Orthopedic surgeons who own or lease MRI equipment are more likely to prescribe scans and perform surgery on patients suffering from lower back pain, according to new research.
Investigators at Stanford University School of Medicine compared the scan rates of 1,271 orthopods before and after they acquired MRI equipment, noting that rates increased by 13% for patients who visited surgeons billing for imaging procedures. In addition, they note, patients who were prescribed MRI scans from financially incentivized docs were 34% more likely to undergo back surgery within 6 months.
"These increases in MRI use appear to lead to increases in low back surgery receipt and healthcare spending among patients of orthopedic surgeons," the researchers write in the April online issue of Health Services Research.
Jean M. Mitchell, PhD, professor of public policy at Georgetown University, says the study shows how the effects of physician self-referrals extend beyond the imaging procedure itself. "If the patient hadn't had the MRI, they never would have had the back surgery," she explains, adding, "Medicare spending alone would go down about 25% if self-referral were really policed or eliminated."
Physicians who refer patients to MRIs in which they have financial interests is a complex issue that skirts federal Stark Law oversight. The law's "in-office ancillary services exception" lets physicians refer patients to an MRI owned or leased by their own group practice, says Joshua Kaye, partner at McDermott Will & Emery's Miami office and co-chair of the firm's Ambulatory Surgical Center Industry Practice Group. However, he warns, there are a number of criteria that need to be satisfied.
Currently, the safest way for physicians to have financial interests in MRIs is for only a single group practice to own and operate the MRI and bill for its services as part of their group practice, explains Jerry Sokol, partner at McDermott Will & Emery and co-chair of the firm's Ambulatory Surgical Center Industry Practice Group.
Daniel Cook
