Nonradiologists with Financial Stake Order 248 Percent More Scans

Non-radiologists – physicians or otherwise – with on-site imaging services are two-and-half times more likely to order imaging than clinicians with no financial interest in imaging, saysa study published in the July edition of the Journal of the American College of Radiology.

The MEDLINE data-based meta-analysis, led by Ramsey K. Kilani, MD of the Duke University Medical School in Durham, N.C., included five studies considering nearly 77 million episodes of care. The researchers found that non-radiologist self-referrers ordered imaging from 1.6 to 4.5 times more than radiologist referrers, with an average of 2.48 times more than radiologists. That translated into a 59.7 percent of imaging being attributable to self-referral.

It’s costing billions of dollars, the authors say. The U.S. Government Accountability Office reported that 64 percent of the $14.1 billion spent on diagnostic imaging in 2006 ($9 billion) went to physician offices, with 68 percent of that $9 billion going to physician offices. Applying the 59.7 percent utilization ratio for self-referrals, the cost of presumably unneeded imaging translated into $3.6 billion in 2006 alone.

Kilani colleagues embarked on the study to understand the hidden costs of self-referrals in light of the need to reduce health care costs.
 
"The cost of this excess imaging to Medicare Part B is likely to be in the billions of dollars annually, on the basis of the best available data. This level of spending on potentially unnecessary medical imaging is concerning in light of the growing emphasis on reducing health care expenditures," Kilani said.