Study: Self-employed urologists double imaging orders of employed docs
Self-employed urologists are nearly twice as likely as their employed colleagues to order imaging, according to an analysis published in the December issue of the Journal of Urology.
In the last decade, advances in imaging technology have correlated with a substantial increase in the volume of radiology services and healthcare expenditures. Policymakers require a better understanding of the relationship between medical uncertainty, local idiosyncratic behavior and the growth of imaging, offered lead author John M. Hollingsworth, MD, assistant professor in the department of urology at the University of Michigan in Ann Arbor.
To help address the question, Hollingsworth and colleagues devised a study to determine the impact of physician employment status on diagnostic imaging ordering patterns among urologists.
The authors leveraged data from the National Ambulatory Medical Care Survey (NAMCS) to identify outpatient urology visits between 2006 and 2007 and extracted three common conditions with broad guidelines for imaging: BPH (benign prostate hyperplasia), urolithiasis and hematuria. Urologists were identified as full or part practice owner or employed, and the researchers assigned a binary indicator corresponding to employment status.
Rates of diagnostic imaging use served as the primary outcome, and imaging modality (bone densitometry, CT/MRI, ultrasound or x-ray) provided the second outcome.
Urologists ordered imaging as part of 22.4 percent of the 37.2 million outpatient visits during the study. Nearly two-thirds of the imaging tests were indicated for BPH, urolithiasis or hematuria evaluations, according to the authors. Ultrasound was the most common imaging study ordered at 60.2 percent of visits involving imaging.
Although imaging use did not vary by patient or practice characteristics, it varied significantly by provider characteristics, reported Hollingsworth and colleagues. Specifically, self-employed urologists more commonly ordered imaging than employed urologists at 24.2 percent versus 13.2 percent, respectively, which translated into a nearly two-fold increase in odds of imaging.
Hollingsworth and colleagues identified several possible causes for the finding, including:
The authors cited several limits to the study. They could not discern the incidence of prior imaging studies nor could they relate imaging to subsequent patient outcomes.
“[T]hese data suggest that in the same patient a medical problem would be evaluated (and perhaps treated) differently by employed vs. self-employed urologists,” wrote Hollingsworth. The authors suggested payment bundling, with reimbursement consisting of a fixed amount to cover the cost of a full range of care during an episode, as a possible strategy to reduce imaging incentives.
In the last decade, advances in imaging technology have correlated with a substantial increase in the volume of radiology services and healthcare expenditures. Policymakers require a better understanding of the relationship between medical uncertainty, local idiosyncratic behavior and the growth of imaging, offered lead author John M. Hollingsworth, MD, assistant professor in the department of urology at the University of Michigan in Ann Arbor.
To help address the question, Hollingsworth and colleagues devised a study to determine the impact of physician employment status on diagnostic imaging ordering patterns among urologists.
The authors leveraged data from the National Ambulatory Medical Care Survey (NAMCS) to identify outpatient urology visits between 2006 and 2007 and extracted three common conditions with broad guidelines for imaging: BPH (benign prostate hyperplasia), urolithiasis and hematuria. Urologists were identified as full or part practice owner or employed, and the researchers assigned a binary indicator corresponding to employment status.
Rates of diagnostic imaging use served as the primary outcome, and imaging modality (bone densitometry, CT/MRI, ultrasound or x-ray) provided the second outcome.
Urologists ordered imaging as part of 22.4 percent of the 37.2 million outpatient visits during the study. Nearly two-thirds of the imaging tests were indicated for BPH, urolithiasis or hematuria evaluations, according to the authors. Ultrasound was the most common imaging study ordered at 60.2 percent of visits involving imaging.
Although imaging use did not vary by patient or practice characteristics, it varied significantly by provider characteristics, reported Hollingsworth and colleagues. Specifically, self-employed urologists more commonly ordered imaging than employed urologists at 24.2 percent versus 13.2 percent, respectively, which translated into a nearly two-fold increase in odds of imaging.
Hollingsworth and colleagues identified several possible causes for the finding, including:
- The threat of medical liability may lead to assurance behavior on the part of self-employed urologists;
- Fragmented healthcare delivery may lead to duplicative studies, a suggestion supported by the lower rates of imaging in urology clinics in fully integrated networks;
- Motivated by financial gain, self-employed urologists may substitute diagnostic imaging for a clinical history and physical examination in an effort to boost throughput and efficiency; and
- The availability of in-office imaging may encourage self-employed urologists to generate revenue by referring patients for in-office imaging studies.
The authors cited several limits to the study. They could not discern the incidence of prior imaging studies nor could they relate imaging to subsequent patient outcomes.
“[T]hese data suggest that in the same patient a medical problem would be evaluated (and perhaps treated) differently by employed vs. self-employed urologists,” wrote Hollingsworth. The authors suggested payment bundling, with reimbursement consisting of a fixed amount to cover the cost of a full range of care during an episode, as a possible strategy to reduce imaging incentives.