“Orthopedists and primary care physicians who begin billing for the performance of MRI procedures, rather than referring patients outside of their practice for MRI, appear to change their practice patterns such that they use more MRI for their patients with low back pain. These increases in MRI use appear to lead to increases in low back surgery receipt and health care spending among patients of orthopedic surgeons, but not of primary care physicians.”
What is it about patients who see primary care physicians that makes them less likely to get back surgery. I can think of a number of reasons:
- Financial Incentives: Primary care physicians would not be the ones performing the surgery and thus have no financial incentive to favor surgery over rehabiliation. Orthopedists who self-refer the surgery stand to gain thousands of dollars from this decision.
- Provider Selection. Doctors who decide to become primary care physicians may favor less invasive treatment.
- Patient Selection. Patients who visit primary care physicians may favor less invasive treatment. Or, patients who visit primary care physicians may be more likely to have lower income and less generous insurance coverage, and thus may be more likely not to opt for the back surgery.
- Shreibati, J. B. and Baker, L. C. (2011), The Relationship between Low Back Magnetic Resonance Imaging, Surgery, and Spending: Impact of Physician Self-Referral Status. Health Services Research, 46: no. doi: 10.1111/j.1475-6773.2011.01265.x