Further Evidence that Self Referral is a Bad Idea

Today’s Managing Health Care Costs Indicator is 86%

An enterprising radiology resident reviewed a series of 500 imaging studies (lower back MRIs) ordered by orthopedists; half had a financial interest in the scanner, and so made more money when a scan was ordered. The other half had no financial interest in the scanner, and their income was independent of MRI scan volume.

Self Referral
No Self Referral
Average Age
% Negative Scans

The results are exactly what you’d expect. The physicians with a financial interest in the MRI scanner ordered scans on younger patients. The scans they ordered were 86% more likely to be negative -- suggesting overutilization. 

This is a small study- done by a single researcher – and he was likely not blinded to which group the orthopedists belonged to.  Still, this is consistent with all the other evidence available. Doctors make different clinical decisions based on their financial interests. 

Physician financial interest in enterprises they refer to continues to be an ethical and financing dilemma.  I don’t believe that many physicians who own imaging consciously believe they are ordering extra tests.  However, there is plenty of evidence that they are.  Here are just a few links to past chapters of this sordid tale:

Incidentally, you might worry for the intrepid radiology resident who did this study. Will he be shunned by colleagues for exposing their dirty laundry?

By no means.  Radiologists have been aggressive at pointing to inappropriate self-referral incentives for specialties that compete with them for some time! Harvard Link