Frequency and costs of diagnostic imaging in office practice - a comparison of self-referring and radiologist-referring physicians

Article Abstract:

To determine whether physicians who perform imaging studies (ultrasonography or X-ray) in their own offices order such tests more often than physicians who routinely refer patients to radiologists for the same types of studies, an evaluation was performed of 60,829 outpatient cases treated by 6,419 physicians. Four diagnoses were of interest: acute upper respiratory infections (chest X-ray); pregnancy (ultrasonography); low back pain (spinal X-ray); and difficulty in urination (in men; various X-ray or ultrasound studies). The physicians who filed the claims were classified as self-referring or as radiologist-referring. Upper respiratory infections made up the majority of episodes (47,794), with normal pregnancy (1,377), back pain (9,634) and men with difficult urination (2,024) following in order of frequency. Self-referring physicians charged more for imaging than those who referred to radiologists for all diagnoses except difficult urination. When an episode involved a self-referring physician, it was between 4 and 4.5 times more likely to lead to imaging than when it involved a radiologist-referring physician. Comparisons among medical specialties revealed that the extent of increased use of imaging by self-referring physicians versus radiologist-referring physicians varied widely (from 2.4 to 11.1 times as often), depending on the specialty. The results were not influenced by differences in patient type or the complexity of studies performed. While the appropriateness of the care provided by any of the physicians cannot be evaluated, the results are certain to be interesting to regulatory and reimbursement agencies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Finance, Physician services utilization

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Responses to a payment policy denying professional charges for diagnostic imaging by nonradiologist physicians

Article Abstract:

A policy change instituted by the United Mine Workers of America to reduce expenditures for diagnostic imaging resulted in an increase in spending. The new policy, which was instituted on January 1, 1993, required that payment for professional diagnostic imaging services be made only to radiologists. Researchers assessed claims and expenditures for imaging exams submitted by physicians in 20 U.S. counties having the largest number of United Mine Workers of America Health and Retirement Fund (Funds) beneficiaries. Claims and expenditures from 1992 were compared with those for 1993. The Funds paid $602,824 more for diagnostic imaging in 1993 than they paid in 1992 because of a greater number of reimbursable claims. Other reasons given for the increase include a greater use of diagnostic imaging, a larger number of technical claims made by nonradiologists, and an organized effort by physicians to reverse the policy. As a result of the policy's failure to cut costs, the Funds are considering dropping the policy.

Economic policy, Health insurance, Health care reform, United Mine Workers, Radiology

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Physicians' utilization and charges for outpatient diagnostic imaging in a Medicare population

Article Abstract:

Patients may undergo more diagnostic imaging tests at a greater cost if their physicians do the tests in their office (self-referral) rather than referring the patient to a radiologist. A study of 174,800 claims submitted to the United Mine Workers of America Health and Retirement Funds within a two-year period found that doctors who did the procedures themselves were much more likely to order the test. The average cost of each test performed in the doctor's office was 1.6 to 6.2 times the cost of the test performed by a radiologist. There has been much in the media about physicians who refer patients to clinics in which the physician has a financial interest. These physicians may order more tests, but there is no evidence that the greater use of diagnostic tests has improved the health of their patients. To reduce health care costs, third-party payers may reimburse self-referring doctors at a lower rate.

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