June/July 2013

Fifteen years ago, when I first started to write about radiology, any attempt to manage or standardize the practice of medicine was met with resistance and derision. Notice that when putting together this issue, we ruled out calling our cover story, “Devising a Cookbook for Radiology.”

Some battles are destined to be fought over and over again. The fight to eliminate the IOASE is one such skirmish; it refuses to go away, after more than a decade of debate.

As radiology enters the era of quantitative imaging, it is well advised to carry with it an old friend, the DICOM standard, according to David A. Clunie, PhD, CTO of CoreLab Partners. He lays out his case in “(Informatics) Standards for Quantitative Imaging,” which he presented on November 28, 2012, at the annual meeting of the RSNA in Chicago, Illinois.

Imaging has been through a long legislative and regulatory grind since the first big blow was struck with the DRA, and there is little to indicate that much will change on that front in 2013, according to Ted Burnes, MPA, director of RADPAC, the political-action committee of the ACR®. With Maurine Dennis, MPH, MBA, a consultant for the RBMA, Burnes copresented “Radiology Economics and RADPAC Update” on May 22, 2013, at the RBMA Radiology Summit in Colorado Springs, Colorado.

Two years ago, a friend of Missouri state Rep Caleb Jones (R) sustained a shoulder injury while playing with his child. While a physician suggested that an MRI exam might be in order, the man’s health-insurance provider would not cover the cost of the study and instructed him to seek care from a sports-medicine practice. Forced to jump through multiple hoops to address his injury, the man endured prolonged pain and frustration before learning that he had not just bruised his shoulder; he had sustained a fracture—with which he had been walking around for two weeks.

A. Mark Fendrick, MD, is a self-described generalist. His research (as a professor of internal medicine and director of the University of Michigan’s Center for Value-based Insurance Design) has probed the cost of the common cold, explored the value of new imaging techniques, and quantified the value of Katie Couric’s colonoscopy in preventing colon cancer in the United States as worth more than $1 billion in National Institutes of Health funding.

As we previously reported,¹ last fall, CMS published its supposedly final guidance² on place-of-service requirements for the professional and technical components of diagnostic tests. Transmittal 2563 (later replaced by Transmittals 2613 and 2679) revised the instructions contained in chapter 13 of the CMS manual system for Medicare claims processing. The most recent transmittal became effective on April 1, 2013. On April 25, CMS issued a frequently asked question (FAQ)3 set to respond to additional concerns about the place-of-service instructions. Among other clarifications in the FAQ list, CMS reported that it will be developing a national enrollment policy for telehealth and telemedicine services.