Self-Referral Leads to Unnecessary MRI Exams

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Self Referral Leads to Unnecessary MRI Exams

Based on a new study published online in the journal Radiology, patients who undergo knee MRI scans are more than likely to receive a negative finding if referred by doctors who have some sort of financial stake in the imaging equipment being used.

Imaging self-referral, is when a non-radiologist physician refers their own patients for imaging to institutions in which they or their partners have a financial interest, is a growing pattern among the medical community and a major driver of healthcare costs. Medical imaging self-referral itself spurs higher utilization and unnecessary imaging examinations.

"Our study was the first to examine one of the most common advanced outpatient imaging studies ordered in the United States today: orthopedic knee MRI. In our work, we were able not only to evaluate the outcome of the knee MRI examinations ordered by physicians with financial interest in the imaging equipment, but to compare this to another matched referral physician group that had no financial stake in the imaging equipment, said co-director of the Interventional Radiology Translational Research Lab at Duke University Medical Center in Durham, N.C, Matthew P. Lungren, M.D.

Begging in 2004 through 2010, the amount of self-referred MRI operations shot up by more than 80 percent, as opposed to a 12 percent increase of non-self-referred MRI operations. Similarly, the U.S. Government Accountability Office reported that the growth rate of expenses for self-referred MRI operations was also higher than for non-self-referred MRI operations.

In 2010, it was approximated that providers who self-referred made as many as 400,000 more referrals for advanced imaging services than they would have if they were not self-referring, costing Medicare around $109 million.

For this study, the researches observed 700 consecutive diagnostic knee exams from 667 patients to conclude if ownership of MRI equipment by ordering physicians influenced the probability of positive findings, and assessed the pathology rates as a metric for comparison of utilization.

The exams had been inferred by one radiology practice between January and April 2009 and referred by two independent physician groups serving the same geographic community.

The first group had financial interest in the MRI equipment used (FI group), and the second had no financial interest in the equipment used (NFI group).

Based on each group, the researchers studied the percentage of negative exams and the regularity of each type of abnormalities found on positive exams.

Results revealed that of the 700 MRI exams (350 per group), there was no major difference in the number of abnormalities per positive scan between the two groups. Yet, the researchers discovered that knee MRI exams ordered by the FI group were 33 percent more likely to be negative, alluding to a considerably higher number of potentially superfluous exams.

Of the 205 negative exams, 117 were part of the FI group, as opposed to 88 for the NFI group. In the FI group, 33 percent of patients referred for exams had negative scan results, while 25 percent of the NFI group has negative scan results.

"This occurred despite otherwise highly similar pathology, demographics and referring physician characteristics between the two groups. These findings suggest that there is a different threshold for ordering MRI examinations which may be due to financial incentive, said Lungren.

Lungren also noted that self-referral has been known to be a significant driver of increasing medical costs, and that this study has presented substantial evidence of greater use of high-tech imaging when physicians can financially benefit.

"This increase in unnecessary costs is of paramount importance in the current national conversation regarding health care cost and implementation," he said.