Some physician organizations continue to portray doctors as always motivated by what is in the best interest of their patients, but decades of research have demonstrated that, like the rest of us, physicians are usually motivated at least in part by doing what will increase their compensation. A series of articles in Health Affairs once again supports this notion. (HA Table of Contents) One of the articles found that for Medicare patients, when orthopedists and neurologists acquired an interest in MRI equipment that allowed them to bill for the technical component, a lucrative opportunity, the amount of imaging they ordered went up substantially, as did overall spending for the patients.
Another article examined one justification for imaging self-referral, that it would provide faster diagnosis and lower costs. The researchers found that for twenty common medical conditions, physicians who had an interest in MRI equipment produced no shortening of illness length but did significantly raise episode costs. Another supposed justification for the practice is that it is more convenient for patients, but again, research largely debunked that excuse. Particularly for CT and MRI use, self-referral was not associated with increases in same-day imaging.
Medicare has changed reimbursement policies several times in regard to a number of imaging practices, with some limited impact on volume. One effect of these changes may be to drive physicians to work for hospitals and do their imaging at hospital facilities, which is more expensive for payers and usually financially advantageous for the physicians. What is fairly clear is that all this imaging ordering is doing nothing for better health outcomes. The message to policymakers is clear, physicians should either not be permitted to have an interest in equipment, procedures or facilities to which they make any referrals or they should not be allowed to make any referrals in which they may gain some compensatory or financial advantage. This rule needs to be applied in the hospital context as well. There is no reason to think that hospital-employed physicians are any less likely to be driven by economic motivations.