Mobile Lawyer and “ER” the TV show

ER: Season 11, Episode 177861, 1/20/2005

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A personal injury lawyer sets up a mobile office outside the ER, infuriating Lewis as he tries to turn dissatisfied patients into clients.

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It turns out that the post on the Mobile Lawyer who showed up at our hospital and ER last spring caught some notice in the blogosphere. Overlawyered picked up the post and I had thousands of hits in a few days. A colleague referred another contact and somehow the story reached the writing staff at the ER production company to appear in the fictionalized version on tomorrow’s show. Imagine that.

Could CMS demand only delayed reads of imaging studies and take Ultrasound billing away from EM?

An Influential Federal advisory panel has voted to recommend lower 2006 Medicare payments than expected by physicians and hospitals, as well as other policy actions affecting both. (emphasis added)

While reimbursement levels are a concern, it’s the other "policy proposals" that really scare me.

The Medicare Payment Advisory Commission voted to recommend a 2.7 percent increase in Medicare payments to doctors, which is less than the expected increase in doctors’ costs, but substantially more than doctors would get under current law, under which payments would be cut five percent next year if Congress takes no action, reported the New York Times.

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The commission expressed concern about the proliferation of imaging equipment and services in doctors’ offices, and urged Congress to direct the secretary of health and human services to set national standards for doctors who perform or interpret diagnostic imaging studies billed to Medicare – a move which would alter the historical role of states and medical specialty boards in physician licensing and certification, the Times noted. The standards would cover the training and education of doctors who bill Medicare for X-rays, CAT scans, PET scans, magnetic resonance imaging, ultrasound, (emphasis added) echocardiography and other imaging. The panel maintained that poor quality diagnostic imaging can lead to repeat tests, misdiagnoses and improper treatment, the Times added.

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So this proposal could entrench delayed reads as the standard for all radiography as a consequence of the requirement that only those meeting federal standards for "training and education" interpreted imaging studies. Also CMS could easily decide that bedside ultrasound imaging was merely a component of the evaluation and management (E&M) service and not separately compensable.