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Self-referral may lead to more negative exams for patients

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Ben E. Paxton

Physicians who have a financial interest in imaging equipment are more likely to refer their patients for potentially unnecessary imaging exams, according to a study presented at the 2011 Annual Meeting of the Radiological Society of North America.

“Self-referred medical imaging has been shown to be an important contributor to escalating medical costs,” Ben E. Paxton, MD, stated in a Radiological Society of North America news release.

The researchers studied if use of lumbar spine MRI differed depending on the financial interest of the physician ordering the exam. According to the release, the team reviewed 500 consecutive diagnostic lumbar spine MRI exams ordered by two groups of orthopedic physicians serving the same community. The first group had a relevant financial interest in the MRI equipment used, while the second group had no such interest.

Abnormalities per positive scan, mean age of patients and negative exam result rates were all analyzed. Among the 500 MRI exams — 250 per group — the researchers found no significant difference in the number of abnormalities per positive scan. However, they noted the mean age of patients in the group with financial interest was 49.6 years, compared with an average age of 56.9 years for patients under the group of physicians without financial interest.

The authors found that the group of physicians with financial interest reported 86% more negative scans than the group of physicians without financial interest. Of 163 negative exams in the study, 106 belonged to the group with financial interests. Forty-two percent of patients referred for exams by physicians with financial interest demonstrated negative scans, compared with 23% of patients under the care of the physicians without financial interest.

“Orthopedic surgeons with financial interest in the equipment had a much higher rate of negative lumbar spine MRIs,” Paxton stated in the release. “In addition, they were much more likely to order MRI exams on younger patients. This suggests that there is a different clinical threshold for ordering MRI exams in the setting of financial incentivization.”

Reference:

• Paxton BE, Lungren MP, Jung S, et al. A case study in lumbar spine MRI and physician self-referral imaging. Paper SSK08-07. Presented at the 2011 Annual Meeting of the Radiological Society of North America. Nov. 27-Dec. 2. Chicago.

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