Turf wars in radiology: the overutilization of imaging resulting from self-referral¹

Abstract 

A recent report by the Medicare Payment Advisory Commission to Congress indicated that the utilization of diagnostic imaging is growing more rapidly than that of any other type of physician service. This has engendered concern among those who pay for health care. In this article, the authors review the role of self-referral in driving up imaging utilization.

A number of studies of the self-referral factor in imaging have been conducted over the past three decades. These have consistently shown that when nonradiologist physicians operate their own imaging equipment and have the opportunity to self-refer, their utilization is substantially higher than among other physicians who refer their patients to radiologists. It has also been shown that the vast bulk of the recent increases in imaging utilization are attributable to nonradiologists who self-refer. The authors estimate that the cost to the American health care system of unnecessary imaging resulting from self-referral by nonradiologists is $16 billion per year.

Keywords:  Medical economics, diagnostic radiology, radiology, radiologists, departmental management, socioeconomic issues

• 1 Editor’s note: This article is the second in a series of what is projected to be 14 articles dealing with the phenomenon of self-referral. The series is intended to both inform readers of the extent and impact of self-referral and advise them on how self-referral issues might be handled in their own practices. Although much of what you will read will be substantiated by published research, I have given the authors wide latitude to express their personal views and experiences.