Journal of the American College of Radiology : JACR
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The participants of the 2004 Intersociety Conference met to discuss the growing problem of self-referral. The United States spends more of its gross national product on health care than other countries, especially Japan and those in Western Europe. Imaging accounts for a large and growing portion of those costs. ⋯ Thus, conference participants agreed that the real problem is inappropriate use, which may arise from (1) ignorance of what specific imaging studies are needed when, (2) high public expectations for imaging tests, (3) the fear of liability for a missed diagnosis (defensive medicine), and (4) self-referral. The Stark laws have been largely ineffective in preventing self-referral because there are many loopholes, and the laws are inconsistently enforced. Among the many potential solutions are the education of our clinical colleagues on appropriateness criteria; the education of the public on the costs of inappropriate use; tort reform; and working with third-party payers, especially the private insurance industry, to develop vigorous privileging programs, to require precertification for self-referred studies, or to establish differential payments for self-referred and non-self-referred imaging.
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The controversy over the role of the "expert" in medical litigation is in some ways the product of semantic confusion. Many physicians mistake the legal definition of an expert with that of ordinary usage, further fueling the resentment of doctors who testify against other doctors. Legally, however, an expert is simply one qualified to offer an opinion. ⋯ Although expert testimony, as defined above, is necessary in most medical malpractice cases, that need is obviated when negligence is so obvious that the law presumes that a lay jury can discover it. Abuses of expert testimony are real. They are, however, in some part the consequence of some of the best doctors' refusal to assist the victims of malpractice, creating a vacuum that the less scrupulous fill.
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During the past 10 years, there have been a number of large health care mergers in which at least one partner has been an academic medical center. This review summarizes the definitions, attributes needed for success, and reasons for failure of mergers. It then describes the various mergers and their outcomes and discusses the impact of the mergers on the involved radiology departments.