Self-referral: A significant factor in imaging growth

Self-referred imaging is identified as physicians (or non-physicians) who are not radiologists directing their patients to their own on-site imaging services or the referral of patients to outside facilities in which the referring physicians have financial interest.

In the current political and economic climate, there is a desire to reduce health care costs; diagnostic imaging expenditure is one area of particular interest.

Researchers identified the relative risk of physicians' referring patients for imaging to facilities in which the physicians have financial interest (self-referrers) compared with physicians' referring patients for imaging to facilities in which they have no financial interest (radiologist referrers).

"This meta-analysis of the available medical literature estimates that non-radiologist self-referrers of medical imaging are approximately 2.48 times more likely to order imaging than clinicians with no financial interest in imaging, which translates to an increased imaging utilization rate of 59.7 percent," said Ramsey K. Kilani, MD, lead author of the study.

"The utilization fraction of imaging attributable to self-referral in our study was calculated as 59.7 percent. According to the 2008 GAO report, $14.1 billion was spent on diagnostic imaging in 2006; of this amount, 64 percent ($9.0 billion) was to physician offices. Of that $9.0 billion, 68 percent went to non-radiologists. Using the 59.7 percent utilization fraction attributable to self-referral, a theoretical associated cost was calculated at $3.6 billion," said Kilani.

"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," he said.