Reducing Payment for Imaging in Referring Doctor's Facility Does Not Reduce Utilization

Impact of curtailing payment for imaging in referring doctor's facility

From 1994 to 1996, researcher teams at the University of Virginia and the Primary Care Outcomes Research Institute (PCORI) at the New England Medical Center conducted two distinct but parallel studies of:

  • Cost and utilization.
  • Patient satisfaction and health outcomes associated with a payment reduction for diagnostic imaging among physicians who served beneficiaries of the United Mine Workers of America Health and Retirement Funds.

An additional cost/utilization study by one of the research teams sought to determine if physicians who own their own diagnostic imaging equipment and charge for both performing and interpreting these tests are more likely to order more imaging tests per episode of care than physicians who refer patients to radiologists.

The research team operated under contract with the United Mine Workers of America Health and Retirement Funds.

Key Findings: Key findings of the two studies and the additional study are as follows:

  • The cost and utilization study suggests that the imaging reimbursement policy had no consistent impact on utilization or costs.
  • The health outcomes and patient satisfaction study suggests that the imaging reimbursement policy had little if any effect on the utilization practices of self-referring physicians.
  • The additional study of diagnostic imaging utilization trends among physicians found that after the new payment policy, there were increased numbers of claims and greater expenditures.
  • Whether one or the other study tells a more accurate story of utilization changes is not evident; however, neither supports the expected decrease in costs and utilization in response to the decrease in reimbursement.
  • The results suggest that even a 30 percent fee reduction may not affect utilization.