Doctor Self-Referral: Should You Get That X-Ray or CT Scan?

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I am also a doctor, a radiologist. I can tell you, and so can my professional society, the American College of Radiology, that this phenomenon is very expensive. In one study the ACR showed using Medicare data that when a patient shows up at a doctor's office complaining of a cough, the doctor who owns the x-ray machine orders a chest x-ray four times more often and bills 50% more. That is 600% over what other responsible physicians cost regarding x-rays.
Kristina, your castigation of our "ill-informed president" is ill-informed. I can tell you with absolute certainty, I have watched the ordering habits of physicians change when they buy a CT scanner. One sub-specialty group increased it's ordered studies by a factor of three. Regarding the risks of medical radiation, I would say Mike Hanley above covers it well.
David, I'm glad you are better, but my joy is tempered by your wish for my death.

Tim H of GA 3:14PM August 03, 2009

Really? I am a doctor and I don't make ANY money when I order any imaging test or labs. We do have a CT scanner in our multispecialty office and I am happy to say I have made many valuable diagnosis with it and avoided hospitalizations and ER visits for many of my patients - essentially saving money to the government and our taxpayers. The majority of physicians nowadays are employees of multispecialty clinics or hospital employees. We are paid only for visits or are salaried. Again, we are not paid for labs, xrays or CT scans! I am tired of hearing this misinformation which was started by our ignorant President.
I am aware that most emergency rooms however, do every lab and CT scan they can because hospitals have discovered that this is less expensive than receiving a lawsuit down the road with a missed diagnosis. This is a fact and the reason why as a resident I was told while doing my ER rotation, to check every lab and do a CT on everyone. This is a result of malpractice and lawsuits, something that is completely absent from our current "healthcare reform" Of course, that wouldn't have anything to do with the contributions made to the Democratic National Committee from all the lawyers? Yes, lawyers do a much better job of buying our congressmen than doctors do, guess thats why we always get screwed or have some lies spread about us while they continue collecting 40% from claims paid.
Primary care doctors are not paid for interpreting EKGs as cardiologist are, for time spent interpreting your labs, arranging home health, home care, end of life counseling, arranging prior authorizations to get you the medicines, scans or studies you need, answering phonecalls or emails. We essentially work for free most of the time, because paperwork takes an enormous amount of time.
You are undermining the reputation of hard working ethical physcians with ill informed lies. Next time you go to your primary care doctors office, try saying Thank You, it would be nice for a change.

Cristina of FL 9:17AM August 03, 2009

Medical decisions always involve weighing the risks and benefits of a procedure or medication. CT scans that will potentially provide life saving information should not be avoided for fear of an assumed small increased risk of cancer. You can visit www.xrayrisk.com to calculate individual risk based on CT scans or x-rays you have had.

Mike Hanley of SC 10:16PM August 02, 2009

i think all of you are so short sited.
i went to the doctor with a persistent cough.
he sent me for a CAT scan, much to my surprise.
but the scan showed abscesses in my lungs.
what i would have normally done with my old school doctor was probably get so infected i die.
now i have 14 days of out patient injections.
but without my doctor sending me to his really expensive machine, i would be dead.
the hell with all you people living in the past.
die
]

david Sander of NJ 6:47PM August 02, 2009

I always wondered why after so much being done for the consumer.. people still complain. @Donna.. I completely agree to the fact that suing is a problem. But one of the problem is that Doctors fail to realize that they did not have Cost estimation as a course in their undergraduate years. There is no need for all doctors to have scanning machines. Have a centralized scanning machine and doctors recommend the patient to get scanned at that place. This will help lower costs of operation by having the scanning machines operate to capacity. Four or five scans would not make a difference then because overall costs have reduced as local doctors would recommend scanning at the centralized scanning machine. This should even reduce chances of lawsuits.
Its time that healthcare industry should stop advertising new scan machines and the number they have. Rather it time for 'DEALS TO BUY'

Akiev Samson of NY 12:12PM August 02, 2009

I'm a physician, and self referral, particularly for imaging studies, is all about making money for the ordering doctors. "Patient convenience" is just a sham excuse. It's also one of the worst contributing factors for the escalation in health care costs. The numbers in the article don't lie; isn't it interesting how one's ordering of CT scans goes up four times when there's suddenly a scanner they own that needs to be run at capacity to make a profit?
What most folks don't know is also that when they are getting a scan at one of these doctor owned scanners, they are often getting a sub-par imaging study and the reading radiologist is also often the "low bidder" and typically not the best radiologist in town. This often results in missed or incorrect diagnoses or the recommendation for more unnecessary studies due to the inability to correctly diagnose what’s on the scan.
I'd advise avoiding any physician owned scanner in an office with any financial interest in said scanner. I'd also advise avoiding stand alone outpatient imaging centers for similar reasons (not affiliated with hospital/health care networks), but that’s another story.

Matt of FL 9:09AM August 02, 2009

How can anyone take your article seriously when all your points are made with unbacked up rhetoric slandering doctors?
Why not bring up the points that 'some' doctors are overly cautious because they're afraid of being sued for missing something? I have lived in 3 different areas of the country, and have never had a doctor prescribe something that didn't make sense at the time. But nearly every doctor and dentist I've seen, sometime in our relationship mentioned the fear of being sued over something minor or ridiculous, or how malpractice insurance was damaging their ability to practice the way they wanted to.
It is disgusting the implications that you, and unfortunately our current president, are making towards a profession WITHOUT ANY DAMN EVIDENCE. I for one trust my relationship with my doctors, and you and Obama and Vedantam can go jump in a lake! Oh, and by the way my insurance is an HSA, we have 3 young kids, and are not rich or even close to it. Economic and social justice? We'll make our own, thank you very much!!!!

Donna of TX 2:04AM August 02, 2009

because you are on a government plan, then it's best to avoid optional diagnostics until health care reform is done, especially if you're self-employed.
You'll be sicker than you already were if you create a record of a pre-existing condition and have that "record" operate to take all the money you have--in order to get insurance or care up through age 65. MANY OF YOU HAVE NO IDEA HOW EXPENSIVE THIS CAN GET IF YOU HAVE TO CHANGE POLICIES AND ACTUALLY BUY A NEW ONE.
Yes, private sector people, I'm talking to YOU. Your government-employee neighbors have got it made compared to you. If you hear some school teacher or firefighter or cop or soldier or bureaucrat bad-mouthing national health care reform---call 'em on it. They're sucking you dry and you're the one on the high wire with no net. So DON'T TOLERATE SMARTY-PANTS PUBLIC SECTOR PEOPLE SAYING, "WELL, I THINK OUR PRESENT SYSTEM IS FINE". They are a protected class. You're not.

Muser of NM 2:43PM August 01, 2009