Levin David C, Rao Vijay M, Kaye Alan
Thomas Jefferson University Hospital, Department of Radiology, 1090 Main, Philadelphia, PA 19107, USA.
J Am Coll Radiol. 2008 Sep;5(9):972-7. doi: 10.1016/j.jacr.2008.02.019.
Self-referral in imaging creates a problem for our health care system in that it leads to higher utilization and costs. Although it is still widespread, there are indications that some states, some regional payers, and the Centers for Medicare & Medicaid Services have begun to take some actions to limit this potentially abusive practice. At the state level, these actions include consideration of anti-self-referral laws, crackdowns on scan-leasing schemes, the institution of mandatory facility accreditation programs, and bans on the installation of advanced imaging equipment in physician offices. Some commercial payers have instituted strict privileging programs in imaging, closed their panels to any facility that is not a full-service imaging provider, and begun requiring accreditation of advanced imaging modalities. The Centers for Medicare & Medicaid Services plans to institute an antimarkup rule and prohibit independent diagnostic testing facilities from leasing space or equipment to nonradiologist physicians, and it has indicated that tightening up the loopholes in the Stark laws may be in the offing. In this paper, the authors review all these recent developments and their implications.
影像检查中的自我转诊给我们的医疗保健系统带来了问题，因为它会导致更高的利用率和成本。尽管这种现象仍然普遍存在，但有迹象表明，一些州、一些地区的医保支付方以及医疗保险和医疗补助服务中心已经开始采取一些行动来限制这种潜在的滥用行为。在州层面，这些行动包括考虑制定反自我转诊法律、打击扫描设备租赁计划、设立强制性的机构认证项目，以及禁止在医生办公室安装先进影像设备。一些商业医保支付方已经在影像检查方面制定了严格的特权授予计划，将不提供全方位服务的影像机构排除在其合作名单之外，并开始要求对先进影像检查方式进行认证。医疗保险和医疗补助服务中心计划制定一项反加价规则，禁止独立诊断检测机构向非放射科医生出租场地或设备，并且表示可能即将收紧《斯塔克法案》中的漏洞。在本文中，作者回顾了所有这些最新进展及其影响。
