Self-Employed Urologists Order More Diagnostic Imaging, Study.

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digital radiography newsA patient with a certain medical condition may be more likely, as much as twice, to undergo a diagnostic imaging test such as x-ray, CT, ultrasound, after consulting a self-employed urologist compared to an employed urologist on salary, according to a new study. Regardless other factors that may play a role, the finding focuses on increasing evidence for the role of financial incentives in physician attitude and the influence of this attitude on elevating healthcare costs in the Unites States. Dr. John M. Hollingsworth, of the University of Michigan Medical School in Ann Arbor, author of the study, said: "In the same patient, a medical problem would be evaluated, and perhaps treated, differently by employed versus self-employed urologists."

Financial incentives derive urologists to order more tests.

Dr. John and his colleagues highlighted in the Journal of Urology that the heaviness of work does not affect the salary of most employed physicians, on contrast to the self-employed who can increase their income by examining more patients or ordering more diagnostic tests. With declining real-dollar incomes, this source of new revenue may be attracting for some doctors. The researching team looked at more than 37 million outpatient visits to urologists across the U.S., using data from the National Ambulatory Medical Care Survey conducted in 2006 and 2007. Four out of every five physicians surveyed were self-employed. They found more than one out of every five urology visits resulted in imaging. Most of the imaging tests were indicated for a benign enlargement of the prostate, kidney stones or presence of blood in urine. Ultrasound was the most commonly selected diagnostic imaging test.

This use of diagnostic testing did not differ by factors such as the patient's age, gender or Medicaid eligibility, nor by the doctor's practice type or location. Self-employed urologists, however, were approximately twice as likely to order diagnostic imaging compared to employed urologists: 24 % versus 13 %. Hollingsworth noted that financial incentives may be a leading cause of this difference but other possibilities are also present such as patient preference, legal concerns and intolerance of medical ambiguity. Regardless of the underlying reason, this trend of frequent ordering of diagnostic imaging could lead to unintended consequences for patients, including a modest increase in radiation exposure and over-diagnosis of "pseudo-disease," Hollingsworth pointed out. The use of imaging is being increased in recent years as a result of advances in the technologies behind the tools. Hollingsworth said: "With physicians controlling much of the demand for imaging, strategies to affect its use should consider the methods by which providers are compensated." He added that these findings are directly relevant to some of the healthcare reform measures in the Affordable Care Act of 2010. Hollingsworth finally noted: "Under the new healthcare law," told Reuters Health, "the Center for Medicare and Medicaid Innovation is charged with testing new reimbursement models, which include varying payment to physicians who order advanced diagnostic imaging services as defined according to the physician's adherence to appropriateness criteria of such services. It will be interesting to see how such a change will impact utilization among self-employed and employed urologists."

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