Imaging: the self-referral boom and the ongoing search for effective policies to contain it

When a physician who isn't a radiologist holds an ownership interest in an advanced imaging machine and refers patients for diagnostic procedures on that machine, this act of self-referral presents a conflict of interest. Numerous studies demonstrate greater use of high-tech imaging when physicians can financially benefit from such referrals. This overview summarizes the issues surrounding imaging self-referral and reviews the history of attempts to control it, as well as options for limiting its impact on spending. Recent payment reductions by Medicare limited the rewards for imaging self-referral, and the Affordable Care Act mandated disclosure of physicians' ownership interests. However, the rewards for imaging self-referral remain strong. Policy makers continue to search for the right mechanisms for containing the practice and for assuring that Medicare beneficiaries receive only medically necessary imaging studies, regardless of who owns or operates the equipment.