Hospital-employed physicians more likely to order unneeded MRIs, study finds

Patients of physicians employed by hospitals are more likely to receive inappropriate referrals for diagnostic imaging, according to a study published May 3 in Health Affairs.

The study — led by researchers from Boston-based Northeastern University, Stonehill College in Easton, Mass., and Boston University — is based on commercial health insurance claims from the Massachusetts All Payer Claims Database, as well as Medicare claims data and data from health plans. Data was collected for MRI referrals for three conditions — uncomplicated lower back pain, nontraumatic knee pain without joint effusion, and nontraumatic shoulder pain without joint effusion — for 2009 through 2016.

For the study, researchers compared a study cohort of 583 primary care physicians who became employed by a hospital in Massachusetts from 2009 through 2016 with 3,102 Massachusetts physicians who were not employed by a hospital during the study period. 

The study found an association between hospital employment of physicians and patients' likelihood of receiving MRI referrals generally. For the study cohort, researchers also found that patients' likelihood of receiving inappropriate MRI referrals climbed by 26 percent related to hospital employment of physicians.

Additionally, researchers said physicians were more likely to refer patients for MRIs once they were employed by a hospital than before that employment began. 

"Our findings are in line with previous studies that have reported an association between hospital-physician integration and higher costs for patient care," the study's authors concluded. "However, our findings offer evidence that such higher costs are not largely a matter of better service access for patients. Rather, hospital-physician integration appears to be a potential driver of low-value care."

Read more about the study here.

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