Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Physicians referring patients to a diagnostic facility they own

Bob Doherty
Policy
April 10, 2011
Share
Tweet
Share

Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue – a practice called “self-referral” – unless the facility is located in their own practice.

This exemption exists to allow patients with access to a laboratory test, x-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less inconvenience and speeder diagnosis and treatment – what could be wrong with that?

Much, say the critics, if it leads to over-utilization and higher costs and doesn’t really represent a convenience to patients. This is the gist of two studies by staff employed by the American College of Radiology, published in the December issue of Health Affairs.

One study analyzes Medicare claims data and concludes that patients aren’t really getting “one-stop-shopping” convenience when their physician refers them to an imaging facility that qualifies for the “in-office” exemption.

“Specifically, same-day imaging was the exception, other than for the most straightforward types of x-rays. Overall, less than one-fourth of imaging other than these types of x-rays was accompanied by a same-day office visit. The fraction for high-tech imaging was even lower—approximately 15 percent.”

The authors say that “a likely explanation is that the equipment required for high-tech imaging is expensive, typically costing $0.5–$2.0 million per machine, and it is inefficient for such equipment to be idle and available to patients on an essentially walk-in basis. Rather, the norm is to schedule appointments ahead of time, to maximize use of the equipment. It is ironic that a major justification for self-referrers’ acquiring this expensive equipment is to provide same-day convenience to their patients—but, presumably to keep their costs down, the physicians inconvenience the vast majority of their imaging patients by scheduling scans for a later date.”

The second study, also from employees of the American College of Radiology, found that with the exception of office X-rays, self-referral provides no health benefit to patients but substantially higher costs:

“Our study provides broad evidence that physician self-referral for imaging typically is not associated with substantial benefits in treatment duration or costs. We found that self-referral for imaging is associated with significantly and substantially higher total care costs in the majority of medical conditions and imaging types we examined. Additionally, we found that self-referral is not associated with shorter illnesses, except in the case of self-referred x-rays for some conditions.”

The authors of both studies conclude that Congress should narrow the “in-office” ancillary services exemption to federal ban on self-referral only to office x-rays.

It should be noted that the American College of Radiology has had a long-standing agenda of wanting to ban physician self-referral, going back to 2003, if not longer. This doesn’t mean that the research done by the ACR’s staff is invalid or biased – it evidently met Health Affairs’ peer review standards – but the fact that they work for an organization that has a political agenda to ban self-referral is relevant.

The American College of Cardiology is fighting back against efforts to eliminate the in-office exemption, maintain that “patients are best served by having a physician who is familiar with a patient’s medical history. In the ideal case, a qualified physician selects the optimal study to perform, interprets the image, and is able to integrate the results with the full knowledge of the patient’s clinical condition before communicating with the patient and establishing a treatment plan. This is inherently the most efficient and comprehensive approach to care. In the case of heart disease, a cardiologist is the most appropriate physician to perform and interpret cardiac imaging studies.”

The American College of Physicians supports a ban on “any financial arrangement that links income generation explicitly or implicitly to the volume or revenues generated by the investor-physicians; referrals if there is no valid medical need for the referral; any arrangement that involves an explicit or implicit inducement or encouragement of physicians by the management of the entity to increase the volume of referrals to the facility; and referrals to any entity (except those specifically exempted by law) unless disclosure has been made to patients of the physician’s financial interest in the facility and, to the extent practicable, a list of alternative facilities from which the goods or services can be obtained.” But ACP also argues that “certain arrangements … should be exempt from regulation … including: such services as those provided by physicians (or physicians in the same group) principally to their own patients (e.g. in-office laboratories and x-ray facilities); other professional and incidental services provided by physicians and their employees in the same group practice as the referring physician.”

There is a risk that the public could view the inter-specialty fights over self-referral as an unseemly fight among doctors in different specialties over who controls the huge amounts of money that can result from referrals to imaging facilities. But the issue, though, really is finding the right balance – of cost, convenience, and the competence of given physicians to perform and interpret a particular imaging test.

ADVERTISEMENT

Today’s questions: What is your reaction to the Health Affairs studies? Do you think the exemption for in-office imaging should be kept as is or limited only to in-office X-rays and labs?

Bob Doherty is Senior Vice President of Governmental Affairs and Public Policy, American College of Physicians and blogs at The ACP Advocate Blog.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Federal workers worried about a shutdown should do what doctors do

April 10, 2011 Kevin 9
…
Next

Physician characteristics that are universally appreciated

April 11, 2011 Kevin 6
…

Tagged as: Patients, Public Health & Policy, Radiology

Post navigation

< Previous Post
Federal workers worried about a shutdown should do what doctors do
Next Post >
Physician characteristics that are universally appreciated

ADVERTISEMENT

More by Bob Doherty

  • Don’t underestimate the appeal of a Trump “health plan”

    Bob Doherty
  • 5 health care lessons from the mid-term elections

    Bob Doherty
  • Medicare’s historic proposal to change how it pays physicians

    Bob Doherty

More in Policy

  • U.S. health care leadership must prepare for policy-driven change

    Lee Scheinbart, MD
  • How locum tenens work helps physicians and APPs reclaim control

    Brian Sutter
  • Why Medicaid cuts should alarm every doctor

    Ilan Shapiro, MD
  • Why physician voices matter in the fight against anti-LGBTQ+ laws

    BJ Ferguson
  • The silent toll of ICE raids on U.S. patient care

    Carlin Lockwood
  • What Adam Smith would say about America’s for-profit health care

    M. Bennet Broner, PhD
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 19 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Physicians referring patients to a diagnostic facility they own
19 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...