11/21/2009 05:12 am ET | Updated Nov 17, 2011

Self Referral Strikes Again

Recently news about the Deficit Reduction Act of 2005 (DRA) and its effect on delivery of healthcare and patients was released. According to a study published in the September issue of the Journal of the American College of Radiology, the negative impact of the Deficit Reduction Act (DRA) of 2005 has hit radiologists much harder than other specialists who perform medical imaging in their own offices. At first glance, this appears appropriate. Imaging has been placed in the spotlight for being responsible for the escalating high cost of healthcare and medical imaging is linked to radiology, so why should not the specialty and radiologists be hit the hardest? The problem is that only a third of imaging performed in private practices, outside of hospitals, is performed by radiologists. Over two thirds of imaging in these settings is performed by nonradiology specialists, e.g., cardiology, orthopaedics, etc.,

Let's look at MRI as an example. This is a direct quote from the article, which is linked to above. For MRI, procedure volume at radiologists' private offices increased by 8.4% yearly from 2002 to 2006, but decreased by 2% in 2007, the first year the DRA was in effect. However, nonradiologists' office volume increased by 24.8% yearly from 2002 to 2006, and then increased by another 7.6% in 2007 according to a study by Dr. David Levin and colleagues at Thomas Jefferson University Hospital in Philadelphia (JACR, September 2009, Vol. 6:9, pp. 620-625). Nonradiologists have offset the DRA's effect by referring more patients to their own practices. When the DRA lowered reimbursement, self referral practices increased. It needs to be recognized that radiologists do not self refer.

The issue is not with the imaging, it is with self referral patterns. This is not (as nonradiologists with imaging equipment in their offices claim) about quality patient care, convenience or offering the best services available. It is about greed and defensive medicine over medical ethics and reasonableness. Radiologists are trained to understand and minimize hazards of ionizing radiation, interpret images properly and provide an unbiased evaluation of the patient's condition. The newer, and expensive, imaging technologies are capable of earlier and more specific diagnosis than ever before, especially when the examinations are acquired and interpreted with expertise. Only the American Board of Radiology (ABR) validates four years of post medical school training and expertise in all aspects of imaging and provides a mechanism through peer review and recertification for this expertise. Radiologists are physician consultants to nonradiologist physicians and provide expertise on appropriate imaging for their patients' suspected condition. Radiologists are "unbiased patient advocates." The problem is not with the imaging, it is with self referral.