Download Opposition of Exclusive Imaging Contracts

PLEASE NOTE: THIS RESOLUTION WILL BE DEBATED AT THE 2016 COUNCIL MEETING. RESOLUTIONS ARE NOT
OFFICIAL UNTIL ADOPTED BY THE COUNCIL AND THE BOARD OF DIRECTORS (AS APPLICABLE).
RESOLUTION:
26(16)
SUBMITTED BY:
Emergency Ultrasound Section
New York Chapter
SUBJECT:
Opposition of Exclusive Imaging Contracts Limiting Clinical Ultrasound Use and Billing
by Emergency Physicians
PURPOSE: Issue a statement declaring opposition to the use of exclusive imaging contracts to limit the use of
clinical ultrasound by non-radiology specialists and the billing by emergency physicians.
FISCAL IMPACT: Budgeted committee and staff resources.
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WHEREAS, Clinical ultrasound in the Emergency Department is a core skill performed by emergency
physicians; and
WHEREAS, Clinical ultrasound is a required procedural competency in Emergency Medicine residency
training; and
WHEREAS, Clinical ultrasound is an invaluable tool that improves patient care, increases patient safety
and helps guide acute patient management; and
WHEREAS, Proficiency in clinical ultrasound requires ongoing dedication, practice, and skill; and
WHEREAS, Clinical, goal directed, focused ultrasound imaging and services are separate and distinct
from radiology diagnostic ultrasound procedures; and
WHEREAS, Exclusive imaging contracts with hospitals can restrict who performs or bills for diagnostic
or procedural imaging techniques; and
WHEREAS, These exclusive contracts can interfere with established or prevent the establishment of
clinical ultrasound services critical to patient care and safety; and
WHEREAS, This limitation or obstruction affects physicians across specialties who utilize clinical
ultrasound to provide the best care for their patients; and
WHEREAS, The American Medical Association’s Resolution 802 indicates that ultrasound imaging is
within the scope of practice of appropriately trained physicians; therefore be it
RESOLVED, That ACEP supports users of clinical ultrasound with a statement declaring opposition to
the use of exclusive imaging contracts to limit the use of clinical ultrasound by non-radiology specialists and the
billing for such services; and be it further
RESOLVED, That ACEP continue to support emergency physicians working to develop and implement
clinical ultrasound programs who face opposition in hospitals where radiologists or others hold exclusive imaging
contracts.
Resolution 26(16) Opposition of Exclusive Imaging Contracts
Page 2
Background
This resolution calls on ACEP to issue a statement declaring opposition to the use of exclusive imaging contracts
to limit the use of clinical ultrasound by non-radiology specialists and the billing by emergency physicians and
continue to support emergency physicians who face exclusive imaging contracts in their facility by working to
develop and implement clinical ultrasound programs.
Emergency physicians are trained in the use of ultrasound during residency and it is recognized as a valuable
diagnostic tool to both expedite emergency diagnosis and treatment and provide cost effective treatment options.
Emergency physicians have pushed back for years on exclusive contracts for interpreting EKGs and x-rays in the
ED setting with mixed success. The same holds true for ultrasound imaging. ACEP has resources available in the
reimbursement area of the web site to assist in these discussions at the hospital level, including discussion of the
“contemporaneous standard” for reporting diagnostic interpretations.
There is not currently an ACEP policy statement specific to exclusive contacting for ultrasound services;
however, there are policy statements on:
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Emergency Ultrasound Guidelines, which details training pathways, quality improvement, documentation and
credentialing guidelines required to implement a successful program in emergency ultrasound. Emergency
physicians, medical staff, hospitals, medical organizations, and regulatory bodies may use these guidelines in
development, maintenance, and growth of emergency ultrasound to enhance patient care at bedside.
Emergency Ultrasound Certification by External Entities, which primarily speaks to short course
requirements offered by other specialties, and
Emergency Physician Contractual Relationships, which contains the statement, “the interests of patients are
best served when emergency physicians practice in a fair, equitable and supportive environment”.
