with financial ties to MRI scanners tend to refer more knee pain patients for
imaging, a new study says.
compared the results of 700 MRI scans of the knee. Half of the scans were
ordered by doctors who made money from the tests because they owned the imaging
equipment – a practice known as self-referral. The other half of the scans were
ordered by doctors with no financial ties to the MRI machines.
group of independent radiologists read all the scans. They weren't aware of the
study at the time they reported their results.
the playing field even further, researchers only looked at knee patients who
were making their first trip for an MRI. They excluded anyone who'd had
previous imaging or surgery from the study.
just looking at who is showing up to the clinic for first time and saying, 'my knee
hurts' ", said study author Dr Matthew Lungren, radiologist duke university, Durham, North Carolina.
referred by doctors who had a financial interest in the MRI tests were 33% more
likely to have a normal result than patients whose doctors had no stake in the
scans. Radiologists read 117 of 350 scans to be normal in the group with
doctors who made money off of the scans, compared with 88 normal readings of
350 scans in the group where doctors didn't get a cut of the testing fee.
concern, of course, that everyone is thinking about is: Are these being ordered
to generate profit?" Lungren said, though he was also quick to point out
that financial incentives often exist on a slippery slope. Doctors who have an
MRI machine in their office may be quicker to order scans because it's easy and
they can see the results quickly. Some doctors order more scans than others
simply because that's how they were trained.
the reason, the scans are expensive for patients and insurers, and they may
lead to more unnecessary tests and procedures if doctors find something that
might need probing.
this will bring the discussion back around to how to cut waste out of the
system," Lungren said.
findings, published online on 17 September in the journal Radiology, were not
surprising to Dr David Levin, chairman emeritus of the department of radiology
at Thomas Jefferson University, in Philadelphia.
focused much of his career on the problem of self-referral, but he was not
involved in the current research.
issue has been studied for 40 years. There have been dozens of papers written
on this subject, and every single one of them has shown that when self-referral
of imaging is allowed, utilisation is going to skyrocket," Levin said.
2012 report by the US Government Accountability Office, for example, found that
doctors who owned imaging equipment ordered 80% more MRIs from 2004 to 2010,
while doctors who didn't own scanners ordered about 12% more MRIs over the same
Laws poorly enforced
states have laws against self-referral, but most are poorly enforced.
patients are supposed to be protected against self-referral by federal
legislation called the Stark Law, which prohibits doctors from having financial
relationships with imaging centres in the same community.
But the law
has a loophole, Levin said, which allows doctors to self-refer patients for imaging
when the scanner is in the doctor's office.
law basically has no teeth, and patients have very little protection,"
So what can
patients do to avoid expensive scans that might not be needed?
think the best thing to do is just ask: 'Do you have a financial relationship
with the imaging that you're sending me to?'" study author Lungren said.
"I feel like a physician should disclose that," he added.