July 8, 2004
To increase their incomes, more and more doctors are installing magnetic resonance imaging (MRI) scanners and other medical imaging equipment in their offices and scanning patients themselves instead of referring them to a radiologist.
The result, says David C. Levin, former chairman of the department of radiology at Thomas Jefferson University Hospital in Philadelphia, is that more and more scans are being done, and insurers and patients are being charged more. Both Medicare and commercial insurers like Blue Cross have noted that imaging is growing more rapidly nationwide than any other physician service.
Although this might seem more convenient for a patient, "self-referral" creates cost and quality problems, explains Levin:
- Nonradiologist physicians don't do as well as radiologists at interpreting imaging tests since they often have little or no formal training in imaging.
- A study of 462 offices that provided imaging in one western state found that more than one-third of offices run by nonradiologists failed inspection, while only 1 percent of the offices of radiologists failed.
- Between 1993 and 1999, all of the increase in Medicare use of imaging and the resulting costs was due to the increase in self-referring doctors.
Some states have begun passing restrictions on MRI scanning -- Maryland, for example, now prevents doctors other than radiologists from putting CAT or MRI scanners in their offices.
A federal law similar to the one in Maryland, says Levin, would help Medicare rein in its imaging costs. Another solution would be to require inspection and accreditation programs for all doctors' offices that provided imaging for patients.
Source: David C. Levin, "Me and My M.R.I.," New York Times, July 6, 2004.
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