Non-radiologist providers are reading almost half of medical images acquired in the office practice setting. A new analysis in AJR raises questions about both the quality of these interpretations as well as whether they are contributing to imaging overutilization.
Radiologists have jealously guarded their role as the primary interpreters of medical images, but keeping referring physicians away is like holding back the tide – especially when they control the patients.
- Progress was made in the 1990s with the passage of Stark legislation prohibiting doctors from referring patients to sites where they have a financial interest, but Stark includes an exemption for imaging performed in the doctors’ own offices.
This in-office exemption is a loophole big enough to drive a truck through, and as in-office imaging has grown radiologists have raised questions about:
1. Whether non-radiologist providers have adequate training in image interpretation.
2. If the economic incentive behind in-office imaging contributes to imaging overutilization.
So to learn more about who’s reading in-office images, researchers from the ACR’s Harvey L. Neiman Health Policy Institute analyzed 1.6M office-based imaging studies from 2022, discovering …
- 44% of office-based medical images are self-interpreted by the provider who ordered them.
- Self-interpretation rates varied by modality: ultrasound (52%), X-ray (50%), nuclear medicine (40%), MRI (6.1%), and CT (5.3%).
- As well as by specialty: orthopedic/sports medicine (76%), cardiology (73%), non-physician providers (31%), primary care (20%), and other specialties (38%).
- Larger practices had lower self-interpretation rates, as did practices with a radiologist on-staff.
High image self-interpretation rates could be a patient care issue given that – other than cardiology – non-radiologist physicians don’t usually receive extensive training in image interpretation.
- Imaging overutilization could also be occurring as there are no reimbursement restrictions on in-office self-referring physicians, and studies have shown that the Stark laws failed to achieve reductions in self-referred imaging volumes.
The Takeaway
The new study sheds light on one of healthcare’s most persistent problems – in-office physician self-referral. The question is whether it’s a problem that will eventually take care of itself as healthcare consolidation leads to larger medical practices that are more likely to have radiologists on staff.
