Find out how Medicare patients are more likely to receive imaging services when treated by doctors who refer most patients to their own practices for imaging scans than when treated by doctors who refer most patients to practices in which they do not have a financial stake, according to a study from the Medicare Payment Advisory Commission.
Depending on the medical condition and the relevant imaging technology, episodes of care with "self-referring" physicians are 2% to 23% more likely to receive an imaging scan, MedPAC staffers said at an April 8 meeting in Washington, D.C. Self-referring episodes also were associated with 5% to 104% higher imaging spending compared to non-self-referring episodes.
Relying on 2005 Medicare data, MedPAC looked at 13 different condition groups, ranging from cerebral vascular accident cases to patients suffering from spinal trauma, migraine headaches or kidney stones, paired with one or more imaging modalities each.
The commission did not release detailed results for each group. But they reported, for example, that for self-referring episodes of care where a patient reported a migraine headache, magnetic resonance imaging was ordered 14% of the time versus 8% with non-self-referrers. The self-referring migraine episodes involved 85% more MRI spending.
They also said that more imaging did not contribute to overall episode savings by avoiding the need for an expensive surgery.
MedPAC, which advises Congress on Medicare, has targeted imaging as a key driver of unsustainable government health care spending. It has offered proposals to restrict self-referring practices as one solution (1"The Gray Sheet" Sept. 15, 2008, p. 20).
But the Access to Medical Imaging Coalition, which represents equipment makers, radiologists and some patient groups, says MedPAC's 2005 data is very limited. "We have more recent data showing that 90% of imaging tests, overall, are ordered by non-self-referring physicians," said Tim Trysla, executive director of AMIC. "Specifically, 96% of CT scans and 90% of MRIs are ordered by non-self-referring physicians."
- Sue Darcey
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