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AAOS Now

Published 3/1/2008
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Charlene MacDonald, MPP

The turmoil over technology

Recent technologic innovations in advanced imaging modalities have enabled orthopaedic surgeons to provide accurate, cutting-edge diagnostic services and improve the overall quality of patient care. In-office imaging is common among orthopaedists, neurologists, urologists, and other specialists who want to provide high-quality, collaborative care by making specialized magnetic resonance imaging (MRI) and computed tomography (CT) services accessible and convenient to patients. For injured, disabled, or elderly patients, the availability of in-office MRI and CT services eliminates scheduling delays, prolonged waits, and the need to travel to other offices, ensuring them immediate access to specialty care.

Those seeking to control imaging services through prohibitions on ownership by nonradiologists may claim that the increase in medical imaging services by physician specialists other than radiologists represents a major cost driver in the healthcare system and charges nonradiologists with overutilization. They may also assert that other physician specialties lack the education and training to conduct these diagnostic procedures.

The American Association of Orthopaedic Surgeons (AAOS), however, points out that documented increases in utilization are fueled primarily by radiologists and that the quality and accuracy of MRI scans performed by orthopaedic surgeons actually surpasses that of radiologists. A 1996 study in the journal Orthopaedics determined that radiologists’ reports for orthopaedic procedures were not promptly available and did not contain sufficient descriptive information for clinical use.

According to the AAOS position statement on In-Office Diagnostic Imaging Studies by Orthopaedic Surgeons, “Radiologists are trained to interpret plain radiographs and other images in descriptive terms, whereas orthopaedic surgeons add functional, anatomical, and clinical assessments, resulting in patient-specific information not typically available to or provided by the radiologist.” Orthopaedic surgeons receive extensive training on the interpretation of advanced imaging techniques, including CT and MRI, and are required to demonstrate their competency as part of the board certification and recertification processes.

A major argument during the self-referral debate in the early 1990s was that the high cost of MRI and other advanced imaging services necessitated legislation to address the potential for overutilization of these services. The cost of these services, however, has steadily decreased with advances in technology, and the orthopaedic surgeon who has in-office imaging services can now provide patients with more immediate, accurate, and complete clinical evaluation and management.

Although the debate persists as radiologists struggle to maintain control of these services, the larger medical community has successfully thwarted attempts to restrict in-office imaging at the federal level and in all but one of the 50 states.

Charlene MacDonald, MPP, is AAOS manager of state legislative and regulatory affairs in the Washington, D.C., office of government relations. She can be reached at macdonald@aaos.org