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Self‐Referral of Imaging Does Not Imply Overutilization
Author(s) -
Hutchinson Michael,
Chawluk John B.,
Gomez Camilo,
Greenberg Jack,
Hussey Francis D.,
Preston William G.,
Zimmerman Earl
Publication year - 2009
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/j.1552-6569.2008.00290.x
Subject(s) - medicine , specialty , referral , odds , incentive , intervention (counseling) , family medicine , nursing , economics , logistic regression , microeconomics
For several years, some sectors of the specialty of Radiology have complained about the practice of self‐referral, where a nonradiologist physician provides and interprets an imaging procedure. It is argued that such practice leads to increased costs since a physician will overutilize technology because of financial incentives. Here we review the literature. The most extensive analysis to date is at odds with the conclusions drawn in the older literature in that it provides little, if any, evidence for overutilization. We performed our own investigation using a poll study and found no suggestion of overutilization in 33 self‐referring neurologists when compared with 900 neurologists who referred imaging to radiologists. The main period of growth in demand for imaging was between 1999 and 2002. Since 2002 there has been a steep decline in the rate of growth, so that it is possible to predict roughly zero growth in MRI utilization by 2009 without any intervention. It is shown why the rise in demand for imaging studies cannot be explained by self‐referral, and it is argued that the sudden expansion of demand 8 years ago was caused by simultaneous technological improvements in the 3 major imaging modalities. Finally, it is shown how self‐referral may actually reduce costs by facilitating the transfer of care from the hospital and ER to the office.