Over the past several years, same-specialty referral among nonradiologists for imaging procedures has become an irritant to radiologists at least and a threat at most. Even the U.S. government has noticed and, for better or worse, has implemented legislation such as the Stark laws and the Deficit Reduction Act (DRA) of 2005 to put a cap on what it sees as the overutilization of medical imaging.
Despite what some might argue, the increase in the practice of same-specialty referral by nonradiologists isn't all in radiologists' heads, according to researchers at the Institute for Technology Assessment at Massachusetts General Hospital in Boston. The group found that nonradiologists indeed had higher rates of imaging utilization, in some cases using imaging technology at rates more than twice as high per episode of care than radiologists.
Dr. Scott Gazelle and colleagues studied insurance claims from a large national employer-based health plan to retrospectively evaluate how often patients had diagnostic medical imaging procedures during an outpatient care episode, and whether these patients were referred for these exams to their own physicians, physicians in the same specialty, or radiologists (Radiology, November 1, 2007; Vol. 245:2, pp 517-522).
Claims data from 1999 to 2003 were grouped into episodes of care for cardiopulmonary disease, coronary and/or cardiac disease, extremity fracture, knee pain, intra-abdominal malignancy, and stroke. For each condition, the referring physician's recommendation was categorized as either same-specialty referral or radiologist referral, using that physician's history of imaging referrals for the condition as context.
Data were processed using software that characterized outpatient episodes of care that consisted of one or more records for a member. The referring physician was defined as the clinician who billed for an office visit. Episodes of care with more than one referring physician were not used in the study.
For each imaging claim, Gazelle and colleagues identified the professional service provider, and compared that provider's specialty with the specialty of the referring physician. Each imaging claim was categorized as being by a radiologist, a clinician of the same specialty as the referring physician, a provider with some other known specialty, or none of the above.
Each referring physician was then assigned to a category that described that person's referral pattern: all imaging by radiologists, all imaging by same-specialty providers, most imaging by radiologists (80% to 99%), most imaging by same-specialty providers, not predominately either, and indeterminate.
Gazelle then compared those who always referred to radiologists to those who always referred to same-specialty clinicians, as well as those who referred to radiologists most of the time and those who referred to same-specialty physicians most of the time. A total of 18,123,121 episodes of care associated with 882,687 referring physicians were included in the study.
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Study Summary Physicians who referred their patients to themselves or to another doctor in the same specialty for diagnostic imaging used imaging between 1.12 and 2.29 times as often, per episode of care, as those who referred their patients to radiologists. |
Physicians who referred their patients to themselves or another doctor in the same specialty for diagnostic imaging used imaging between 1.12 and 2.29 times as often, per episode of care, as those who referred their patients to radiologists. After controlling for patient age and comorbidity, the likelihood of having an imaging procedure was 1.196 to 3.228 times greater for patients under the care of same-specialty referring physicians than for patients under the care of radiologist-referring physicians.
What remains unclear, according to Gazelle and his co-researchers, is whether the increased use of diagnostic imaging by same-specialty referring physicians results in better patient care or outcomes, as well as the extent to which financial incentives boost the use of imaging.
The group pointed out that patients may be more likely to undergo imaging procedures if they can be done on the same day as office visits, and that the study showed that patients seen by same-specialty referring physicians more often had imaging procedures on the same day as an office visit.
By Kate Madden Yee
AuntMinnie.com staff writer
November 8, 2007
Related Reading
Maryland court backs state's self-referral law, October 26, 2007
Imaging self-referral comes under scrutiny in California, April 20, 2007
Illinois AG's lawsuit may chill equipment leasing deals, January 24, 2007
Illinois AG joins leasing suit against MRI centers, January 18, 2007
DRA 2005: The potential impact on the outpatient imaging market, December 11, 2006
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