Physician self-referral for imaging and the cost of chronic care for medicare beneficiaries

Medical Care

Volumn 49, Issue 9, 2011, Pages 857-864

  Hughes, Danny R ^a   Sunshine, Jonathan H ^b   Bhargavan, Mythreyi ^c   Forman, Howard ^d  

^a UNIVERSITY OF OKLAHOMA HEALTH SCIENCES CENTER   (United States)

^b YALE UNIVERSITY   (United States)

^c JOHNS HOPKINS UNIVERSITY   (United States)

^d YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

chronic care; health care costs; physician self referral

Indexed keywords

ARTICLE; CHRONIC DISEASE; COMPUTER ASSISTED TOMOGRAPHY; DISEASE SEVERITY; GYNECOLOGIC CANCER; HEALTH CARE COST; HEALTH CARE UTILIZATION; HUMAN; MEDICARE; NUCLEAR MAGNETIC RESONANCE IMAGING; PHYSICIAN SELF-REFERRAL; PRIORITY JOURNAL; ULTRASOUND; X RAY;

AGED; CHRONIC DISEASE; COST CONTROL; DIAGNOSTIC IMAGING; EPISODE OF CARE; FEE-FOR-SERVICE PLANS; HEALTH CARE COSTS; HUMANS; MEDICARE; MEDICINE; MULTIVARIATE ANALYSIS; PHYSICIAN SELF-REFERRAL; UNITED STATES;

EID: 80052164089     PISSN: 00257079     EISSN: 15371948     Source Type: Journal    
DOI: 10.1097/MLR.0b013e31821b35ee     Document Type: Article

References (41)

