From the "Duh!" Department...Study finds high utilization rate on scanners owned by self-referring physicians

Image courtesy of http://www.tomgpalmer.com

Diagnostic Imaging magazine online today reviewed this article from the upcoming issue of Radiology. (The link will work if only if you already have online access to the Grey Journal.)

To make a long story and article short, the team from the Institute of Technology Assessment at Massachusetts General Hospital "analyzed more than 526 million claims filed between 1999 and 2003 with an employer-based health insurance plan having about four million members." Dr. G. Scott Gazelle, lead author, took a slightly different approach than some other researchers in this field:

We chose to look at same-specialty referral instead of just self-referral because "self-referral" may represent referral to one's partners or colleagues. This broader definition may have resulted in the inclusion of some physicians with no financial or other relationship with the referring physician and may thus have reduced the magnitude of the observed increase in utilization (ie, if same-specialty–referring physicians without financial relationships did not demonstrate increased utilization of diagnostic imaging, their inclusion would have diluted the effect). Compared with Hillman (4) and Hillman et al (5), who defined self-referring physicians as individuals who charged at least once for an imaging procedure, we categorized referring physicians on the basis of their entire referral history for the condition of concern. Same-specialty referrers must have always referred patients to themselves or to others in the same specialty. Finally, our logistic regression analysis, which controlled for patient age and comorbidity, may provide a more accurate estimate of the effect of same-specialty referral on the utilization of diagnostic imaging procedures.

The bottom line, from DI's review:

The results indicate that physicians who refer their patients to themselves or to others of the same specialty for imaging use imaging 1.12 to 2.29 times more often than physicians who refer their patients to radiologists for imaging.

The study also found that patient age and comorbidity do not explain the increased frequency for self-referred imaging. After controlling the data set for patient age and comorbidity, imaging frequency was 1.196 to 3.228 times greater for the self-referred patients.

The numbers are somewhat lower than those Drs. David Levin and Bruce Hillman, and others have found over the years, perhaps due to the methodology of this particular paper.

Levin criticized the study design for focusing only on the professional component of insurance claims, a tactic he believes misses "carloads" of self-referred cases.

"The numbers in this study are impressive enough on their own, but they significantly underestimate the magnitude of the problem," Levin said. "Policymakers have to realize that if we continue to allow self-referral, costs will skyrocket."

But they already have, Dr. Levin, they already have.

A companion piece in today's DIMAG.com notes another "Duh":

Self-referring physicians are among the first casualties of reductions in Medicare technical payments from the new 2005 Deficit Reduction Act rules implemented in January. Some nonradiologists are shutting down their self-referred imaging businesses, according to Dr. Harvey L. Neiman, executive director of the American College of Radiology.
Neiman spoke Oct. 25 at the 2007 Economics of Diagnostic Imaging National Symposium in Arlington, VA. . .

Estimates on Medicare's cost-savings from the DRA cuts vary from $1.4 billion in first year to as much as $13 billion over a three-year period.

While the DRA cuts were probably not designed to limit self-referral per se, they will have that effect, at least in some cases.

I smell a schism within the ACR. Half of the ACR is rabidly trying to overturn the imaging cuts of DRA, and they don't mention self-referral in polite company so as not to offend their "friends" within AMIC. But here, we have Dr. Neiman speaking very publically about how DRA is helping to curb self-referral. Hmmmmmmmmm. Maybe if we all worked together on this, we might accomplish something. Ya think?