Best way to report unethical EMG/NCV practices?

[maw4bc]

This is my first post on these boards and I was interested in getting everyones input on a matter that I run across constantly in my job role.

A little about myself to begin with. I am not a Neurologist or Medical student, but I have been doing marketing for a neurologist for the past 2 years. After spending the past two years getting to know the physicians in the area I have come across a large amount of what I see as "unethical" practices.

I come across a lot of IM/FP type doctors (even see Neurosurgeons/Spine/Hand) who use "mobile diagnostic" companies that either A) Do Nerve Conduction in their office performed by technicians and are read remotely by neurologist B) Do EMG studies performed by Chiropractors or Technicians that are read remotely by a Neurologist.

My question, if anyone has an answer, is what the best process is to report these types of companies? Or what is the best way to report the Neurologists who are signing off on these types of studies?

I have contacted Texas Medical Board multiple times and haven't gotten anywhere. I did have a good discussion with AANEM in regards to problems they have encountered with this type of situation. They told me that medicare regulations are as follows:

Nerve Conduction: Can be performed by certified technicians as long as their is a doctor certified in Neurology/PMR/electrodiagnostic medicine in the building.

EMG: Must be performed by a doctor certified in Neurology/PMR/electrodiagnostic medicine.

From what I see in the field every day there are a large amount of practices that are using these type of diagnostics. Any insight from you all would be greatly appreciated.

Mike

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[MS3B]

Anonymous complaints are generally not allowed by medical boards. You can ask that they keep your name confidential and some states will.

Why not ask the people you think are offenders if they possess the required certification. Maybe they took the required courses and training?

Maybe these other internists find a problem and refer it to neurologists? Do you know of any cases where people have been injured or harmed?

If you want these people to stop, perhaps you should notify them of the state regulations? Print out the regulations, highlight them in yellow and send it to them. Also highlight the penalties for violating the regulations. If you want to give it a lot of teeth, open a PO Box and sent it to them by certified mail. Then you can report it to the state.

 

[J-Rad]

What, in particular, is your ethical concern? In regards to the IM/FPs using the mobile diagnostic crews with remote reading-I doubt this scenario is as uncommon as you think. This type of setup can save patients trips to referral centers which may be far away for tests that may be negative anyway. The medicare rules may not apply to other insurance carriers in re reimbursement. The "in the building" clause, may only apply if immediate reading isn't available (in these days of electronic transmissions, that often isn't the case). In my world in pediatric cardiology, we receive many outside echocardiograms to read done at smaller community facilities. If it's an unremarkable study, we tell the sending doc. If some follow up (future or immediate) is needed, we'll tell the doc. I don't see how your NC/EMG scenario is much different. As for the chiropractors doing this, we could have a big debate on the merits of chiropractic and their qualifications to do these studies, but that would be outside the purview of your question. But, if the chiro is is considered appropriately trained in the procedure by their licensing board and they are making appropriate referrals for medical care if indicated by the study (this is where you may get into the ethical grey areas), they're probably on ethical/legal solid ground. I'm sure it will be state and insurance carrier specific whether the procedure will be reimbursable if done by a chiro vs. requiring the patient to pay out-of-pocket. Having a certified tech and a boarded neurologist read the study may circumvent some of that issue as long as scope of practice for chiros includes referral for this particular diagnostic study.

 

[BrainBuff]

First of all, individual insurance companies have different policies regarding reimbursement and they are not the same as Medicare. But it is all up to the insurance companies and the issue has to do only with reimbursement. There is NO regulation by ANY STATE MEDICAL BOARD in the country that dictates that ONLY NEUROLOGISTS ARE ALLOWED TO INTERPRET NERVE CONDUCTION STUDIES. Just like there is no regulation that dictates that THE RADIOLOGIST IS THE ONLY ONE ALLOWED TO READ XRAYS, MRIs, ETC.

It is a fact and you have no one to complaint to if for instance, patients are paying cash for the service.

Unfortunately as medicine becomes more competitive, I have seen all sort of FPs, IMs and Surgeons interpret and sign nerve conduction studies, just like I know of a lot of neuro guys who sign their own MRI interpretations, as long as they owe the equipment.

 

[neurologist]

First of all, individual insurance companies have different policies regarding reimbursement and they are not the same as Medicare. But it is all up to the insurance companies and the issue has to do only with reimbursement. There is NO regulation by ANY STATE MEDICAL BOARD in the country that dictates that ONLY NEUROLOGISTS ARE ALLOWED TO INTERPRET NERVE CONDUCTION STUDIES. Just like there is no regulation that dictates that THE RADIOLOGIST IS THE ONLY ONE ALLOWED TO READ XRAYS, MRIs, ETC.

It is a fact and you have no one to complaint to if for instance, patients are paying cash for the service.

Unfortunately as medicine becomes more competitive, I have seen all sort of FPs, IMs and Surgeons interpret and sign nerve conduction studies, just like I know of a lot of neuro guys who sign their own MRI interpretations, as long as they owe the equipment.

Thanks for making this point. It is an important one. There are huge differences between "unethical," "not competent" and "illegal." None of what the OP describes is "illegal" anywhere. The main (expressed) argument of the AANEM in trying to restrict these studies to neuro/PMR is one of "competence." As one who does these studies, I see their point, up to a limit, but I also suspect there is a strong financial undercurrent to their "concern" about the matter. The "ethical" issues I won't even touch because I hate ethics arguments.