Hancock attacks integrity of orthopedic surgeons

February 11, 2011

As a physician who has devoted 25 years to caring for patients in our great state, I was deeply distressed to read Jay Hancock's column attacking the integrity of orthopedic surgeons and other doctors who rely on modern tools such as MRI and CT scans to diagnose patients' injuries and illnesses ("Orthopedist-owned MRIs a recipe for soaring costs," Feb. 9).

Mr. Hancock's claim that orthopedic surgeons drive MRI utilization and cost is contradicted by federal government data showing that more than 80 percent of all advanced imaging services paid by Medicare go to radiologists and free-standing radiology centers, not to orthopedic surgeons and other treating physicians. That same federal data shows that from 1995 to 2005, payments made for advanced imaging services to free-standing radiology centers, commonly owned by the radiologists for whom Mr. Hancock advocates, jumped seven-fold to 23 percent. By contrast, in 2005, orthopedic surgery accounted for only 3 percent of Medicare payments for advanced imaging.

The patient is all but forgotten in Mr. Hancock's attack. Without legislative action, we will become the only state in the country where a urologist cannot use an in-office CT machine to diagnose painful kidney stones. An emergency medicine physician operating an urgent care clinic will not be allowed to use CT in the office to diagnose potentially life-threatening pulmonary embolisms or appendicitis. And orthopedic surgeons like myself will not be able to rely on in-office MRI to diagnose the most serious injuries that require immediate surgical attention, such as painful and debilitating Achilles tendon tears.

Mr. Hancock's bias might be most evident when he writes that "Maryland orthopedists decided the law didn't apply to them" when they installed MRI machines in their offices. The reality is that the first judge to consider the legality of in-office MRI ruled in favor of orthopedic surgeons. As a member of one of the medical practices that challenged the Board of Physicians' ruling in the Court of Appeals against the backdrop of that prior judicial decision, I believe Mr. Hancock should have shared this fact with his readers.

Mr. Hancock calls the 1993 Maryland law "a model for the nation." No law that seeks to fragment health care delivery at a moment when we are moving toward more patient-focused, integrated medical care can fairly be regarded as a model. Maryland patients deserve better, and The Sun's readers deserved a more balanced analysis of a critically important health care issue.

Dr. James York, Glen Burnie

The writer is an orthopedic surgeon in the Chesapeake Orthopaedic & Sports Medicine Center and is president of the Maryland Patient Care and Access Coalition.

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