Turf wars in radiology: Other causes of overutilization and what can be done about it
Section snippets
Other causes of the overutilization of noninvasive diagnostic imaging
Although self-referral is the principal cause of the overutilization of imaging, there are other factors at work as well (1). Defensive medicine is likely the next most important reason for overutilization. The fear of malpractice liability pervades the thoughts and daily activities of most practicing physicians these days. One way physicians protect themselves is to get imaging studies on patients of theirs just so no one can ever accuse them in court of not having gotten those studies, no
Rationales used by nonradiologist physicians to justify self-referral for imaging
After the publication of the Hillman studies on self-referral for imaging in the New England Journal of Medicine [10] and the Journal of the American Medical Association [11], a number of physicians in other disciplines wrote letters to the editors attempting to justify self-referral for NDI by nonradiologists. Temple [15] argued that an ordering physician can integrate clinical with imaging information better than a radiologist and also pointed out that outpatient imaging in a private
Self-referral (or autoreferral) by radiologists
Varipapa [16] has charged that self-referral is also rampant among radiologists, a practice he termed autoreferral, and some radiologists have acknowledged that this is a concern 17, 18. Baumgarten and Nelson [18] carried out the only systematic study of this phenomenon of which we are aware. They reviewed 545 consecutive abdominal CT scans and tracked recommendations for additional imaging. In 105 (19%), the interpreting radiologists recommended additional imaging, but the treating physicians
Steps that could be taken to curb the overutilization of noninvasive diagnostic imaging
There are a number of steps that could be taken to curb the overutilization of NDI, regardless of the cause. Some are steps that should be supported by radiologists. Others are steps that the radiology community should actively undertake. Still others are steps that could adversely affect radiologists, albeit not to any great degree.
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Nonresearch Industry Payments to Radiologists: Characteristics and Associations With Regional Medical Imaging Utilization
2017, Journal of the American College of RadiologyCitation Excerpt :For these reasons, it may be difficult for many diagnostic radiologists—regardless of how well financially incentivized—to directly increase imaging utilization as a result of industry payments. Although radiologists are, in many instances, specifically prohibited from self-referring patients for medical imaging, some authors have described the phenomenon of “auto-referral” wherein radiologists effectively influence overutilization of downstream imaging by recommending unnecessary follow-up testing [24,25]. Although our study methods do not permit us to evaluate the extent to which this process may impact utilization, our results suggest that if auto-referral truly exists and truly drives downstream imaging utilization, it is likely not influenced by industry payments.
Physician and patient characteristics affecting repeat use of abdominal ultrasound: A nationwide population-based study
2014, Journal of the Chinese Medical AssociationCitation Excerpt :Many researchers have investigated the role of radiologists in the seemingly excessive use of advanced medical imaging. Some are concerned that self-referral by radiologists will exacerbate the current situation,4,11 while others have been more optimistic.5,6 Similarly, behaviors such as self-referral by gastroenterologists may play a role in the use of abdominal ultrasound, especially repeat scans.
Turf Issues in Radiology and Its Subspecialties
2012, Neuroimaging Clinics of North AmericaUtilization effect of integrating a chest radiography room into a thoracic surgery ward
2012, Journal of the American College of RadiologyAdoption and meaningful use of computerized physician order entry with an integrated clinical decision support system for radiology: Ten-year analysis in an Urban Teaching Hospital
2012, Journal of the American College of RadiologyCitation Excerpt :Similar trends were observed in private insurance groups and individual institutions [5,6]. In addition to expanded clinical indications, potential driving forces for imaging growth include defensive medicine, uncertainty or knowledge gaps among ordering physicians about imaging indications, self-referral by physicians, diagnostic uncertainty, a lack of availability of prior images, the aging population, and patient expectations [4,7-10]. Promoted by the Obama administration, the widespread adoption of electronic health records and computerized physician order entry (CPOE) has become an important cornerstone of national health care policy [11].
Patient-centered imaging
2012, American Journal of Medicine