Court bans doctors’ in-office referrals for MRI and CT scans

Posted: 6:00 pm Thu, January 27, 2011
By Danielle Ulman
Daily Record Legal Affairs Writer

The Court of Appeals has upheld a lower court’s decision that a 1993 law banning doctors from making in-office referrals applies to referrals for MRI and CT scans.

In a Jan. 24 ruling, the state’s top court sided with the Maryland State Board of Physicians, which found in 2006 that self-referrals for MRI tests and CT scans are not among the three exceptions to the Maryland Patient Referral Law.

“It’s a really complicated, ambiguous statute in part,” said Thomas Keech, assistant attorney general, who represented the appellee board.

“I really thought the board’s take on it was the most rational take,” he said. “The [legislation] was designed so doctors would not have their financial interest conflict with the patient’s interest.”

Keech said the board, in issuing its declaratory ruling, made a real effort to interpret the statute as a whole.

Montgomery County Circuit Court Judge DeLawrence Beard upheld the medical board’s interpretation of the law, prompting doctors’ groups to seek review by the Court of Special Appeals. The Court of Appeals chose to hear the case before the intermediate court could consider it.

Potomac Valley Orthopaedic Associates, along with 11 other medical practices specializing in orthopedics, urology, radiation oncology and emergency medicine, noted the appeal.

The American College of Radiology applauded the court’s decision in a prepared statement. “Studies have shown that there is very little, if any, patient benefit to self-referral of advanced imaging and radiation therapy,” said John A. Patti, chair of the college’s board.

Instead, he said, the practice can result in unneeded use of imaging, added exposure to radiation and extra dollars spent.

But supporters of in-office referral said the benefits of the practice include convenience to the patient, who is often in pain.

The American Academy of Orthopaedic Surgeons said in a statement that it was “disappointed” in the court’s decision.

“Significant technological advances have been made in our field so that patients can receive timely and accessible screenings from the comfort of their doctor’s office,” said John J. Callaghan, president of the academy.

“This ruling could have a dramatic effect on the treatment and quality of care of Maryland patients,” he said.

CareFirst BlueCross BlueShield, which filed one of the original petitions requesting the board’s declaratory ruling, declined to comment.

The board determined that the exception allowing patient referrals within a practice is necessary for practical reasons, such as when the original doctor is out of the office, but that it does not cover referrals for tests within the office.

A supervision exception allows doctors to refer patients for tests they perform or oversee, the board said, but only for those done outside the practice’s office.

In the final exception, the court agreed with the board’s reading that certain tests can be referred within the office, but self-referral for MRI, CT scans and radiation therapy services are specifically banned by the statute.