Entrepreneurial imaging centers raise important issues about self-referral

Regarding "Image conscious" (Article, May 17): Singularly lacking in your article was any analysis of the impact that self-referral of expensive imaging procedures has on the cost, and cost-effectiveness of health care.

Numerous studies have shown that nonradiologists who perform imaging studies order them at significantly higher rates than do those who refer to radiologists, without any evidence that care of those patients is improved. Your article not only failed to deal with this, but seemed to justify the ever-increasing number of CT and MR devices as an appropriate entrepreneurial adventure.

There are several reasons for the organized medical community to review such attitudes. With accelerating medical costs again occupying center stage in the public consciousness we need to be seen as advocates for efficient and high quality care delivery, not as advocates for every means to squeeze a few more dollars out of the system.

Self-referred imaging fails both counts. It encourages overutilization of expensive resources, and, by virtue of being a sideline rather than the center of a practice, is often of lower quality than the sort of work produced by imaging specialists.

Finally, the temptation to order a study of dubious necessity because it might just turn out to be helpful, creates an avoidable ethical question. No longer is the diagnostic utility of the examination the only factor that needs to be assessed; now the honest practitioner must wonder whether the potential for profit is influencing a clinical decision.

By requiring that any study that is not necessarily part of an office visit be performed by someone other than the referring doctor, or associate, we would go a long way toward saving wasteful imaging practices, radiation exposure, and our reputation as a profession.

Michael Komarow, MD, Wappingers Falls, N.Y.

Editor's note: Dr. Komarow is a radiologist and chief medical officer for CareCore National LLC, a radiology benefit management company.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/06/07/edlt0607.htm.