Whither Self Referral?

There is a wonderful scene in the book Sho-Gun in which a Portuguese pilot helps save the life of an English pilot when both are in a treacherous part of the world, far from the sea-based battleground where their respective countries battle for turf supremacy. Since the two find themselves facing a common foe in the Japanese, the Portuguese “Anjin” says to the English “Anjin”: “Now we’re in this together, but if we ever meet on the high seas, look to your life, English…” Sounds a bit like our radiology armament that has been temporarily redirected toward the common foe known as the Deficit Reduction Act of 2005. There has been no little discussion concerning the distraction that this 2007 reimbursement crisis has had on the profession’s previous public position: that a portion of the increase in imaging utilization can be traced directly to self referral. Indeed, study after study has made the case forcefully that the dramatic increase in utilization is directly related to a coincident rise in in-office imaging. However, the logic of taking a “big tent” approach to lobbying on behalf of finding relief for the pending reimbursement cuts contained in the DRA is solid and makes perfect sense, at least in the short term. The new payment methodology will have similar or equal affects on all providers of the technical component piece of the imaging examination being billed to Medicare (with private payors likely to follow). Since cardiologists and orthopedic surgeons face a similar dilemma, why not partner in Washington and benefit from the additional strength that these organizations can provide-especially since these two associations have a major presence on “the Hill?” But does it mean that the self referral concerns (quality, over-use, credentialing, etc) no longer matter? Not likely. The pragmatic approach to the new rallying cry of these cuts hurting ALL professions certainly will not dissuade the self referral zealots, nor should it. The profession has fought too long and too hard to permanently abandon the fight against self referral and in favor of quality imaging. For the short term, then, let’s turn our attention to the common foe, but when we again meet on the turf battlefield: “Look to your scan volume, cardiologist.”