A third paper, by Laurence Baker, chief of health services research at Stanford University, specifically examines increased billing for MRI scans by orthopedists and neurologists, who purchased or contracted for use of the machines and started billing for these tests between 1999 and 2005.
Once they started billing for the MRI tests, "the number of MRI procedures used within 30 days of a first visit increased by about 38%," he wrote. Also, spending for other aspects of care rose as well.
These specialists "changed their practice patterns, increasing the use of MRI for their patients" in what Baker called "a distinct and easily observable jump." Even more interesting, he wrote, "the change appears primarily to reflect doctors' recommending MRI for patients for whom they would not have recommended the service before they acquired the ability to bill."
Much of the observed increase, he continued, did not take place on the same day of the initial visit, in effect diminishing "the argument that convenience was the central driver."
He suggested that such practices run the risk of increasing inefficiencies by promoting the overuse of new services.
A fourth paper, the second by Baker, looked at use of a newer technology, CT angiography, which is safer and more cost-effective than traditional catheter angiogram of the carotid arteries, the leading cause of stroke.
Although growth in the use of this test expanded the number of patients getting tested, a Health Affairsstatement saysthe authors found no evidence that it also increased the use of treatments for carotid artery disease. The authors note that the use of new technologies often spreads beyond situations in which value is clear.
The fifth paper, by Bruce Hillman, a professor of radiology at the University of Virginia in Charlottesville, called the practice of self-referral "a conflict of interest" from which physicians who are not radiologists benefit financially.
Even though the 2005 Deficit Reduction Act called for Medicare to place limits on imaging self-referral payments, and the March health reform law mandates physicians to disclose their ownership interests, "the rewards for imaging self-referral remain strong" and may result in a lot of unnecessary testing and exposure to risks such as dangerous levels of radiation and reactions to contrast dyes, Hillman wrote, with co-author Jeff Goldsmith, president of Health Futures Inc., a healthcare consulting firm in Charlottsville.