risky business. All imaging specialties refer patients sometimes to their own practice settings -- it often makes sense for patients and efficiency. There are disclosure mechanisms that can help avoid inappropriate self-referral. The minority of imaging physicians of all specialties -- obviously including radiology as much as any other -- who engage in inappropriate self referral should not be tolerated by any of us. But this missive was all about crass competition and divisiveness. It’s sad.