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February 12, 1997

Reducing Rates of Diagnostic Imaging-Reply

Author Affiliations

University of Michigan Medical Center Ann Arbor

JAMA. 1997;277(6):459-460. doi:10.1001/jama.1997.03540300027024

In Reply.  —We thank Dr Greenberg for his interest in our article. Dr Greenberg suggests that 1 reason there was no difference in utilization between the 2 internal medicine services studied was that the physicians were knowledgeable on the subject of appropriateness of radiology testing. We, however, speculated that the complexity of inpatient problems leads to significant clinical uncertainty. That, combined with the need to decrease inpatient length of stay, makes inpatient utilization management difficult and outpatient utilization management more attractive.Dr Greenberg raises concerns that we used the example of in-office self-referral as an area in which utilization management has been successful in the outpatient setting; however, we failed to cite published research that refutes the argument. The article by Hillman et al1 cited in our article and a subsequent article by Hillman et al2 clearly show that nonradiologists who own radiology equipment order more tests than nonradiologists who