Regulations Are Stripping Away Your Access to Proper Diagnosis and Treatment

The Huffington Post—October 14, 2009

As a specialist who has been practicing musculoskeletal radiology for more than 25 years, I find the recent policy proposal of The National Quality Forum ("National Voluntary Counselors Standards for Outpatient Imaging Efficiency") requiring physical therapy (PT) prior to obtaining an MR of the lumbar spine for "Low Back Pain" and/or providing enhanced reimbursement for the MR examination contingent on this criterion to be somewhat concerning. This decision, if it is instituted, will seriously handicap patient care and negatively affect the radiologist's relationship with the patient and the referring physician.

This mandate will potentially cause patients to have increased pain and injury from the PT if being performed for an inadequately or inaccurately diagnosed symptom. The PT appointments and follow up visits with specialists will further prolong a patient's time away from work and will further delay obtaining an accurate diagnosis and initiation of appropriate PT and/or intervention.

The policy also positions nonradiology, self-referring physicians who own in-office MR equipment and control their own (self) referrals, to order PT, indicated or not, prior to their ordering their in-office MR in order to assure that they will be reimbursed at the enhanced rate.

This proposed policy, if instituted, will result in the ordering of more PT and more MR and will neither cut costs nor facilitate optimal patient care.

If you are concerned about the quality of your ongoing level of care, and/or if you plan to visit your local physician about lower back pain, reach out to The National Quality Forum ( and ask them about the rationale behind this initiative.

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