1991年宾夕法尼亚蓝盾保险的参保者在私人诊所进行影像检查时的自我转诊情况。

Self-referral in private offices for imaging studies performed in Pennsylvania Blue Shield subscribers during 1991.

作者信息

Levin D C, Edmiston R B, Ricci J A, Beam L M, Rosetti G F, Harford R J

机构信息

Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107.

出版信息

Radiology. 1993 Nov;189(2):371-5. doi: 10.1148/radiology.189.2.8210362.

DOI:10.1148/radiology.189.2.8210362

PMID:8210362

Abstract

PURPOSE

To define the frequency of physician self-referral for diagnostic imaging studies.

MATERIALS AND METHODS

High-volume radiographic (n = 65) and ultrasound (US) (n = 29) procedural codes in claims filed by Pennsylvania Blue Shield subscribers were analyzed to determine private-office (nonhospital) utilization of these examinations by radiologists and nonradiologists during 1991. A total of 787,703 radiographic and 159,281 US claims were filed.

RESULTS

Nonradiologists self-referred 550,878 radiographic examinations (69.9%) and 99,931 US examinations (62.7%). Patterns of utilization varied considerably by anatomic category: The imaging studies with the highest rates of utilization by nonradiologists were skeletal radiography, vascular US, and obstetric and pelvic US. Aggregate reimbursement allowance by Pennsylvania Blue Shield for all examinations in these 94 codes was approximately $68 million, of which $44 million (65%) went to non-radiologists.

摘要

目的

确定诊断性成像研究中医师自我转诊的频率。

材料与方法

分析了宾夕法尼亚蓝盾保险投保人提交的理赔申请中的大量放射成像（n = 65）和超声（US）（n = 29）程序代码，以确定1991年放射科医生和非放射科医生在私人诊所（非医院）对这些检查的使用情况。共提交了787,703份放射成像理赔申请和159,281份超声理赔申请。

结果

非放射科医生自我转诊了550,878次放射成像检查（69.9%）和99,931次超声检查（62.7%）。使用模式因解剖类别而异：非放射科医生使用率最高的成像研究是骨骼放射成像、血管超声以及产科和盆腔超声。宾夕法尼亚蓝盾保险对这94个代码中所有检查的总报销金额约为6800万美元，其中4400万美元（65%）支付给了非放射科医生。