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Study: MRI-Owning Docs Order More Scans

December 30, 2010
Written by: , Filed in: Diagnostic Imaging, Medical Ethics, Practice Management
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Following up on yesterday’s post about the number of physicians whose practices own or lease advanced imaging equipment: a new study published this month in Health Affairs finds that physicians who buy an MRI system start ordering significantly more scans.

Author Laurence C. Baker, PhD, chief of health services research, a professor of health research and policy, and a Center for Health Policy/Center for Primary Care and Outcomes Research fellow at Stanford University, wrote:

“As policy makers and others grapple with the implications of spreading physician-ownership of equipment, understanding the extent to which it influences diagnosis and treatment choices is important. The acquisition by nonradiologists of advanced imaging equipment—a trend that has occurred over the past decade or two—provides a useful opportunity to investigate these effects.”

Dr. Baker checked a random sample of 20 percent of Medicare claims submitted from 1999 through 2005 by neurologists and orthopedists. He found (probably to no one’s astonishment) that those who acquired the ability to bill for MRI use, through either buying the machines or contracting with other facilities that owned machines, began ordering more MRI scans:

In the first quarter after they began billing, orthopedists jumped from using about 20 more MRIs per 1,000 episodes than traditional users to using about 45 more. Neurologists jumped by more, increasing their rate by about 60 to nearly 145 procedures per 1,000 episodes more than traditional users.

Dr. Baker looked only at the numbers, so he did not address the reasons for the increased MRI usage. “This study did not assess health implications of expanded MRI use associated with beginning to bill,” he wrote. “It is quite possible that additional use of MRI led to improvements in health outcomes. … At the same time, it is worth noting that physicians who began billing for MRI could and did refer patients for MRI before they began billing, and the characteristics of their patients did not change substantially after they began to bill. This raises the possibility that the additional patients who came to receive MRI after their physicians began billing were those for whom use of MRI was less clearly indicated and for whom the possible benefits were smaller.”

Such a delicate way of putting it.

Here’s the bottom line: after adjusting for other variables, orthopedists who billed for MRI scans charged about $25 more per episode and neurologists about $91 more. Those are averages across all patients, not just those who received MRI. Obviously, patients who did receive scans received the bulk of those increased charges.

Dr. Baker points out that since the period of the study, Medicare has lowered reimbursement rates for in-office imaging. So his findings may not reflect current reality. However, he wrote:

“Regardless of evolution in the specific payment environment for in-office imaging, the results here should be a powerful reminder of the potent forces at work when physicians acquire new and advanced equipment and gain the ability to bill directly for its use.”

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