During the fiscal year of 2010, self-referrals amounted to over $109 million dollars in extra payments from Medicare, which equates to approximately 400,000 diagnostic imaging examinations for seemingly arbitrary purposes.

Self-referral leads to more images, more treatment, more surgeries, etc., and contributes to the escalation in the unsustainable rising health-care costs. It is a vicious cycle. So why not just eliminate self-referral?

Health care today is in a state of transition. Ultimately, good outcomes must prevail and delivery of services must be based on access to affordable quality care, not on discount shopping.

Patients should participate in the process of questioning as to what medical exams are to be performed and why. Active patient involvement will have the strongest impact on helping to curtail unnecessary testing, which is contributing to the health care crisis.

Nonradiology specialty training in imaging is extremely varied. Medical schools and nonradiology residency programs provide limited training regarding how to acquire and interpret images accurately.

This is not about quality patient care, convenience or offering the best services available. It is about greed and defensive medicine over medical ethics and reasonableness.