Study Shows Correlation Between Imaging Utilization Rates, Self-Referral

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Referring physicians with a financial interest in medical imaging services have higher imaging utilization rates than their colleagues with no such interest, reveals a study published online in the November issue of the American Journal of Roentgenology.

According to the study, non-radiologists who perform their own imaging studies are, at minimum, 1.7 to 7.7 times more likely to order imaging studies than non-self-referring physicians in the same specialty who treat patients with the identical problems. In cases where self-referral involves referral to an outside facility in which the referring physician holds a financial stake, imaging increases by up to 54%, with the modality as the variable.

Additionally, imaging costs incurred by the younger population varied from three to 17 times as high as those incurred by older populations, depending on the specialty and clinical presentation.

Moreover, imaging services performed on-site by non-radiologists were shown to account for 60% to 88% of radiography and sonography in non-hospital settings. Non-radiologists' share of procedures was lowest in private offices and freestanding centers, with MR and CT exams taking a 9% share. Referring physicians shared ownership in 21% of radiologists' offices before federal physician self-referral laws went into effect.

As for quality and access, the study findings peg radiologists' interpretation of radiographs as generally more accurate than those of emergency physicians and most other imagers.

The study’s authors say the passage of the Stark legislation and similar state laws covering all patients demonstrates that much can be done about self-referral to outside facilities, “although some may continue to avoid regulation by restructuring referral patterns and ownership arrangements in inventive ways.” Another limitation of control by legislation, they point out, is that the federal legislation covers only Medicare and Medicaid patients, and some states do not have similar legislation covering other patients.

The researchers also note that with self-referral involving outside financial interests having received major legislative attention, most remaining self-referral presumably involves physicians' own on-site services, and a similar level of attention toward curbing the negative consequences seems warranted.

“Voluntary approaches in the private sector may be the most effective because public policy remedies require intrusion into the actual operations of a physician's practice, in a way largely alien to current public policy, through widespread requirements for credentialing and specialty-specific limitations on scope of practice,” they write. “Effective strategies could follow the leads of the cited insurers' initiatives and, like them, be tied to reimbursement.”

What’s more, the authors observe, examples from private insurers show that the latter can take a number of effective actions. For instance, they can limit physicians who are not imaging specialists—that is, non-radiologists—to the kinds of imaging closely related to their specialty.

Private insurers can also demand credentialing or do some of their own, as well as provide quality assurance guidelines and link their quality assurance policies to reimbursement, the authors conclude.

To read the abstract, click here: http://www.ajronline.org/content/197/5/W891.abstract?sid=b5e26ef6-9f53-4...