Imaging self-referral associated with higher costs and limited impact on duration of illness

Self-referral for imaging services occurs when a physician sends patients to receive an imaging procedure from a device that the physician owns or leases. Advocates argue that this shortens the duration of illness and lowers costs. For twenty common combinations of medical conditions and types of imaging, we evaluated the association between self-referral, duration of illness episode, and three measures of cost. Self-referral was associated with significantly and substantially higher episode costs for most of the combinations of medical conditions and imaging that we studied. There was no decrease in the length of illness, except when doctors self-referred patients to receive x-rays for a few common conditions. These findings indicate that except for x-rays, constraining the self-referral of imaging may be appropriate.