Physicians who refer patients to their own facilities or machines for scans account for much of the increase in diagnostic imaging ordered for privately insured patients said a Baylor College of Medicine expert in a commentary that appears in the current issue of the journal Medical Care.
Based on a study also appearing in the same issue, Dr. Vivian Ho, professor of medicine at BCM and associate professor of economics at Rice University, wrote: "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."
The increase was seen mainly in those patients covered through private insurance that provided the physician with a fee for service reimbursement.
In the study upon which Ho was commenting, Dr. Jean M. Mitchell, professor of public policy at Georgetown University in Washington, D.C., reviewed data recorded between 2000 and 2004 from a large private insurer in California. This information was then compared to a report by the Medicare Payment Advisory Commission. Both reports showed an increased use of imaging tests for those with private insurance.
"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," Ho said. "The other option would be to refer the patient to a radiologist or an outside diagnostic center."
Federal law does not allow reimbursements for many self-referral arrangements, unless the imaging is done in-office. This exception is allowed because physicians who perform the procedure in-office are providing a convenience to patients.
However, in most cases reviewed in the Mitchell study, the doctors did not have the imaging machinery in their offices. Physicians are able to skirt the restriction by leasing an imaging center's facilities and employees for a fixed period per week.
"This creates revenue for both parties involved," Ho said. "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?"