According to a new study, one in six physicians in 2008 reported that their practice owned or leased advanced imaging equipment.
Funded by the Robert Wood Johnson Foundation and released last week by the Center for Studying Health System Change, the study reports that physician practice ownership or leasing of a broad array of medical equipment, ranging from equipment for laboratory testing to invasive procedures, is quite common.
Policy makers have long been concerned that physicians owning or having a financial interest in medical facilities and equipment would make more referrals than medically necessary. Since the mid-1990s, the federal physician self-referral law, commonly known as the Stark Act, has prohibited physicians from self-referring Medicare and Medicaid patients to certain health services, ranging from clinical laboratory services to advanced imaging services. However, there are numerous exceptions to the self-referral prohibitions, most notably if the service is provided within the physician's office or practice.
While previous research on physician self-referral has focused on particular services, such as advanced imaging, there has been little national information about the breadth of physician ownership or leasing of medical equipment. HSC's 2008 Health Tracking Physician Survey asked physicians whether their main practice owned or leased equipment used for:
- Laboratory testing, including routine blood work;
- X-rays;
- Other diagnostic imaging, such as CT or MRI scans;
- Non-invasive testing aside from electrocardiograms or EKGs (e.g. echocardiograms, treadmill, nuclear testing, sleep testing); and
- Invasive procedures, such as endoscopy or cardiac catheterization.
Of 2,750 physicians in community-based, physician-owned practices, 25.2 percent reported their practice owned or leased equipment for laboratory services, 22.7 percent for X-rays, 17.4 percent for advanced imaging, 28.9 percent for non-invasive procedures and 11.4 percent for invasive procedures.
Overall, the study found that almost one in seven physicians (13.2 percent) reported that their practice owned or leased three or more types of equipment.
The study was co-authored by HSC Senior Researcher James Reschovsky, PhD, HSC Public Affairs Director Alwyn Cassil and former HSC Senior Researcher Hoangmai H. Pham, MD.