Poisonings Top Crashes for Injury-Related Deaths

Abstract

cer of the American College of Cardiology (ACC), defended cardiologists owning their own testing equipment. “Obviously there is a perverse incentive when physicians own the equipment they are billing for on a fee-forservice basis, but the reality is most physicians are cognizant to use that equipment appropriately, knowing [regulators and payers] are looking over their shoulders,” Lewin said. “Officebased equipment is today’s stethoscope; your cardiologist sees you in his office, offers a test, you immediately get the results, and you go home. It is a patient convenience, and it is also a less stressful approach for the patient to know what is happening immediately instead of waiting weeks to get a result.” But other research contradicts the patient-convenience argument. Analysis of 2006 and 2007 Medicare data showed self-referral resulted in same-day imaging for straightforward x-rays, but only 15% of self-referred advanced imaging, such as computed tomography or MRI, occurred on the same day. The researchers speculated that using such advanced imaging equipment on essentially a walk-in basis is inefficient, so physicians have patients schedule appointments to bunch them together (Sunshine J and Bhargavan M. Health Aff [Millwood]. 2010;29[12]:2237-2243). Lewin said the real issue is not selfreferral but inappropriate imaging, regardless of the setting. “Price control will not curtail imaging costs,” Lewin said. “What we need to do is pay for quality. In cardiology we have appropriate use criteria for all the imaging modalities, and these tools, at the point of care, can suggest what the best test would be or if a test is even needed. We can reduce the cost of imaging using these modalities.” Another researcher who has followed the self-referral issue, David Levin, MD, emeritusprofessorofradiologyatThomas JeffersonUniversity inPhiladelphia, said the ACC has tried to reduce the perverse incentives of self-referral, but this effort cannotovercomehumannature.“Iagree that appropriate use criteria are very important,”Lewinsaid. “Theproblemis it is too easy to game the system.”