The AMA also has a relevant policy Privileging for Ultrasound Imaging (H-230.960), last modified in 2010
which states:
(1) AMA affirms that ultrasound imaging is within the scope of practice of appropriately trained physicians;
(2) AMA policy on ultrasound acknowledges that broad and diverse use and application of ultrasound
imaging technologies exist in medical practice;
(3) AMA policy on ultrasound imaging affirms that privileging of the physician to perform ultrasound
imaging procedures in a hospital setting should be a function of hospital medical staffs and should be
specifically delineated on the Department's Delineation of Privileges form; and
(4) AMA policy on ultrasound imaging states that each hospital medical staff should review and approve
criteria for granting ultrasound privileges based upon background and training for the use of ultrasound
technology and strongly recommends that these criteria are in accordance with recommended training and
education standards developed by each physician's respective specialty.
The AMA policy, Reimbursement for Office-Based or Outpatient Ultrasound Imaging (H-385.934), states, “Our
AMA supports reimbursement for ultrasound imaging performed by appropriately trained physicians.”
ACEP Strategic Plan Reference
Goal 1 – Reform and Improve the Delivery System for Emergency Care
Objective A- Develop and promote delivery models that provide effective and efficient emergency medical care
in different environments.
Tactic 22. Develop and market an Emergency Clinical Ultrasound Accreditation Program designed to accredit
programs within hospitals to improve quality and reimbursement.
Objective C – Pursue strategies for ensuring fair payment and practice sustainability.
Tactic 12. Oppose budget-neutral legislative proposals that benefit other specialties to the detriment of emergency
medicine.
Resolution 26(16) Opposition of Exclusive Imaging Contracts
Page 3
Objective F – Pursue strategies for ensuring fair payment and practice sustainability.
Tactic 4. Promote key messages to increase awareness about the pivotal role of emergency physicians and their
ability to save money in health care costs. Increase visibility of emergency physicians as leaders in health care.
Fiscal Impact
Budgeted committee and staff resources to develop a policy statement and supporting resources.
Prior Council Action
Amended Resolution 27(15) Reimbursement for Ultrasound Performed by Emergency Physicians adopted.
Directed ACEP to issue a statement declaring emergency physicians should be paid for performing and
interpreting ultrasound studies and support efforts to reduce payment denials.
Resolution 51(05) Emergency Physician Autonomy in the Performance and Interpretation of Diagnostic Imaging
Studies adopted. Directed ACEP to join the AMA in opposing any MedPAC recommendation that would limit a
physician other than a radiologist to provide diagnostic imaging.
Amended Substitute Resolution 42(90) Ultrasound adopted. Directed ACEP to support and encourage the
immediate availability of ultrasound technology for ED patients by appropriately trained and credentialed
physicians, including emergency physicians; develop guidelines by which an emergency physician would be
considered appropriately trained; and work with third-party payers to insure that emergency physicians receive
fair and appropriate reimbursement for providing ultrasound diagnostic services in emergency facilities-adopted.
Prior Board Action
June 2016, approved the revised “Emergency Ultrasound Guidelines;” originally approved October 2008. The
updated document will be posted on the ACEP website when available.
Amended Resolution 27(15) Reimbursement for Ultrasound Performed by Emergency Physicians adopted.
June 2014, approved the policy statement, “Emergency Ultrasound Certification by External Entities.”
October 2012, approved the revised policy statement, “Emergency Physician Contractual Relationships;” revised
and approved January 2006, March 1999, August 1993; originally approved October 1984 with the title
“Contractual Relationships between Emergency Physicians and Hospitals.
October 2010, sunsetted the policy statement, “Use of Ultrasound Imaging by Emergency Physicians,” approved
June 1997; revised and approved June 2001; replaced “Use of Ultrasound for Emergency Department Patients”
January 1991.
Resolution 51(05) Emergency Physician Autonomy adopted.
Amended Substitute Resolution 42(90) Ultrasound adopted.
Background Information Prepared by: David McKenzie, CAE
Reimbursement Director
Sandy Schneider, MD, FACEP
Emergency Medicine Practice Director
Reviewed by: James Cusick, MD, FACEP, Speaker
John McManus, MD, FACEP, Vice Speaker
Dean Wilkerson, JD, MBA, CAE, Council Secretary and Executive Director