A study of over 24 million Medicare office visits found that clinicians who self-interpret their ordered imaging have nearly twice the odds of ordering imaging overall compared to those who don't self-interpret, suggesting that radiologist involvement is crucial for reducing low-value imaging studies.
- Clinicians who self-interpret all ordered imaging have 188% higher odds of imaging overall compared to non-self-interpreters.
- Practices referring 100% of imaging to radiologists show 5% to 41% lower odds of imaging across most modalities.
- An estimated 2 to 5 out of every 10 imaging studies are considered low-value, providing no treatment benefit.
- Nearly half of office-based imaging exams are self-interpreted by ordering clinicians rather than radiologists.
- Office-based imaging could be reduced by approximately 17% if clinicians stopped self-interpreting their ordered studies.
Self-interpretation by ordering clinicians may be tied to higher imaging use, according to research published September 1 in the Journal of the American College of Radiology.
Visits involving clinicians who self-interpreted all their ordered imaging had a nearly two-fold higher odds of imaging overall than visits involving clinicians who did not self-interpret, wrote a group led by Eric Christensen, PhD, and colleagues from the Harvey L. Neiman Health Policy Institute in Reston, VA.
“Our results point to the importance of radiologists as part of the care team to ensure that imaging is necessary, appropriate, and aligned with clinical need,” Christensen said in a statement.
An estimated two to five out of every 10 imaging studies are of low value since they do not affect treatment and merely add to costs. Nearly half of office-based imaging exams are self-interpreted by ordering clinicians. Existing evidence suggests that self-interpretation is lower in practices with radiologists in the mix.
Christensen and colleagues studied associations between ordering rates following office-based evaluation and management visits. They also studied the percentage of a practice’s imaging studies interpreted by a radiologist versus an ordering provider.
The study included over 24.2 million Medicare office visits. Of these visits, 13.6% had imaging with a self-interpretation rate of 33.2% by ordering providers.
The researchers reported the following findings:
Visits involving clinicians who self-interpreted all their ordered imaging had 188% higher odds of imaging overall than visits with clinicians who did not self-interpret.
This association achieved significance across every modality studied, ranging from 54% higher odds for MRI to 251% higher odds for ultrasound.
Practices referring 100% of imaging to radiologists had 5% to 41% lower odds of imaging for these modalities, except CT.
Office-based imaging may be reduced by about 17% in the absence of self-interpretation by ordering providers.
The study authors suggested that low-value imaging could be reduced by setting up requirements for clinical decision support systems along with radiologist consultation and education on best practices toward appropriate imaging.
“Policy that establishes more stringent standards for non-radiologist interpretation may reduce inappropriate imaging that increases economic burdens and poses patient-safety risk,” Christensen said.
American College of Radiology (ACR) CEO Dana Smetherman, MD, said in a statement that the study underscores the need for evidence-based tools “that help ensure imaging is ordered for the right patient, at the right time, for the right clinical indication.”
“This is among the reasons the [ACR] supports passage of the Patients First Act [H.R. 9693], legislation that includes a section requiring physicians ordering advanced imaging to consult appropriate use criteria prior to those studies being performed,” Smetherman said.
Read the full study here.
