Footnote:
In: Medical Care, Vol. 49, No. 9, pp. 857-864, 2011
Nach Informationen von SSRN wurde die ursprüngliche Fassung des Dokuments September 20, 2011 erstellt
Description:
As the cost of both chronic care and diagnostic imaging continue to rise, it is important to consider methods of cost containment in these areas. Therefore, it seems important to study the relationship of self-referral for imaging and the cost of care of chronic illnesses. Previous studies, mostly of acute illnesses, have found self-referral increases utilization and, thus, probably imaging costs. To evaluate the relationship between physician self-referral for imaging and the cost of episodes of chronic care. Using Medicare’s 5% Research Identifiable Files for 2004-2007, episodes of care were constructed for 32 broad chronic conditions using the Symmetry Episode Treatment Grouper. Using multivariate regression, we evaluated the association between whether the treating physician self-referred for imaging and: total episode cost, episode imaging cost, and episode non-imaging cost. Analyses controlled for patient characteristics (e.g. age and general health status), the condition’s severity, and treating physician specialty. Self-referral in imaging was significantly (P=<.01) associated with total episode costs in 41 of the 76 medical condition and imaging modality (CT, MRI, etc.) combinations studied. Total costs were higher in 38 combinations and lower in three. Even non-imaging costs were much more often significantly higher (in 24 combinations) with self-referral than lower (in 4 combinations). We find broad evidence that physician self-referral for imaging is associated with significantly and substantially higher chronic care costs. Unless self-referral has empirically demonstrable benefits, curbing self-referral may be an appropriate route to containing chronic care costs