1. Dentzer S. Reform chronic illness care? Yes, we can. Health Aff. 2009;28:12-13.
2. Thorpe KE, Florence CS, Howard DH, et al. Trends: the impact of obesity on rising medical spending. Health Aff. 2004;23:w480-w486.
3. Thorpe KE, Ogden LL, Galactionova K. Chronic conditions account for rise in medicare spending from 1987 To 2006. Health Aff. 2010;29:718-724.
4. Paez KA, Zhao L, Hwang W. Rising out-of-pocket spending for chronic conditions: a ten-year trend. Health Aff. 2009;28:15-25.
5. Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295:1549-1555.
6. Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303:235-241.
7. Mokdad AH, Serdula MK, Dietz WH, et al. The spread of the obesity epidemic in the United States, 1991-1998. JAMA. 1999;282:1519-1522. (Pubitemid 29504044)
8. Flegal KM, Graubard BI, Williamson DF, et al. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA. 2007;298:2028-2037. (Pubitemid 350074800)
9. Malnick SD, Knobler H. The medical complications of obesity. QJM. 2006;99:565-579. (Pubitemid 44540533)
10. Cowie CC, Rust KF, Byrd-Holt DD, et al. Prevalence of diabetes and impaired fasting glucose in adults in the US population. Diabetes Care. 2006;29:1263-1268.
11. Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in US adults. The third national health and nutrition examination survey, 1988-1994. Diabetes Care. 1998;21:518-524. (Pubitemid 28172927)
12. Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy (March 2005). http://www.medpac.gov/docu ments/Mar05- EntireReport.pdf. 2005. 9-1-2010. Ref Type: Report.
13. Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy (March 2006). 3-1-2006. 9-1-2010. Ref Type: Report.
14. Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy (March 2008). http://www.medpac.gov/docu ments/Mar08- EntireReport.pdf. 3-1-2008. 9-1-2010. Ref Type: Report.
15. Medicare Payment Advisory Commission. Report to the Congress: Medicare payment policy (March 2010). 3-1-2010. 4-15-2010. Ref Type: Report.
16. Hillman BJ, Goldsmith JC. The Sorcerer's Apprentice: How Medical Imaging is Changing Health Care. Oxford: Oxford University Press; 2011.
17. Hillman BJ, Joseph CA, Mabry MR, et al. Frequency and costs of diagnostic imaging in office practiceFa comparison of self-referring and radiologist-referring physicians. N Engl J Med. 1990;323:1604-1608.
18. Hillman BJ, Olson GT, Griffith PE, et al. Physicians' utilization and charges for outpatient diagnostic imaging in a Medicare population. JAMA. 1992;268:2050-2054.
19. Mitchell JM. Utilization trends for advanced imaging procedures: evidence from individuals with private insurance coverage in California. Med Care. 2008;46:460-466.
20. Mitchell JM. Utilization changes following market entry by physicianowned specialty hospitals. Med Care Res Rev. 2007;64:395-415. (Pubitemid 47084217)
21. Iglehart JK. The new era of medical imagingFprogress and pitfalls. N Engl J Med. 2006;354:2822-2828.
22. Gazelle GS, Halpern EF, Ryan HS, et al. Utilization of diagnostic medical imaging: comparison of radiologist referral versus samespecialty referral. Radiology. 2007;245:517-522. (Pubitemid 47612534)
23. Mitchell JM. The prevalence of physician self-referral arrangements after Stark II: evidence from advanced diagnostic imaging. Health Aff (Millwood). 2007;26:w415-w424.
24. Brenner DJ, Hall EJ. Computed tomographyFan increasing source of radiation exposure. N Engl J Med. 2007;357:2277-2284. (Pubitemid 350190758)
25. National Council on Radiation Protection and Measurements. Ionizing Radiation Exposure of the Population of the United States (Report 160). 2009. Bethesda, Maryland. 10-11-2010. Ref Type: Report.
26. Fazel R, Krumholz HM, Wang Y, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med. 2009;361: 849-857.
27. Hughes DR, Bhargavan M, Sunshine JH. Imaging self-referral associated with higher costs and limited impact on duration of illness. Health Aff (Millwood). 2010;29:2244-2251.
28. Levin DC, Rao VM, Parker L, et al. Medicare payments for noninvasive diagnostic imaging are now higher to nonradiologist physicians than to radiologists. J Am Coll Radiol. 2011;8:26-32.
29. Harris KM. How do patients choose physicians? Evidence from a national survey of enrollees in employment-related health plans. Health Serv Res. 2003;38:711-732. (Pubitemid 36570036)
30. Weiss LJ, Blustein J. Faithful patients: the effect of long-term physician-patient relationships on the costs and use of health care by older Americans. Am J Public Health. 1996;86:1742-1747.
31. Parchman ML. The Gordian knot of chronic illness care. J Am Board Fam Med. 2008;21:487-489.
32. Anderson G, Horvath J. Chronic Conditions: Making the Case for Ongoing Care. 2002. Princeton, NJ, Robert Wood Johnson Foundation's Partnership for Solutions. Ref Type: Report.
33. Boyd CM, Darer J, Boult C, et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294: 716-724. (Pubitemid 41159291)
34. Hutchinson M, Chawluk JB, Gomez C, et al. Self-referral of imaging does not imply overutilization. J Neuroimaging. 2009;19:80-83.
35. American Urological Association. Talking Points: Physician Self-Referral. http://www auanet org/content/legislative-and-regulatory/imaging/ selfreftalkingpoints pdf [serial online]. 2005. Available at: http://www.auanet.org/content/legislative-and-regulatory/imaging/selfref talkingpoints.pdf. Accessed October 4, 2010.
36. Williams KA. Statement of Kim Allan Williams, MD, Professor of Medicine, Director of Nuclear Cardiology, University of Chicago, Chicago, Illinois, at the Hearing on Managing the Use of Imaging Services: Hearing before the Subcommittee on Health of the Committee on Ways and Means, House of Representatives. 109th Congress 29. 3-17-2005. Committee on Ways and Means, House of Representatives, Subcommittee on Health. 7-15-2008. Ref Type: Hearing.
37. Pontzer K. Statement of Kathy Pontzer, American Association of Orthopaedic Surgeons, submitted for the record at the Hearing on Managing the Use of Imaging Services: Hearing before the Subcommittee on Health of the Committee on Ways and Means, House of Representatives. 109th Congress 29. 3-17-2005. Committee on Ways and Means, Subcommittee on Health. 7-15-2008. Ref Type: Hearing.
38. Centers for Medicare and Medicaid Services. Berenson-Eggers Type of Service (BETOS) Codes. http://www cms hhs gov/data/betos/default asp [serial online]. 2004. Available at: http://www.cms.hhs.gov/data/betos/default.asp. Accessed July 16, 2009.
39. Centers for Medicare & Medicaid Services. Wage Index and Capital Geographic Adjustment Factor, Tables 4A, 4B, and 4C, Federal Regulations and Notices, Acute Inpatient Prospective Payer System, PPS Final Rule for FY 2004, (Part 3), reproduced from the Federal Registed on the CMS web-site. http://www cms hhs gov/providers/hipps/cms1470f/default asp? [serial online]. 2005; Accessed May 28, 2005.
40. Bureau of Labor Statistics. Consumer Price Index-All Urban Consumers. http://data bls gov/PDQ/servlet/SurveyOutputServlet [serial online]. 2009; Accessed June 16, 2009.
41. Medicare Payment Advisory Commission. Report to the Congress: Improving Incentives in the Medicare Program (June 2009). 2009. 9-2-2010. Ref Type: Report.