Radiology, Rising Healthcare Costs and Self-Referral

05/29/2009 05:12 am ET | Updated May 25, 2011
  • Helene Pavlov, M.D. Fellow, American College of Radiology; Radiologist in Chief, Hospital for Special Surgery

Over the past few months a number of articles have surfaced discussing on one hand, the ills of our health insurance system and the impact from expensive high tech imaging examinations including CT scans, MRI's and other imaging technologies and on the other hand, the importance of these diagnostic examinations on patient outcomes.

The fact is that imaging has contributed to the increase in the cost of healthcare over the last few years. More and more images are being prescribed, but what many fail to realize is that physicians are incentivised by equipment vendors and their colleagues to install their very own MRIs, CTs and X-Ray machines in their offices and to self-refer.

Additionally, patients do not always realize that "All Images and Image Interpretations are not created equal". Non-radiologist physicians with imaging equipment in their offices have the ability and license to take an image using CT or MR, similar to having a camera. Anyone can do it, or can they?

Capturing a diagnostic image appropriate for the underlying condition and then correctly interpreting that image is not an easy task. Imaging perfection and accuracy requires the expertise of a trained radiologist. Radiologists are physicians with four years of dedicated residency training in the physics of ionizing radiation (X-ray and CT) as well as magnetic resonance (MR) post medical school. This training is focused on image acquisition as well as training in image interpretation. Typically, radiologists do another year or more of fellowship training in a specific subspecialty (gastrointestinal, musculoskeletal, etc.) and become highly proficient in recognizing image artifacts that can mimic or mask diseases and subtle conditions to the untrained eye or the eye of a non-radiologist physician.

When radiologists supervise radiological technologists, optimal imaging at minimal radiation dose and without requiring repeat exposures or re-imaging is more likely to be achieved. Also, radiologists are more familiar with the various imaging equipment and can best determine the appropriate imaging modality (e.g. CT vs. MR) for the patient's symptomatology. Patients can be protected from unnecessary imaging examinations and potential delayed onset or inappropriate treatment.

Radiologists, by law, cannot self refer. That is, they do not order the initial or additional imaging examinations. All images acquired by a radiologist require a prescription from a primary care physician or specialist. Fellowship trained sub specialized radiologists who work in an academic hospital setting are impartial unbiased patient advocates. Their expertise increases the potential of capturing the right image for the clinical concern and even more importantly their interpretation of that image is without motivation to suggest surgery or intervention. The radiologists' job is to interpret and consult with the referring physician as to appropriate next steps. Finding an ailment that needs further care or to recommend an operation is not motivation for the radiologist. Capturing the right image, collaborating with the physician and ensuing quality patient care is their main focus.

Radiologists have an ongoing commitment to quality patient care and safety. Patients as well as insurance companies should demand that all physicians not trained in radiology collaborate with radiologists on each and every image they request.

Radiologists are unbiased and impartial physicians and patient advocates. They are not the cause, although usually blamed, for the high costs of healthcare. In fact, radiologists have the potential to lower costs and provide healthcare systems' checks and balances. Patients and the healthcare system would both benefit and costs could be controlled should this resource be recognized.

Patients have an advocate on their side when imaging is concerned and they should ask for and receive the highest quality in patient care at all times. Patients should know to ask their physicians the following questions -"Who is performing my imaging examination?" "Who will interpret my imaging examination study?" and "Who is truly looking out for me?"