Post documents self-referred, in-house scans

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The Washington Post‘s Shankar Vedantam explores the well-documented phenomenon in which physicians who own scanners are far, far more likely to order scans than those who don’t, and the lack of attention this extra screening is getting in the health care cost debate. The screening, Vendantam writes, has been shown to be unhelpful and perhaps even harmful.

Government panels have found that, across several areas of medicine, ordering more procedures does not improve health outcomes. In the case of medical scans, unnecessary imaging also creates a health risk — as many as 1 percent of all cancers in the United States appear to be caused by radiation from medical imaging, according to Amy Berrington de Gonzalez, a radiation epidemiologist at the National Cancer Institute.

Defenders of in-house screening argue that it increases speed and efficiency, though those assertions aren’t always borne out by national statistics. A 1992 law aimed to prevent a too-close relationship between physicians and the profits from screening devices has fallen prey to a loophole that technology has made it possible to exploit.

The issue was ostensibly settled in 1992 when the Stark Law was enacted. The legislation prohibited physicians from referring patients to the doctors’ own scanning devices. The law offered an exception, however, for physicians whose scanners were in the same office building as their practice. The exception was designed to allow doctors to keep small X-ray machines to quickly figure out, for example, whether a limping patient had a sprain or a fracture.
But since the law was passed, high-tech MRI and CT scanners have become smaller, making it possible for many more physicians to use the “in-office” exception.

As more expensive scans are being ordered more often, the percentage of income physicians earn from scanning has risen rapidly since 2000, Vendantam reports. For their part, physicians say that they are simply taking advantage of technology to provide better care.

President Obama has pledged that health care reform will include efforts to cut costs and some in Congress have seized upon limiting self referrals for scans as one way to bring costs down.

Congress, as part of health-care-reform efforts, is considering a proposal, championed by Reps. Jackie Speier (D-Calif.),  Anthony Weiner (D-N.Y.) and  Bruce Braley (D-Iowa), to prohibit the practice. Maryland is the only state that bans self-referrals, but the law is rarely enforced.

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