A ruling that bolsters one of the country's toughest anti-self-referral laws was cheered by radiologist groups but jeered by orthopedic surgeons in the latest legislative scrap over one of medicine's thorniest issues.

The Maryland Court of Appeals upheld a lower court's ruling that the state's anti-self-referral law prevents orthopedic surgeons, and by extension most nonradiologists, from referring patients for CT, MRI and radiation therapy services on machines in their own offices.

In a ruling issued Jan. 24 that took into account the law's texts and the murky world of lawmaker's intent, the court decided that the 1993 law's various exemptions don't apply to these modalities.
Radiologist and radiation oncologist lobbies, which had filed friend-of-the-court briefs against the appeal, welcomed the news. "Today's ruling represents a victory for patients in Maryland," said Laura I. Thevenot, CEO of ASTRO, in a statement.

These groups have long argued that self-referral by doctors on equipment they own leads to overutilization of imaging and the waste of health care dollars on unnecessary treatments or exams.

However, supporters of self-referral defend it for its convenience for the patient and because it ensures access to proper care in rural or other underserved areas. They also believe it's critical for comprehensive patient management by specialists.

The American Academy of Orthopaedic Surgeons, which filed an amicus brief in support of the appeal, said it was "disappointed."

"Significant technological advances have been made in our field so that patients can receive timely and accessible screenings from the comfort of their doctor’s office," AAOS president Dr. John J. Callaghan said in a statement e-mailed to DOTmed News. "This ruling could have a dramatic effect on the treatment and quality of care of Maryland patients."

At issue in the current case was the Maryland State Board of Physician's 2006 decision that exemptions allowing doctors to self-refer services under certain conditions don't apply to radiation therapy and the two advanced imaging modalities.

That decision prompted a lengthy court battle, with 12 medical practices in orthopedics, oncology and emergency medicine filing suit against the state medical board, in Potomac Valley Orthopaedic Associates, et. al. v. Maryland State Board of Physicians.

The Circuit Court for Montgomery County, which heard the case, sided with the medical board, in a ruling upheld this week by the Appeals Court.

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