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Cool cardiac imaging conflicts with contract know how

Radiology Administrator's Compliance and Reimbursement Insider, May 1, 2007

Editor’s note: This is the fifth in a series about approaches to the cardiology-radiology debate over professional ownership of heart imaging techniques and reimbursement.

One resolution to the cardiology/ radiology turf war lies in contract negotiations between the physician groups and the hospital.

Radiology administrators may play a major or a minor role in guiding physicians and hospital higher-ups, depending on their sphere of influence and professional obligations.

By simply understanding the benefits and detriments of these agreements on the department and the physicians attempting to use them, administrators may help ease the conflict—and their own turf war battle fatigue.

Not-so-exclusive agreements

Many hospital-based radiology practices have “exclusive” agreements with hospitals for radiology services.

But exclusive agreements don’t automatically give radiologists the right to read every exam.

Instead, “exclusive” may mean that one radiology practice is the only radiology practice allowed to work at that particular hospital.

It may not mean it is the only specialty allowed to interpret radiological tests, says Michael Schaff, JD, attorney and chair of the healthcare team at Wilentz Goldman & Spitzer, PA, in Woodbridge, NJ.

“Hospital-based radiology practices should negotiate in their contracts a broad exclusivity provision that focuses on the services they provide,” says Schaff.

For example, if your hospital plans on becoming the premiere heart care center in your area, you’ll want to help both sides focus on the needs of those clients and your radiology department services.

Options for contracts

Essentially, two choices exist for exam ownership. Physicians can try to use their influence to obtain an exclusive right to perform those services, or they can share the pie, Schaff says.

For hospital management, both of these resolutions represent workable opportunities.

Shared responsibility contracts allow two physicians to split the professional fee by using a modifier to denote shared responsibility.

Or, the radiologist can agree to overread the cardiologist’s interpretation for a fair market value fee that the cardiologist pays to the radiologist, or vice versa.

“Many radiologists see shared contracts as an opportunity for other subspecialties to grab a share of radiology,” explains healthcare attorney W. Kenneth Davis Jr., JD, partner at Katten Muchin Rosenman LLP, in Chicago. “Radiologists worry that this kind of shared agreement may set a precedent—if they let cardiologists read, then the neurologists will want to read, too.”

Choice evaluation

Make sure to assess all the pros and cons of both arrangements prior to encouraging either exclusive or shared contract choices with hospital management, Schaff says.

Talk to your facility attorney, gather more information about potential arrangements, and consider the following items first: