ÌìÃÀ´«Ã½

Newswise — Reston, VA – A new Harvey L. Neiman Health Policy Institute study investigated whether office-based providers are more likely to refer imaging to a radiologist, or to self-refer and interpret the ordered imaging studies themselves.  The study found 43.6% of office-based studies were interpreted by the ordering provider, and 58.5% were interpreted within the ordering provider’s practice. Rates of self-interpretation varied by the specialty of the ordering provider and the imaging modality. This study, published in the American Journal of Roentgenology, was based on over 1.6 million office-based imaging claims for Medicare fee-for-service beneficiaries in 2022 that were ordered by non-radiologists.

By modality and across all specialties, the study found that the self-interpretation rate for office-based imaging was 50.4% for radiography and fluoroscopy, 52.0% for ultrasound, 39.5% for nuclear medicine, 5.3% for CT, and 6.1% for MR. Self-interpretation by specialty was 19.9% for primary care physicians, 75.7% for orthopedic/sports medicine physicians, and 30.5% for non-physician practitioners.

Practice size was another important determinant of self-interpretation rates, which were substantially less in the largest practices (500+ providers) than the smallest practices (1-9 providers): 24.2% vs 48.9%, respectively.

“Whether or not there was a radiologist in the ordering provider’s practice was highly correlated with self-interpretation of imaging by the ordering provider,” said Eric Christensen, PhD, Research Director at the Neiman Health Policy Institute. “If there was a radiologist in the practice, the odds of self-interpretation about one-half compared with practices without a radiologist on staff. Conversely, the odds of within-practice interpretation were generally 2 to 3 times higher if there was a radiologist in the practice.”

“Ongoing healthcare consolidation, which is creating larger, multispecialty practices, may serve to reduce imaging self-interpretation by increasing access to a within-practice radiologist,” said Dr. Christensen. “Such centralization of radiology services may encourage referral of imaging interpretation to the within-practice radiologist in lieu of potential self-interpretation.”

“Our results raise potential implications for quality of patient care. Non-radiologist specialties, aside from cardiology, lack the rigorous and comprehensive training in imaging interpretation that occurs during the 4 years of a radiology residency program. Some specialties may provide targeted training in imaging interpretation that is narrow in scope, such as in ultrasound for emergency medicine or obstetrics/gynecology,” said Vijay Rao, MD, Senior Vice President, Enterprise Radiology, Jefferson Health, and Professor of Radiology, Thomas Jefferson University. “The large differences between radiologists and non-radiologists in interpretation training could lead to differences in diagnostic accuracy.”

“At present, there is little restriction on imaging interpretation by non-radiologists and concerns of financial conflicts of interest related to self-referral contributed to the passage of the federal Stark law in the 1990s, intended to curb the practice of self-referral,” said Dr. Rao. “However, the law’s in-office ancillary exception greatly weakens its ability to restrict imaging self-referral. Hence, our results highlight a need to revisit the in-office ancillary exception policy to impact the potential financial incentives that lead to self-referral.”

To arrange an interview with a spokesperson, contact Nichole Gonzalez at [email protected].

###

About the Harvey L. Neiman Health Policy Institute

The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at  and follow us on , and .