Doctors with Financial Interest in Self-Referring MRI Scans Yield More Negative Results

November 30, 2011

CHICAGO - Nonradiologists with a financial interest in imaging equipment tend to self-refer imaging to patients who are more likely to turn up negative results, according to a study presented Wednesday at RSNA.

Doctors with Financial Interest in Self-Referring MRI Scans Yield More Negative Results
By Renee Lee

CHICAGO - Nonradiologists with a financial interest in imaging equipment tend to self-refer imaging to patients who are more likely to turn up negative results, according to a study presented Wednesday at RSNA.

Study authors Ben E. Paxton, MD, radiology resident at Duke University Medical Center, and Ramsey Kilani, MD, said imaging has been a significant driver of healthcare costs in the country.
Paxton called the study “exciting,” because unlike similar ones done in the past, this study actually looked at whether imaging results were positive or negative, instead of relying on billing and ordering patterns.

Of 500 consecutive lumbar spine MRI exams ordered by two physicians, one with financial interest and one without, 86 percent more negative results were found in doctors with financial incentive. This indicates some procedures may have been ordered unnecessarily.

“Most people are not surprised that there are more negatives with those with financial interest,” Paxton said, “but what is surprising is the degree of difference. With 86 percent extrapolated across the country, that’s a lot of money.”

The imaging order data of those with financial interest versus no financial interest reviewed by Paxton and Kilani came from doctors with similar variables. The doctors had similar experience levels and similar training backgrounds.

The results showed 42 percent of imaging orders from those with financial interest were negative, compared to 23 percent for non-interest. The mean age for imaging also bore significant differences. The mean age for financial interest was 49.6, significantly younger than non-financial with 56.9 years of age.

Kilani emphasized they were not saying the results meant particular image orders were actually unnecessary.

“We aren’t saying this is a particularly sinister act,” Kilani said. “We need to get a handle on the magnitude of the problem because we can’t afford to waste money on healthcare these days.”

In fact, there were an estimated 662 million Medicare imaging studies done in 2007. Forecasted estimates for 2017 include $4.3 trillion in total healthcare costs and $884 billion in Medicare expenditures.

When asked what this means for patients dealing with doctors ordering scans, Kilani stressed his belief that the results of the study should have more of an impact on the government more so than specifically at the patient-doctor level. Paxton added that increased imaging utilization may place the patient at risk for potential adverse consequences.

“It is important for patients to be aware of the problem of self-referral and to understand the conflict of interest involved when their doctor orders an imaging exam and then collects money on that imaging exam,” he said.