title: Ownership or leasing of CT scanners by nonradiologist physicians: a rapidly growing trend that raises concern about self-referral.
abstract: OBJECTIVE
  The aim of this study was to examine recent nationwide trends in the ownership or leasing of computed tomographic (CT) scanners in private offices by nonradiologist physicians.
  
  
  METHODS
  The Medicare Part B fee-for-service data sets for 2001 though 2006 were used to identify all CT scans performed in nonhospital, private-office settings. Ownership or leasing of CT scans was determined by tabulating all global and technical-component-only claims. Professional-component claims were excluded. The specialty of the owner or lessee was determined using Medicare's physician specialty codes. Procedure volume trends and growth rates among all nonradiologist physicians as a group were compared with those among radiologists. Individual specialty volume trends and growth rates were also studied.
  
  
  RESULTS
  From 2001 to 2006, Medicare private-office CT scan volume in facilities owned by radiologists increased by 85%. CT scan volume in facilities owned or leased by nonradiologist physicians as a group increased by 263%. The nonradiologic specialties with the largest volumes in 2006 were primary care (192,255 scans), internal medicine subspecialties other than cardiology and medical oncology (184,991 scans), urology (125,850 scans), cardiology (104,739 scans), and medical oncology (61,976 scans). Excluding CT scans performed in independent diagnostic testing facilities (for which physician ownership cannot be determined), nonradiologists' private-office CT market share rose from 16% in 2001 to 28% in 2006.
  
  
  CONCLUSIONS
  The majority of Medicare private-office CT scans are done in facilities owned by radiologists. However, nonradiologist physicians are acquiring or leasing CT scanners in increasing numbers, and the growth trend is much more rapid among them than it is among radiologists (85% among radiologists from 2001 to 2006, compared with 263% among nonradiologists). As a result, nonradiologists' market share has increased considerably. At a time when both cost containment and reduction in radiation exposure are urgent priorities, the self-referral opportunities resulting from this trend should be of concern to payers and policymakers.
authors.affiliation: Department of Radiology, Center for Research on Utilization of Imaging Services, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA. david.levin@mail.tju.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Levin
authors.forename: Vijay M
authors.initials: VM
authors.lastname: Rao
authors.forename: Laurence
authors.initials: L
authors.lastname: Parker
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Frangos
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Sunshine
mesh_terms: D016265:Conflict of Interest; D007860:Leasing, Property / Q000706:statistics & numerical data* / Q000639:trends*; D010067:Ownership / Q000706:statistics & numerical data* / Q000639:trends*; D018584:Physician Self-Referral / Q000706:statistics & numerical data* / Q000639:trends*; D010820:Physicians / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000295:instrumentation* / Q000706:statistics & numerical data*; D014481:United States