Frequency and Costs of Diagnostic Imaging in Office Practice — A Comparison of Self-Referring and Radiologist-Referring Physicians

Abstract

Physicians who do not refer their patients to radiologists for medical imaging use imaging examinations more frequently than do physicians who refer their patients to radiologists, and the charges are usually higher when the imaging is done by the self-referring physician. From our results it is not possible to determine which group of physicians uses imaging more appropriately.

Stark Regulation: A Historical and Current Review of the Self-Referral Laws

“…The official position of the AMA is that "In general, physicians should not refer patients to a healthcare facility outside their office practice at which they do not directly provide services when they have an investment interest in the facility (Mitchell and Scott, 1992b). The AMA has also stated that the referral of patients to facilities in which physicians have an ownership interest is permissible provided that patients are apprised of this relation and have other choices, and provided that physicians always act to their patients best interests (Hillman et al, 1990).…”

“…The authors concluded that the differences could not be attributed to the physicians' specialty or the diagnostic classifications of the patients (Hillman et al, 1990). Hillman et al (1992) compared charges and utilization of diagnostic imaging in a broad range of clinical presentations and found that physicians who own imaging technology employ imaging significantly more often than do physicians who refer their imaging examinations to non-entity radiologists.…”

“…Confounding issues to consider may include higher levels of use secondary to convenience, or because physicians who use such services or more likely to acquire their own (Hillman, et al, 1990).…”

“…Physician ownership of healthcare businesses to which they refer patients has been debated in the literature (Hillman, Joseph, and Mabry et al, 1990;Mitchell and Scott, 1992a). These arrangements have attracted attention in the medical community, media, and from healthcare policymakers.…”

“…These arrangements have attracted attention in the medical community, media, and from healthcare policymakers. Physician ownership and referral has also been the subject of government study and legislation (Hillman, Joseph, and Mabry et al, 1990;Scott, 1992a, 1992b). Evidence of overutilization leading to the current physician ownership laws was first reported in 1989 in an OIG report, that investigated physician owned laboratory ventures (Office of Inspector General, 1989).…”