When Doctors Profit from MRI the Back Scans and
Surgery Increase for Medicare Patients
‘Medicare spending alone would go down about 25
percent if self-referral were really policed or eliminated’
By Carl Sherman, Contributing Writer
Health Behavior News Service
April 26, 2011 - When doctors own or lease MRI
equipment, their patients are more likely to receive scans for low back
pain. Patients of orthopedists are more apt to undergo back surgery as
well, according to a study published online in Health Services Research.
Financial incentives, inherent in self-referral,
“seem to have an influence on physician behavior that we can’t ignore,
and an impact on patient care in the long run,” said Jacqueline Baras
Shreibati, M.D., of Stanford University School of Medicine, lead study
There is no definitive evidence that either MRI or
surgery for low back pain improve outcomes, the authors say.
The study compared scan rates for Medicare patients
of 1,033 primary care physicians and 1,271 orthopedists, before and
after the physicians acquired MRI equipment — either by purchase, or by
entering into lease arrangements whereby they billed directly for scans
As earlier research has shown, when physicians
begin self-referral for MRI they become significantly more likely to
order scans: in this study the rate increased by 13 percent for
orthopedists’ patients, and 32 percent for patients of primary care
What was more, patients who visited an orthopedist
after he or she had acquired an MRI were 34 percent more likely to
undergo back surgery within six months.
The study intent was not to assess whether the
additional surgeries were necessary, Shreibati said. Yet, it did show “a
direct relationship from imaging to surgery — in a group of patients
where surgery is very controversial.”
Jean M. Mitchell, Ph.D., professor of public policy
at Georgetown University, said, “the main contribution of this research
is what it shows about ‘cascade effects’” of self-referral — its impact
“not just on the procedure itself, but things that happen as a result.
If the patient hadn’t had the MRI, they never would have had the back
Federal regulations prohibit physicians from
referring Medicaid or Medicare patients for health services in which
they have a financial interest, but make an exception for “in-office”
procedures, which has been interpreted to include MRIs done with offsite
equipment leased on a per-scan basis.
“Medicare spending alone would go down about 25
percent if self-referral were really policed or eliminated,” Mitchell
While the findings do not indicate that patients
should second-guess their doctors’ recommendations, Shreibati said, “I
think it’s important for them to keep in mind that financial incentives
may influence the care they receive.”
The study authors presented an earlier version of
the study at a research meeting in June 2010.
Research Source: Health Services Research
Information Source: Health Behavior News Service is
a Product of the Center for Advancing Health, which is funded by by The
Annenberg Foundation and the W.K. Kellogg Foundation.
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