A bill approved near the end of this year’s legislative session will raise the bar for magnetic resonance imaging (MRI) devices used in the state, but also make it easier for doctors to set up smaller, cheaper MRI machines in their offices and get paid as much as hospitals.
MRIs use super-powerful magnets and radio waves to map out the inside of the body, allowing doctors to differentiate between fat, muscle, tendons and ligaments, analyze blood flow in and out of organs, and detect problems such as brain injuries, slipped or herniated discs, heart conditions, and a variety of orthopedic conditions.
All agree that MRIs are important diagnostic tools, but many health care experts say they may be overused. And because MRIs are highly profitable – reimbursed at $600 to $800 apiece – a turf war has developed over who should be allowed to do the procedures.
On one side are orthopedists and other specialists who have bought their own MRI machines; on the other are radiology centers and hospitals that rely on MRI profits to offset losses from other operations. Both proposed legislation this year at the General Assembly.
The hospitals’ and radiologists’ bill, which never got a House vote or a Senate hearing, would’ve required a “certificate of need” evaluation before anyone could install an MRI, CT scan or PET scan machine, regardless of cost. Right now, CON review is only required for equipment worth $1 million or more, but some MRI gear is cheaper.
The doctors, for their part, backed two bills: one to stop allowing only MRIs done at facilities accredited by the American College of Radiology, and interpreted by ACR-accredited doctors, to be reimbursed by insurers, and another to treat facilities with a pending application as “provisionally accredited.”
It was those two bills, which were combined into a single measure and amended heavily, that the House and Senate approved on June 30. The final language, said Rep. Peter F. Kilmartin, D-Pawtucket, one of the original sponsors, reflects a compromise between both sides.
“All the concerned parties got together and were able to agree on language that hopefully addressed everyone’s issues,” Kilmartin said.
However, the doctors got the most important thing they wanted: an alternative to getting accredited by the ACR, which has favored radiologists in the turf war and to date hasn’t set standards for the lower-priced extremity MRI machines (as opposed to full-body MRIs) some patients prefer.
The new law, which goes into effect Jan. 1, allows insurers to pay for MRIs done at any facility accredited by the ACR or “an alternate nationally recognized accrediting organization” with standards “substantially similar to and no less stringent than” the ACR’s.
The standards must include “provisions for establishing the qualifications of the physician,” quality control, the qualifications of the operating technologist, personnel and patient safety guidelines, and ongoing quality control, the law says. But the accreditation requirement for doctors interpreting the MRI results is gone.
Still, Dr. Mark Ridlen, president of the Rhode Island Radiology Society, said his group was “pretty happy” about the final legislation, which he said was “fair” and “important for patient safety and quality as time goes forward.”
Ridlen also said the state’s largest insurer, Blue Cross & Blue Shield of Rhode Island, had actually been paying for MRIs at non-accredited facilities, so in fact this law will introduce some tighter controls. “I thought it was a reasonable compromise for both sides,” he said.
Dr. John J. Cronan, head of diagnostic imaging at Rhode Island Hospital, offered a different perspective, however. The tighter rules are, indeed, a step forward, he said, but he described them as “bare-minimum” standards to assure patients that their MRIs are good.
More important, Cronan said, the rules will do little, if anything, to stop the rapid proliferation of MRI machines in the state. Rhode Island already has 51 MRI devices, or one per 20,000 residents – twice the national average of one per 40,000. “Even if it slowed 5 or 10 percent,” Cronan said, “it’s still going to look like a tidal wave.”
Cronan acknowledged that the CON bill was “very controversial,” and given the strong opposition expressed by the R.I. Department of Health, it was doomed to fail. But as the MRI machines multiply, he said, there’s a real risk to the finances of hospitals, especially, and the fight cannot end here.
“Now it’s up to the hospitals really to lead the charge,” he said. “MRIs are the No. 1 or No. 2 revenue source for hospitals. … My understanding is that all the hospitals are seeing a significant erosion of their outpatient volume.”
