The Health Affairs website today published a study that shows how physicians are often stretching or breaking the law when they refer patients to diagnostic imaging facilities with which they have a financial relationship. Excerpts:
"Laws enacted during the early 1990s to curb physician self-referral were a major step toward addressing the concerns about these arrangements; however, they contain exceptions that could enable self-referral to reappear but in a different form tailored to fit the exemption. This study is the first to document the prevalence and scope of self-referral arrangements in light of these exceptions. ...Posted by schwitz at April 17, 2007 11:26 AM | TrackBackUsing data from a large insurer in California, we identified the self-referral status of providers who billed for advanced imaging in 2004. Nearly 33 percent of providers who submitted bills for magnetic resonance imaging (MRI) scans, 22 percent of those who submitted bills for computed tomography (CT) scans, and 17 percent of those who submitted bills for positron-emission tomography (PET) scans were classified as "self-referral." Among them, 61 percent of those who billed for MRI and 64 percent of those who billed for CT did not own the imaging equipment. Rather, they were involved in lease or payment-per-scan referral arrangements that might violate federal and state laws. ...
These findings should be of considerable concern to policymakers, employers, insurers, and consumers who recognize the need to control rapidly escalating health care spending. Efforts that address the exemptions in existing federal and state prohibitions on physician self-referral are likely to have major impacts on the increased use that characterizes these arrangements."