Economic motivation may affect how often some physicians order imagi...( Diagnostic imaging has been one of t...),Health

Diagnostic imaging has been one of the fastest growing areas of health care in recent years. Some of that increase can be attributed to the availability of improved imaging studies, but whether some imaging utilization may be inappropriate has been an issue of concern. Now a study from the Institute for Technology Assessment in the Massachusetts General Hospital (MGH) Department of Radiology finds that physicians who consistently refer patients to themselves or members of their own specialty for imaging studies, rather than to radiologists, are more likely to order such studies for a variety of medical conditions. The results suggest that economic motivation could underlie some of the excess referrals.

Its looking like a significant part of the increase in imaging utilization is due to self- and same specialty referral, says G. Scott Gazelle, MD, MPH, PhD, director of the Institute for Technology Assessment, who led the study being published in the November issue of Radiology. We need to have some mechanism in place to control this sort of inappropriate utilization of imaging.

Potential conflicts of interest in imaging studies have been of concern for several decades, leading to the passage in the 1990s of laws restricting some forms of self-referral physicians ordering tests that they will be reimbursed for interpreting. Some earlier studies found that self-referral was associated with higher utilization of imaging studies. Other studies that documented a greater number of imaging studies being performed by non-radiologists were not able to distinguish whether that increase was due to differences in referral patterns or to increased numbers of non-radiologists offering such procedures.

The current study was designed to retrospectively examine how frequently physicians ordered imaging studies for outpatients treated for specific medical conditions and if that varied depending on whether the studies were performed by radiologi
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