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Economic motivation may affect how often some physicians order imaging studies
Date:10/29/2007

sts or by members of the referring physicians own specialty, who could be colleagues in the same practice. The researchers analyzed data from a nationwide, employer-based health plan with around 4 million members: employees at all levels, their dependents and retirees. They identified pairings of six common medical conditions cardiopulmonary disease, heart disease, arm or leg fracture, knee pain or injury, abdominal malignancy, or stroke with a diagnostic imaging procedure, and compiled information on each physician who had seen at least six patients in one or more of those condition/imaging pairings in the years 1999 to 2003.

The investigators analyzed every imaging referral and categorized the physicians according to their referral patterns. For purposes of this study, they compared only those physicians who referred all patients to themselves or members of their own specialty for imaging studies with those physicians who always referred to radiologists. The results showed that, depending on the condition/imaging pairings, those making self- or same-specialty referrals were from 12 percent to more than 200 percent more likely to order an imaging procedure than were physicians referring to radiologists.

Some of those who self-refer will say that their patients are sicker, but we found that controlling for the effect of patients age and additional health conditions made the likelihood of imaging among self- or same-specialty referrers even stronger more than 300 percent in some conditions. Others may claim to be offering greater convenience for patients, but when we looked specifically at CT and MR studies, less than 20 percent were carried out on the same day as the referring physician visit, which means the procedures should not be considered part of an office visit but rather separate visits specifically for the purpose of imaging, says Gazelle.

Gazelle notes that the range of variation in imaging utilization among same-sp
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Contact: Sue McGreevey
smcgreevey@partners.org
617-724-2764
Massachusetts General Hospital
Source:Eurekalert

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