AJR 2002; 179:843-850.
Kouri BE, Parsons RG, Alpert HR.
As shown in this article, the empiric literature reveals that self-referral constitutes approximately 60-90% of nonhospital radiography and sonography and smaller percentages of imaging in other modalities and settings. Nonradiologists performing their own imaging are at least 1.7-7.7 times as likely to order imaging as non-self-referring physicians in the same specialty who see patients with the same problems. When self-referral consists of referral to an outside facility in which the referring physician has a financial interest, imaging is increased by as much as 54%, depending on the modality. Nonradiologists' interpretation of images is usually less accurate than that of radiologists; the practical significance of this difference in some instances is debated. Other important deficiencies, such as in image quality or patient safety, are up to 10 times as common among nonradiologists as among radiologists, although a very few specialties, particularly cardiology and orthopedics, have records approximating those of radiologists. The limited evidence available generally indicates that increased financial incentives, such as those in self-referral, lead to more imaging and that self-referral involves overutilization.
Legislation has substantially curbed referral to outside facilities in which physicians have a financial interest. To assure quality and contain costs, private insurers have begun to limit physicians to imaging in which they have expertise and to require physician and facility credentialing. These insurers report encouraging results [1,2].