MedPAC: Self-referring docs use more imaging

Physicians who own or lease their own imaging equipment in some cases utilize imaging twice as often as physicians who don't, according to a new study by the Medicare Payment Advisory Commission (MedPAC).

The findings came from MedPAC's June 2009 report to the U.S. Congress on ways to improve efficiency in the Medicare program. Imaging self-referral was one of several areas identified as a source for overutilization in the federally run healthcare program.

MedPAC researchers noted that imaging costs have risen twice as fast as healthcare costs in general in recent years. For example, between 2002 and 2007, the volume of imaging services paid under Medicare's Physician Fee Schedule grew by 44% per fee-for-service beneficiary, compared with 23% for all physician services.

For the current report, MedPAC researchers used 2005 Medicare claims data from eight U.S. metropolitan regions, then grouped that data into 13 episode treatment groups (ETGs) based on the type of condition being treated and its severity. The researchers then compared imaging usage rates among physicians who did not self-refer to those who did (with self-referring physicians defined as those who sent 50% or more of their imaging studies to their own practice). Both direct equipment ownership and equipment leasing arrangements were classified as self-referral.

Finally, the researchers compared the expected level of spending that should have occurred for a particular ETG (based on average spending) with the level of spending that they actually observed for that particular episode.

According to their findings, self-referring physicians in some cases were twice as likely to use imaging as those who didn't self-refer. For example, in the ETG covering the use of MRI for the category "other minor orthopedic disorders, back," 14% of episodes involving self-referring physicians used imaging, versus 6% for non-self-referring physicians. Other selected utilization rates are as follows:

ETG type and modality used Percent of imaging episodes, self-referring Percent of imaging episodes, no self-referring
Ischemic heart disease -- nuclear medicine 38% 19%
Valvular disorder -- nuclear medicine 16% 8%
Bursitis and tendonitis, shoulder -- MRI: other 26% 14%
Ischemic heart disease -- echocardiography 50% 27%

The report also found that treatment episodes with self-referring physicians had higher ratios of observed (actual) spending, compared to spending that would be expected based on the average cost of similar episodes in the geographic area. The differences ranged from 5% to 104% depending on ETG, with a mean difference of 68%, according to the report.

The report concludes by stating that MedPAC researchers plan next to review Medicare claims data from multiple years, as well as review how physician specialty affects imaging use. MedPAC also plans to explore policies "to encourage more prudent use of imaging."

Related Reading

Tracking outpatient imaging reimbursement? Watch for these trends, June 10, 2009

Senate report offers details on accreditation, Stark disclosure, May 6, 2009

Imaging self-referral: An inside manifesto, March 19, 2009

Study shows CT use has increased, diagnostic yield has not, March 3, 2009

CT utilization spikes among nonradiologists, December 17, 2008

Copyright © 2009

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