Doctors Order More Tests when They Benefit Financially

Every day across America, millions of people undergo some type of diagnostic imaging test. Do physicians order too many of these diagnostic imaging tests? According to a recent press release, in a recent study researchers found that many physicians engaged in excessive testing. The question that begs to be answered is, "why?"

Researchers from the Institute for Technology Assessment at the Massachusetts General Hospital Department of Radiology found that there was no mistaking that diagnostic imaging tests were being ordered far more than they deemed necessary.

They also determined that many doctor's referred their patients to imaging centers that were affiliated with their practice, or were even done by the doctor's own staff. When a physician has such a close relationship with the provider conducting the imaging study, there is the possibility that the physician will benefit financially from ordering additional imaging studies.

While researchers are quick to admit that not all health care providers who refer patients for additional testing, including diagnostic imaging, are in it for the money, they do suggest that there are a certain number of physicians who engage in this practice purely for financial reasons.

Very few states have any type of legislation or law that makes referring a patient to your own medical practice for additional testing or studies illegal.

"It's looking like a significant part of the increase in imaging utilization is due to self- and same specialty referral. We need to have some mechanism in place to control this sort of inappropriate utilization of imaging," said G. Scott Gazelle, MD, MPH, PhD, director of the Institute for Technology Assessment, and a professor of Radiology at Harvard Medical School and a professor in the Department of Health Policy and Management at Harvard School of Public Health.

Analyzing data from health insurance plans with over 4 million members nationwide, researchers discovered 6 distinct categories of medical conditions that were the most frequent reasons for ordering diagnostic imaging tests. They compiled data on these conditions along with the names of physicians who ordered at least 6 tests for at least one of these conditions between 1999 to 2003.

The 6 health conditions were abdominal malignancy, arm or leg fracture, cardiopulmonary disease, heart disease, knee pain or injury, or stroke.

The results of their investigation and study revealed that when a physician referred a patient to their own practice, or a specialty clinic that was affiliated with the physician, the number of imaging studies ordered increased greatly.

Physicians were far more likely to order imaging tests when they appeared to benefit financially from doing so. Between 12 percent to 200 percent more tests were requested when their office or an affiliate instead of being done by an independent radiologist did it.

Sources:
http://www.eurekalert.org/pub_releases/2007-10/mgh-emm101907.php
http://en.wikipedia.org/wiki/Medical_imaging