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Increase in Diagnostic Imaging Fueled by Self-Referring Doctors

Revamping reimbursements could ensure high-quality care at best cost, study says

THURSDAY, April 24 (HealthDay News) -- A growing number of privately insured patients in the United States are being referred for imaging scans, and much of that increase is due to physicians who refer patients to their own facilities or machines, a new study and commentary find.

For the study, Dr. Jean M. Mitchell, a professor of public policy at Georgetown University in Washington, D.C., reviewed data collected between 2000 and 2004 by a large private insurer in California and compared that analysis to a report by the Medicare Payment Advisory Commission. Both showed increased use of imaging tests for people with private insurance.

The findings were published in the current issue of Medical Care.

"Increases in utilization rates were substantially higher for scans performed by self-referring physicians than for images that originated from a referral to a radiologist or hospital," Dr. Vivian Ho, a professor of medicine at Baylor College of Medicine and an associate professor of economics at Rice University, wrote in commentary about the study.

The bulk of the increase was seen in patients with private insurance that provided the physician with a fee for service reimbursement.

"Physicians seem to choose the self-referral option, meaning they do the imaging in their own office, because they are reimbursed by private insurance companies. The other option would be to refer that patient to a radiologist or an outside diagnostic center," Ho wrote.

Under federal law, reimbursements for many self-referral arrangements are not permitted unless the imaging is done in-office. This is allowed, because it's convenient for patients. However, the study found that many doctors didn't have imaging equipment in their offices. Instead, they leased an imaging center's facilities and employees for a fixed amount of time per week.

"This creates revenues for both parties involved," Ho noted. "But it also raises a lot of questions, such as would it have mattered if another test had been done, one that didn't receive a reimbursement?"

"Unfortunately, the legal system, the method of reimbursing physicians, and our lack of tools to monitor appropriateness of testing have led to significant increases in diagnostic imaging, which likely provide little health benefit to patients," Ho wrote.

She said eliminating these reimbursements would penalize doctors who actually provide in-office imaging as a convenience to patients. She called for policy makers, insurers, physicians and health service researchers to come up with creative solutions to the problem.

"Only then can we insure that advanced imaging technologies yield a benefit, rather than become a burden to the health-care system," Ho concluded.

More information

The American Academy of Orthopaedic Surgeons has more about diagnostic imaging.

-- Robert Preidt

SOURCE: Baylor College of Medicine, news release, April 24, 2008

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