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APHA Scientific Session and Event Listing

Mythreyi Bhargavan, PhD, Jonathan Sunshine, PhD, and Cristian Meghea, PhD. Research, American College of Radiology, 1891 Preston White Drive, Reston, VA 20191, 703-648-8983, mbhargavan@acr.org

Rationale: Imaging is usually provided through physician referral, and therefore, may be influenced by financial incentives faced by the referring physician. Medical imaging is a large component of health care costs in the United States, with an estimated annual cost almost $100 billion, and has one of the fastest growth rates among all medical services. Therefore, a better understanding of factors that affect it will help educate patients and physicians on assessing appropriateness of imaging utilization.

Objective: To measure the effect of physician financial incentives, as captured by self- versus radiologist-referral, on the utilization of imaging studies, controlling for patient demographics and co-morbidities, geographic location, practice setting (physician office, outpatient hospital, or inpatient hospital), and other physician-related factors.

Methods: We use claims data from a large national employer plan for five years (1999-2003). We identify patients with certain conditions such as acute upper respiratory tract symptoms, headache, and knee pain. We construct episodes of care and for each episode, measure the difference between imagers and non-imagers in whether an image was ordered, the type of image, total imaging costs, and total patient care costs. Each medical condition is analyzed independenntly. Standard logistic and log-linear regression techniques are used in the analyses.

Preliminary Results: Between 1999 and 2003, patients with headaches, were approximately 4 times (4.5 in 1999, 3.7 in 2003) as likely to have a CT if the treating physician had a financial interest in a CT unit than if he or she did not, and nearly 3 times (3.3 in 1999, 2.8in 2003) as likely to have an MRI is the treating physician was an MR imager than if her or she was not. However, there was little significant difference in average imaging dollars per patient for those who did get an image.

Patients with knee pain with MR imagers as treating physicians were more than 3 times (3.5 in 1999, 3.1 in 2003) as likely to have a knee MRI as patients of non-MR-imagers. Of those who did get an image, patients of MRI imagers had imaging costs 1.6-1.8 times (1.6 in 2003, 1.8 in 2000 and 2001) the imaging costs of patients of non-MR imagers.

Conclusions: There is some evidence that probability of imaging is higher if a treating physician has a financial interest in the imaging equipment than if the patient is treated by a physician with no financial interest in the imaging.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to

• Evaluate appropriateness of health service utilization with a recognition of the role of physician incentives.
• Recognize the roles of different physicians in the decision making process as it applies to diagnostic imaging.
• Identify the capabilities of administrative claims data in the analysis of physician behavior.

Keywords: Utilization,

Presenting author's disclosure statement:

Not Answered