The neurologist as neuroimager

Vast numbers of MRIs, CTs, ultrasounds, and cerebral angiograms are performed annually in the United States. Most of these procedures, as part of the neurodiagnostic evaluation, are performed in tertiary care hospitals and regional institutions or community facilities. Imaging has become essential to the management of many medical conditions, has immensely improved medical care, constitutes an important part of the evaluation of the neurologically ill patient, and is integral to the thinking process of the neurologist in planning the care of a high proportion of their patients. In most imaging facilities, a significant number of patients are referred by neurologists.

At one time, approximately 18% of neurologists interpreted CT, MR, and ultrasound in outpatient free-standing imaging centers as a reimbursable service to their patients. ^[1] The Stark Anti-Self Referral legislation confined this activity. ^[2] Recently, some insurers have attempted to exclude all physicians except radiologists from interpreting MRI studies by instituting restrictive reimbursement policies. A credentialing process to determine competence in neuroimaging has been developed by both the American Board of Medical Specialties (ABMS) and the American Society of Neuroimaging (ASN), but how thirdparty payors will regard these examinations with respect to reimbursement is unclear. ^[3] Neurologists should be concerned that universally accepted certification in neuroimaging and neurosonology be available to those who have active interest and skill in these procedures.

In 1993, the United Mine Workers Health and Retirement Funds (UMWHRF) instituted a new policy requiring proof of board certification in radiology for reimbursement of professional components of imaging studies. This was based on data obtained by Hillman et al. ^[4] indicating that utilization of imaging studies was greater and more expensive among physicians who referred patients to their own imaging centers. Other insurers, including Aetna and US Healthcare, later adopted similar policies. Recently, a follow-up study by the …