There May Be An Economic Motivation -- MEDICA - World Forum for Medicine

“It’s looking like a significant part of the increase in imaging utilization is due to self- and same specialty referral,” says G. Scott Gazelle, MD, MPH, PhD, director of the Institute for Technology Assessment in the Massachusetts General Hospital (MGH) Department of Radiology, who led the study. “We need to have some mechanism in place to control this sort of inappropriate utilization of imaging.”

The current study was designed to retrospectively examine how frequently physicians ordered imaging studies for outpatients and if that varied depending on whether the studies were performed by radiologists or by members of the referring physician’s own specialty, who could be colleagues in the same practice.

The researchers analyzed data from a nationwide, employer-based health plan with around 4 million members. The results showed that, depending on the medical condition and imaging technique, physicians making self- or same-specialty referrals were from 12 percent to more than 200 percent more likely to order an imaging procedure than were physicians referring to radiologists.

“Some of those who self-refer will say that their patients are sicker, but we found that controlling for the effect of patients’ age and additional health conditions made the likelihood of imaging among self- or same-specialty referrers even stronger – more than 300 percent in some conditions. Others may claim to be offering greater convenience for patients, but when we looked specifically at CT and MR studies, less than 20 percent were carried out on the same day as the referring physician visit, which means the procedures should not be considered part of an office visit but rather separate visits specifically for the purpose of imaging,” says Gazelle.; Source: Massachusetts General Hospital