New study fuels fire over self-referral

A new study documenting overuse and overcharging of imaging studiesby nonradiologists could add another log to the blaze of stateand federal efforts to ban self-referral.

Referring physicians who own and operate their own imagingequipment perform up to seven times more tests and charge up tosix times more for them than radiologists, according to researchersat the University of Virginia.

The findings mirror those reported in other studies of self-referringphysicians conducted by the same investigators. In both 1990 and1991, Dr. Bruce J. Hillman, director of radiology at the university,uncovered disparities in use and charges among radiologists andnonradiologists who perform imaging exams.

Hillman's study fans flames ignited by earlier findings bythe Florida Health Care Cost Containment Board. In 1991 the agencyforged the link between physician ownership of imaging centersand overuse of procedures. A study completed in June of self-referralpractices in California found similar abuses among the state's198 freestanding imaging centers.

The United Mine Workers of America, which funded the lateststudy, has indicated it will reduce payments to referring physicianswho own and operate their own imaging equipment, according toHillman. The strategy is designed as an economic disincentiveto self-refer, he said.

The study, published in the Oct. 21 Journal of the AmericanMedical Association, may also fuel efforts to outlaw self-referral.Bills banning the practice have been enacted in seven states--fourof which passed within the past six months.

Self-referral fallout is already apparent in Florida, whichpassed model legislation in April banning joint ventures. An amendmentprohibiting new physician joint ventures is now in effect. Joint-venturedfacilities have until October 1995 to divest.

"People who are affected by the law are looking for waysto divest and are exploring options," said Dr. Lawrence Muroff,director of MR, CT and nuclear medicine at University CommunityHospital in Tampa.

Although opponents of blanket self-referral bans have challengedthe new law, radiologists in the state are satisfied with themeasure, he said. A court ruling removed a controversial cost-capamendment to the bill, which both radiologists and other physiciansopposed.

"The bill is not ideal, but it's the best we could havehoped for under the circumstances," he said. "We believeit will eventually lead to better and more cost-effective care."

Despite increasing data on self-referral abuses like the recentHillman study, a federal ban is not a foregone conclusion. Glitchesin the legislative process and last-minute amendments can changethe intent of a bill, said Muroff, who acted as the Florida RadiologicalSociety's representative in debates over that state's bill.

"I would like to think a federal ban is inevitable, buta lot of what goes on in any legislative body is not a prettysight," he said. "That was certainly the case here inFlorida."