IS ULTRASOUND BY FP LEGAL?

QUESTION:

Do family physicians need to be credentialed to perform ultrasounds? Do they need to be credentialed to bill for the ultrasounds that they perform? My boss is putting barriers in my way. I'm pulling your articles now that show that ultrasounds are performed by family physicians. I think the billing issue is just worked out each time you negotiate a contract with an insurance carrier. If we can negotiate reimbursement, we can get it. If they prefer that we send patients to emergency rooms or radiologists, then they can pay for that. They can be stupid, and financially short-sighted, or not... Would you agree?

Linda

WMR REPLY:

There is no law about required credentialing for privileges allowing reimbursement. Adminstrative roadblocks are evidence-free, and they lower health care quality. The hyper-regulation of services such as diagnostic ultrasound for women, diminishes access and increases cost. Under the banner of "protecting the public", special interests have gained control of the expert panels which advise insurance executives. Their exclusion of reimbursement for community based non-radiologists is an attempt to preserve training cartels which create economic monopolies. But, we have prevailed.

In the 1990's there was a famous series of articles by a radiologist named Hillman(I think) who maintained that imaging equipment should not be allowed in the offices of primary care physicians. He was supported by the American College of Radiology, and his work was accepted in the peer review process of JAMA and the NEJM. But, the AAFP and others were able to win the day on the basis of political votes. This is similar to the original restrictions against colposcopy by family physicians. We have prevailed.

Hospital committees have also been infected and controlled by special interests. Major discrimination against FP colonoscopy and FP OB exists in most medical school hospitals. This environment shapes the DNA of tomorrow's physicians. But, we have prevailed.

While humbled by the challenges ahead, we rejoice in the distance we have traveled...

2008--We formed a Board Certification process for surgical Family Medicine Obstetrics. see Avery DM. J Fam Pract March 2011 online.

2009--Senior editor for the American Journal of Clinical Medicine reshaped its editorial mission to support all of the above. Indexed BioMedLib.com, and goinginto Google scholar as we speak. PubMed next.

2010--Issued first certificates for OB-Gyn ultrasound in family medicine obstetrics. Certification includes transvaginal and gall bladder. We have over 20 peer reviewed publications to back us.

2011--Debut of "Surgical Family Medicine OB" in Venezuela, Guatemala, and others.

2012--Scheduled nervous breakdown.

 After all, "In the land of the blind, the one-eyed dog is still King", or as eloquently stated by the Big Lebowski, "The Dude abides." As we prepare for the STFM in New Orleans, Dr Scholcoff and I will be available at FP-OB fellowship table Thursday AM 0700, colonoscopy 1030 Thursday, and at the ultrasound curriculum table 0700 Saturday. Otherwise I will be in the bar at the Sheraton.

--WMR over and out.

QUESTION:

Who issues the certificates you refer to, below, and don't they, in themselves, add a barrier, if we now have to go get one?

Linda

REPLY (WMR):

Me+others,  no, and you don't have to get one.

The certificate symbolizes completion of an educational structure which can be used as an antidote to procedural helplessness or as a political assistance for those who need it.

I am so glad to know about this!! . I have been trying to do it in our program without much echo and support from the radiology department. I would love to learn if still could bill for it. Is there any specifications as far as doing it as a separate appointment? Or ultrasound could eventually be used as an extension of the stethoscope?

Best regards,

Jose Leonardo Loaiza, M.D.