AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES
Resolution: 228
(A-05)
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Introduced by:
American Academy of Neurology
American Academy of Orthopaedic Surgeons
American Association of Clinical Endocrinologists
American College of Cardiology
American College of Obstetricians and Gynecologists
American College of Surgeons
American Gastroenterological Association
American Medical Group Association
American Society for Gastrointestinal Endoscopy
American Society of Cataract and Refractive Surgery
American Society of Neuroimaging
American Urological Association
Subject:
Freedom of Practice in Medical Imaging
Referred to:
Reference Committee B
(Richard M. Peer, MD, Chair)
Whereas, Recent data show significant growth in overall Medicare and private payer spending, including
increased number and intensity of office visits, more frequent and complex imaging, and increased
laboratory testing; and
Whereas, Congress, the Administration and private payers are aggressively pursuing immediate solutions
to curb this growth despite the lack of analysis of the reasons why, or appropriateness for such growth,
particularly with regard to imaging services; and
Whereas, Specialists are faced with the challenge of balancing the increasing value of imaging tests as
an integral part of patient care with payers’ efforts to impose cost-conscious restrictions on using imaging
for their patients; and
Whereas, In this environment, the House of Medicine should be collaboratively seeking (1) to explain the
growth of imaging and the growth of Medicare Part B and private payer services in the context of the
value of appropriate patient care, and (2) solutions to spending growth that are based on analyses of
credible information; and
Whereas, The American College of Radiology (ACR) recently adopted formal policy stating, “that in
accordance with the philosophy of the ACR Code of Ethics, the practice of healthcare providers referring
patients to imaging facilities in which they have a financial interest is self referral and may not be in the
best interest of patients....The ACR should continue to educate policymakers and others regarding the
adverse effects of self-referral,” and “that the ACR advocate with Congress, appropriate Federal agencies
and third party payers that medical imaging procedures, image guided interventional procedures, and
radiation therapy services, be reimbursed only if appropriate and if provided by qualified physicians in
facilities that have met defined quality and safety standards, and that the ACR Code of Ethics, Practice
Guidelines and Technical Standards, Appropriateness Criteria and accreditation programs serve as the
foundation for the development of this reimbursement policy”; and
Whereas, Existing American Medical Association policy (E-8.032) states that “Physicians are free to enter
lawful contractual relationships, including the acquisition of ownership interest in health facilities,
products, equipment....The requirement that the physician directly provide the care or services should be
interpreted as commonly understood”; and
Resolution: 228 (A-05)
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Whereas, Several state legislative attempts to restrict imaging services, particularly MR, CT and PET to a
single specialty, i.e., radiology, through strategies such as revisions to certificate-of-need laws and
limitations on the provision of office-based services, have been introduced and defeated; and
Whereas, The AMA, in collaboration with other specialty societies, is on record (D-385.986) as
advocating reimbursement for appropriately trained physicians to perform diagnostic imaging regardless
of medical specialty; and
Whereas, The AMA adopted Resolution 235 at its Annual Meeting in June 2004, which calls upon the
AMA to work collaboratively with state medical societies and specialty societies to actively oppose any
and all federal and state legislative and regulatory efforts to repeal the in-office ancillary exception to
physician self-referral laws, including as they apply to imaging services; therefore be it
RESOLVED, That our American Medical Association urge Congress to request further study on growth in
Medicare Part B services, specifically the increases in the growth of medical imaging, and that our AMA
encourage and support collaborative specialty development and review of any appropriateness criteria,
practice guidelines, technical standards, and accreditation programs, particularly as Congress, federal
agencies and third party payers consider their use as a condition of payment, and to use the AMA Code
of Ethics as the guiding code of ethics in the development of such policy (Directive to Take Action); and
be it further
RESOLVED, That our AMA actively oppose efforts by private payers, Congress, state legislatures, and
the Administration to impose policies designed to control utilization and costs of medical services unless
those policies can be proven to achieve cost savings and improve quality while not curtailing appropriate
growth and without compromising patient access or quality of care (Directive to Take Action); and be it
further
RESOLVED, That our AMA actively oppose efforts to require patients to receive imaging services at
imaging centers that are mandated to require specific medical specialty supervision and that our AMA
support patients receiving imaging services at facilities where appropriately trained medical specialists
can perform and interpret imaging services regardless of medical specialty (Directive to Take Action); and
be it further
RESOLVED, That our AMA actively oppose any attempts by federal and state legislators, regulatory
bodies, private and government payers, and others to restrict reimbursement for imaging procedures
based on physician specialty, and continue to support the reimbursement of imaging procedures being
performed and interpreted by physicians based on the proper indications for the procedure and the
qualifications and training of the imaging specialists in that specific imaging technique regardless of their
medical specialty. (Directive to Take Action)
Fiscal Note: Implement accordingly at estimated staff cost of $4,580.
Received: 5/19/05
RELEVANT AMA POLICY
D-270.995 Physician Ownership and Referral for Imaging Services
Our AMA will work collaboratively with state medical societies and specialty societies to actively oppose any and all
federal and state legislative and regulatory efforts to repeal the in-office ancillary exception to physician self-referral
laws, including as they apply to imaging services. (Res. 235, A-04)
D-385.986 Payment For Sonography
Our AMA, in collaboration with other specialty societies, shall vigorously advocate with Medicare and other payers
that all appropriately trained physicians regardless of specialty be reimbursed for performing diagnostic sonography
with appropriate documentation (including sonographically directed biopsy, aspiration, etc.) in situations with defined
clinical indications. (Res. 108, A-02)
See also:
E-8.032 Conflicts of Interest: Health Facility Ownership by a Physician.