Physicians and Outpatient Diagnostic Imaging: Overexposed?-Reply

In Reply. —We thank Drs Alagona, Cooley, and Varipapa for their interest in our research. Their letters do not directly address the design or findings of our study—that depending on the patient's clinical presentation, self-referral for diagnostic imaging examinations in office practice results in 1.7 to 7.7 times higher utilization and 1.6 to 6.2 times higher costs than when physicians refer their patients to radiologists. Rather, they present, in anecdotal fashion, their perceptions about some related issues, specifically patient convenience, the relative quality of imaging by radiologists and self-referring physicians, and radiologists' suggesting follow-up studies. As Alagona notes, it is more convenient for patients to receive imaging examinations in the offices of their physicians. However, implicit in Alagona's statement is that "convenience" may importantly contribute to the observed higher utilization by promoting the performance of marginal examinations that otherwise might not be performed. The policy issue raised by our research