Self-referral boosts imaging use for private payors

Apr 29, 2008

Reports by the Medicare Payment Advisory Commission (MedPAC) have shown dramatic increases in the use of diagnostic imaging procedures among Medicare patients. However, whether this is also a trend among privately insured patients is unclear.

A new study indicates that it might be. Jean Mitchell, Ph.D., a professor of public policy at Georgetown University in Washington, DC, used data from a large private insurer in California to assess trends in the use of MRI, CT, and PET scans between 2000 and 2004. She will publish her findings in an upcoming issue of Medical Care (May 2008, Vol. 46:5, pp. 460-466).

Mitchell collected data that allowed for calculations of relative changes in use rates by provider type, including self-referral physicians, radiologists, hospitals, and independent diagnostic testing facilities (IDTFs).

She found that statewide rates of use for these three advanced imaging modalities rapidly increased during the four-year span:

MRI increased by 51%, from 21.92 to 33.16 per 1,000 enrollees
CT increased by 54%, from 20.76 to 31.94 per 1,000 enrollees
PET increased by almost 400%, from 2.4 to 12 per 10,000 enrollees

Her findings pointed to physician self-referral and IDTFs as contributors to this increased use, particularly for MR and PET. Hospitals posted small relative changes for the use of these modalities. Mitchell also found that use rates were higher in Southern California compared with the northern part of the state.

She concluded that trends in advanced diagnostic imaging that have been noted in the Medicare population are also occurring in the population of privately insured patients in California.

Same-specialty referring physicians use imaging more frequently, study says, November 8, 2007

CMS delays in-office self-referral decision with new MPFS rule, November 7, 2007

Maryland court backs state's self-referral law, October 26, 2007

Imaging self-referral comes under scrutiny in California, April 20, 2007