Journal of the American College of Radiology
Volume 5, Issue 7 , Pages 806-810 , July 2008

Turf Wars in Radiology: Updated Evidence on the Relationship Between Self-Referral and the Overutilization of Imaging

  • David C. Levin, MD

      Affiliations

    • Department of Radiology, Thomas Jefferson Uiversity Hospital and Jefferson Medical College, Philadelphia, Pennsylvania.
    • HealthHelp Inc., Houston, Texas.
    • Corresponding Author InformationCorresponding author and reprints: David C. Levin, MD, Thomas Jefferson University Hospital, Department of Radiology, 1090 Main, Philadelphia, PA 19107
    • ,
  • Vijay M. Rao, MD

      Affiliations

    • Department of Radiology, Thomas Jefferson Uiversity Hospital and Jefferson Medical College, Philadelphia, Pennsylvania.

References 

  1. Johnson T. Interview (ABC World News With Charles Gibson). New York: ABC News; 2007;November 28
  2. Armstrong D. MRI and CT centers offer doctors way to profit on scans. In: The Wall Street Journal. 2005;p. A1;May 2
  3. Falling short of professional standards (The New York Times). 2007;[editorial]. December 24
  4. Levin DC, Rao VM. Turf wars in radiology: the overutilization of imaging resulting from self-referral. J Am Coll Radiol. 2004;1:169–172
  5. Gazelle GS, Halpern EF, Ryan HS, Tramontano AC. Utilization of diagnostic medical imaging: comparison of radiologist referral versus same-specialty referral. Radiology. 2007;245:517–522
  6. Hillman BJ, Joseph CA, Mabry MR, Sunshine JH, Kennedy SD, Noether M. Frequency and costs of diagnostic imaging in office practice—a comparison of self-referring and radiologist referring physicians. N Engl J Med. 1990;323:1604–1608
  7. Hillman BJ, Olson GT, Griffith PE, et al. Physicians' utilization and charges for outpatient diagnostic imaging in a Medicare population. JAMA. 1992;268:2050–2054
  8. Mitchell JM. The prevalence of physician self-referral arrangements after Stark II: evidence from advanced diagnostic imaging. Health Aff. 2007;26:w415–w424http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.3.w415Accessed December 28, 2007
  9. Levin DC, Rao VM, Parker L, Frangos AJ, Sunshine JH. Ownership or leasing of MRI facilities by nonradiologist physicians is a rapidly growing trend. J Am Coll Radiol. 2008;5:105–109
  10. Boden WE, O'Rourke WA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–1516
  11. Hueb W, Soares PR, Gersh BJ, et al. The Medicine, Angioplasty, or Surgery Study (MASS-II): a randomized, controlled clinical trial of three therapeutic strategies for multivessel coronary artery disease. J Am Coll Cardiol. 2004;43:1743–1751
  12. Levin DC, Intenzo CM, Rao VM, Frangos AJ, Parker L, Sunshine JH. Comparison of recent utilization trends in radionuclide myocardial perfusion imaging among radiologists and cardiologists. J Am Coll Radiol. 2005;2:821–824
  13. Williams KA. President's message: advocacy for nuclear cardiology—the self-referral issue. J Nucl Cardiol. 2004;11:751–753
  14. Lucas FL, DeLorenzo MA, Siewers AE, Wennberg DE. Temporal trends in the utilization of diagnostic testing and treatments for cardiovascular disease in the United States, 1993-2001. Circulation. 2006;113:374–379
  15. Hayes KJ, Pettengill J, Stensland J. Getting the price right: Medicare payment rates for cardiovascular services. Health Aff. 2007;26:124–136
  16. Litt AW, Ryan DR, Batista D, Perry KN, Lewis RS, Sunshine JH. Relative procedure intensity with self-referral and radiologist referral: extremity radiography. Radiology. 2005;235:142–147
  17. Levin DC, Rao VM, Parker L, Frangos AJ, Sunshine JH. The effect of the introduction of MR and CT angiography on the utilization of catheter angiography for peripheral arterial disease. J Am Coll Radiol. 2007;4:457–460
  18. Levin DC, Rao VM, Parker L, Frangos AJ, Sunshine JH. Recent trends in utilization rates of noncardiac thoracic imaging: an example of how imaging growth might be controlled. J Am Coll Radiol. 2007;4:886–889

PII: S1546-1440(08)00058-6

doi: 10.1016/j.jacr.2008.01.025

Journal of the American College of Radiology
Volume 5, Issue 7 , Pages 806-810 , July 2008

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