Maryland court rules against physician self-referral of patients for radiation, advanced imaging

Orthopedists, neurologists note that the decision by the Maryland Court of Appeals could have a dramatic impact on patients’ treatment and quality of care.

A Maryland state appeals court recently affirmed a 2007 decision by a lower court prohibiting physician self-referral of patients for radiation therapy, MRIs and CT scans, according to a press release from the American Society for Radiation Oncology.

The latest ruling is viewed by the American Society for Radiation Oncology (ASTRO) and other groups as preserving strong patient protection against abusive physician self-referrals.

“Today’s ruling represents a victory for patients in Maryland. We hope this decision will jump start congressional action to ensure that all Americans can make independent treatment decisions based on quality care, not perverse financial incentives,” ASTRO CEO Laura I. Thevenot stated in a press release.

Orthopedists comment

The American Academy of Orthopaedic Surgeons (AAOS) along with other imaging and musculoskeletal organizations, such as the American Association of Neurological Surgeons (AANS), American College of Surgeons and Mid-Maryland Musculoskeletal Institute, filed an amicus brief to appeal the 2007 decision.

John J. Callaghan

In a recent statement, AAOS Immediate Past President John J. Callaghan, MD, noted the organization’s disappointment with the decision made by the Court of Appeals of Maryland. “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,” he stated. “This ruling could have a dramatic effect on the treatment and quality of care of Maryland patients. In the interest of our patients, the academy will maintain our commitment to this issue.”

Litigation in Potomac Valley Orthopaedic Associates, et al v. Maryland State Board of Physicians started in 2006 after the Board interpreted language in the Maryland Self-Referral Law as prohibiting referral of patients to facilities for MRIs in cases when the referring physician owned the equipment, according to information at the AAOS website and the ASTRO press release.

Language and exceptions

Orthopedists and related nonradiology specialists argued that the exceptions in the Maryland law applied to imaging and radiation therapy. However, the latest decision by the Circuit Court for Montgomery County has clarified the interpretation of the wording for those exceptions.

In a statement on the latest decision provided to Orthopedics Today, the AANS commented, “Diagnostic imaging is an integral component of neurosurgical care, and the ability of neurosurgeons to provide in-office diagnostic imaging services to their patients ensures they get the best possible and timely care available. The American Association of Neurological Surgeons is therefore deeply disappointed in the decision issued by the Maryland Court of Appeals.”

Orthopedics Today Business of Orthopedics Editorial Board Member, David M. Glaser, JD, called the decision by the Maryland Court of Appeals “troubling” — both legally and as a matter of policy.

“From a legal perspective, Maryland law says it does not apply when a practitioner refers a patient for tests or services ‘personally performed by or under the direct supervision’ of the practitioner. By its plain language, this exception allows MRIs that are directly supervised, but the court claims this exception doesn’t protect services done by the physician’s own clinic — it only applies when an outside entity provides the imaging. That conclusion is unsupported by the text,” Glaser told Orthopedics Today.

“From a policy perspective, the obsession on physician self-referral seems odd, given that every professional, and nearly every business, has the same issue. Hospitals certainly attempt to keep patients ‘in the system.’ I fail to understand why physician self-referral is singled out for legislation. Professionals, almost by definition, are gatekeepers of the services they provide,” he added. — by Gina Brockenbrough and Susan M. Rapp