Health Affairs, 28, no. 2 (2009): 599 doi: 10.1377/hlthaff.28.2.599 © 2009 by Project HOPE	New Online   Senate Health Reform Bill   Rewarding Providers   Public Option Policy Brief   Health Reform & Abortion   Delivery System Reform

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Letters

Some Facts On Rapid Imaging Growth

Self-referral, by which providers refer patients to imaging centers or equipment they own, presents a significant conflict of interest and has been identified by private insurers and government agencies as a primary driver of spiraling costs. There is no financial incentive for ordering physicians to increase imaging utilization unless they self-refer.

Government Accountability Office (GAO) reports and published research document that imaging skyrockets when providers directly profit from ordering scans.¹ As much as half of self-referred imaging may be unnecessary and may cost the health care system up to $16 billion annually.²

Self-referred imaging also presents significant quality and safety issues for patients. The Medicare Payment Advisory Commission (MedPAC) cited a major insurer study that found that 78 percent of nonradiologist imaging facilities had at least one serious deficiency—many of which could have "tragic" consequences.³ Also, the National Council on Radiation Protection and Measurements cited self-referral as a primary driver of a fivefold increase in Americans’ exposure to radiation over the past twenty years.⁴

Imaging is increasingly replacing more invasive procedures—enhancing and extending the lives of patients. Any imaging policy should curb growth in inappropriate imaging, not imaging that has clearly benefited patients. Efforts to discourage self-referral are the most direct and sensible way to reach this goal.

James H. Thrall
Board of Chancellors, American College of Radiology, Boston, Massachusetts

NOTES

 

1. L.G. Aronovitz, "Referrals to Physician-Owned Imaging Facilities Warrant HCFA’s Scrutiny," Pub. no. GAO/HEHS-95-2 (Washington: Government Accountability Office, 1994), 5; B.J. Hillman et al., "Physicians’ Utilization and Charges for Outpatient Diagnostic Imaging in a Medicare Population," Journal of the American Medical Association 268, no. 15 (1992): 2050–2054[Abstract/Free Full Text]; and S. Gazelle, "Utilization of Diagnostic Medical Imaging: Comparison of Radiologist Referral versus Same-Specialty Referral," Radiology 245, no. 2 (2007): 517–522.[Abstract/Free Full Text]
2. D.C. Levin and V.M. Rao, "Turf Wars in Radiology: The Overutilization of Imaging Resulting from Self-Referral," Journal of the American College of Radiology 1, no. 3 (2004): 169–172.[CrossRef][Medline]
3. Medicare Payment Advisory Commission, Report to the Congress: Medicare Payment Policy (Washington: MedPAC, March 2005).; and H. Moskowitz et al., "The Effect of Imaging Guidelines on the Number and Quality of Outpatient Radiographic Examinations," American Journal of Roentgenology 175, no. 1 (2000): 9–15.[Abstract/Free Full Text]
4. D.A. Schauer, "Medical Radiation Exposure of the U.S. Population: Preliminary Results from NCRP Scientific Committee 6-2 and Other Related Issues," slides 20 and 22, Presentation to the International Congress of Radiology, International Society of Radiology, 5–8 June 2008, http://www.ncrponline.org/PDFs/ICR_2008_DAS.pdf (accessed 14 November 2008).

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