According to a new study by the Neiman Healthy Policy Institute, office-based physicians are interpreting hundreds of thousands of medical images they ordered themselves each year, rather than sending them to trained radiologists.
The study, published April 1 in the American Journal of Roentgeology, found that nonradiologists working in physician offices ordered over 1.6 million imaging exams for Medicare beneficiaries in 2022. Of those, they interpreted about 43.6% themselves, as opposed to review by radiologists.
Researchers used the CMS 5% research identifiable file for 2022 to identify claims for office-based, nonbreast diagnostic imaging ordered by nonradiologists for a nationally representative sample of Medicare fee-for-service beneficiaries. Only 36.4% of those claims were interpreted by radiologists, and 58.5% were interpreted by another clinician within the same practice as the referrer.
Ordering physicians self-interpreted about 50.4% in radiography and fluoroscopy, 52% for ultrasound, 39.5% of nuclear exams, 6.1% MRIs and 5.3% of CT scans.
The odds of a physician self-interpreting images were typically lower if they had a radiologist working within the practice and if the practice employed 500 or more physicians. Among specialties, orthopedic/sports medicine specialists accounted for the largest share of physician self interpretation at 75.7%, followed by cardiologists at 73%.
Vijay Rao, MD, a co-author of the study and senior vice president of enterprise radiology at Jefferson Health in Philadelphia, said in a statement that the study’s findings indicate a need for federal policy reform.
“Our results raise potential implications for quality of patient care. Nonradiologist specialties, aside from cardiology, lack the rigorous and comprehensive training in imaging interpretation that occurs during the four years of a radiology residency program,” he said in the statement. “The large differences between radiologists and nonradiologists in interpretation training could lead to differences in diagnostic accuracy.”
The authors note that there are currently few restrictions around imaging interpretations handled by nonradiologists. While concerns about potential conflicts of interest resulted in the implementation of Stark law many years ago, the law’s exception for in-office ancillary services allows for providers to refer patients for certain services, such as imaging.
“To address ongoing concerns regarding self-referral, some health plans have instituted privileging programs that limit the imaging that may be performed by certain specialties, for example limiting orthopedic surgeons to performing skeletal [X-rays] or OB-GYN physicians to performing gynecologic [ultrasounds],” the authors wrote. “Nonetheless, given reported growing rates of imaging interpretation by nonradiologists, potentially associated with self-interpretation, broader federal action may be warranted, including possible modification of the in-office ancillary exception to the Stark Law to more strongly limit nonradiologist interpretation.”
The authors note that workforce shortages were a likely factor behind why physicians may choose to self-interpret images.
