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Increase in Diagnostic Imaging Primarily Due to Self-Referring Physicians

By MedImaging staff writers
Posted on 19 May 2008

Physicians in the United States who refer patients to their own facilities or machines for scans account for much of the increase in diagnostic imaging ordered for privately insured patients.

The study was published in the May 2008 issue of the journal Medical Care. Based on a study also appearing in the same issue, Dr. Vivian Ho, professor of medicine at Baylor College of Medicine (BCM; Houston, TX, USA) and associate professor of economics at Rice University (Houston, TX, USA), wrote, "Increases in utilization rates were substantially higher for scans performed by self-referring physicians than for images that originated from a referral to a radiologist or hospital.”

The increase was seen mainly in those patients covered through private insurance that provided the physician with a fee for service reimbursement. In the study upon which Dr. Ho was commenting, Dr. Jean M. Mitchell, professor of public policy at Georgetown University (Washington, DC, USA) reviewed data recorded between 2000 and 2004 from a large private insurer in California. This information was then compared to a report by the U.S. Medicare Payment Advisory Commission. Both reports showed an increased use of imaging tests for those with private insurance.

"Physicians seem to choose the self-referral option, meaning they do the imaging in their own office, because they are reimbursed by private insurance companies,” Dr. Ho said. "The other option would be to refer the patient to a radiologist or an outside diagnostic center.”

U.S. federal law does not allow reimbursements for many self-referral arrangements, unless the imaging is done in-office. This exception is allowed because physicians who perform the procedure in-office are providing a convenience to patients. However, in most cases reviewed in the Mitchell study, the physicians did not have the imaging machinery in their offices. Physicians are able to evade the restriction by leasing an imaging center's facilities and employees for a fixed period per week.

"This creates revenue for both parties involved,” Dr. Ho said. "But it also raises a lot of questions such as would it have mattered if another test had been done, one that didn't receive a reimbursement?” According to Dr. Ho, it is important to note that imaging technology has advanced in the past years and now takes the place of much more invasive diagnostic measures such as surgery. However, she said, no one has evaluated whether one test would have had benefit over another during the course of a patient's illness.

Dr. Ho cited other studies of a trend toward manufacturing and marketing less expensive, lower quality imaging instruments. However, the level of reimbursement, regardless of the cost or quality of the equipment used, remains the same. "The current reimbursement system lacks incentives to provide high quality imaging in a cost effective manner,” she reported in her article.

Finding an answer to this problem will take creativity. "Doing away with the reimbursements will only penalize those physicians who are actually providing imaging in-office as a convenience to their patients,” Dr. Ho said. In her commentary she wrote, "Unfortunately, the legal system, the method of reimbursing physicians, and our lack of tools to monitor appropriateness of testing have led to significant increases in diagnostic imaging, which likely provide little health benefit to patients.”

The solution should involve policy makers, insurers, physicians, and health service researchers. "Only then can we insure that advanced imaging technologies yield a benefit, rather than become a burden to the health care system,” Dr. Ho concluded.

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61 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

62 (!!!!! 7808.9237213135): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

63 (396.9669342041): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

64 (!!!!! 1111.9842529297): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

65 (!!!!! 1114.1300201416): SELECT fid FROM jos_deeppockets WHERE id=282340000 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=282340000 AND published='1' LIMIT 1

66 (!!!!! 1895.9045410156): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=217 ORDER BY `ordering`

67 (!!!!! 4142.0459747314): select jos_twitters.link from jos_twitters where cat=10

68 (496.14906311035): select jos_facebook.link from jos_facebook where cat=10

69 (49.829483032227): select jos_google_plus.link from jos_google_plus where cat=10

70 (164.98565673828): select jos_linkedin.link from jos_linkedin where cat=10

71 (575.06561279297): SELECT fid FROM jos_deeppockets WHERE id=282340000 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=282340000 AND published='1' LIMIT 1

72 (854.9690246582): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=217 ORDER BY `ordering`

73 (702.1427154541): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=282340000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (!!!!! 1240.0150299072): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=282340000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (!!!!! 2558.9466094971): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

76 (720.02410888672): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (53.882598876953): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (141.85905456543): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (379.08554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (180.00602722168): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (451.08795166016): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (193.11904907227): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (604.86793518066): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (!!!!! 5483.865737915): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=282340000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (593.18542480469): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=282340000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (66.995620727539): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

93 (!!!!! 3841.1617279053): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (949.14436340332): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (969.88677978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (169.03877258301): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (132.79914855957): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (!!!!! 5549.1924285889): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (!!!!! 8035.8982086182): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (!!!!! 8109.8079681396): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (!!!!! 7549.0474700928): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (!!!!! 8259.0579986572): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 7572.1740722656): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (!!!!! 7885.9329223633): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (!!!!! 8004.903793335): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (!!!!! 7669.9256896973): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

108 (!!!!! 7380.9623718262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

109 (!!!!! 4762.8879547119): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=282340000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (965.11840820312): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=282340000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 5132.9135894775): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

112 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

113 (!!!!! 4237.8902435303): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=282340000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (!!!!! 1086.950302124): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=282340000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (!!!!! 10296.106338501): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

116 (!!!!! 2698.8983154297): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

117 (!!!!! 3838.062286377): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

118 (124.93133544922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

119 (!!!!! 1204.9674987793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

120 (370.02563476562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

121 (897.16911315918): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

122 (412.94097900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

123 (627.99453735352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

124 (666.85676574707): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

125 (516.17622375488): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

126 (!!!!! 117661.95297241): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

127 (!!!!! 7692.0986175537): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=282340000 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=282340000 AND type='deeppockets_item' AND published='1' LIMIT 1

128 (!!!!! 7512.092590332): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

129 (!!!!! 5298.1376647949): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

130 (!!!!! 1558.780670166): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

131 (650.88272094727): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

132 (814.19944763184): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

133 (344.99168395996): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

134 (60.081481933594): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

135 (45.061111450195): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

136 (441.07437133789): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

137 (179.05235290527): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

138 (!!!!! 1425.02784729): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (706.91108703613): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

140 (!!!!! 1461.0290527344): SELECT name FROM jos_deeppockets WHERE id=217

141 (298.97689819336): SELECT name FROM jos_deeppockets WHERE id=217

142 (717.8783416748): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))217((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (!!!!! 3012.1803283691): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))217((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

144 (!!!!! 1827.0015716553): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

145 (!!!!! 1394.9871063232): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

146 (!!!!! 12831.926345825): TRUNCATE TABLE jos_trademed_module

147 (!!!!! 5599.9755859375): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=282340000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (!!!!! 2334.1178894043): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=282340000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

149 (!!!!! 2609.0145111084): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (647.06802368164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

151 (!!!!! 7458.9252471924): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

152 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

153 (!!!!! 5347.9671478271): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

154 (!!!!! 4972.9347229004): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

155 (674.96299743652): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

156 (227.92816162109): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=282340000 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=282340000 AND type='deeppockets_item' AND published='1' LIMIT 1

157 (364.06517028809): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=217 or channel_id is null)

158 (205.99365234375): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=217 or channel_id is null)

159 (439.88227844238): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

160 (!!!!! 1169.2047119141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

161 (!!!!! 1240.0150299072): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=282340000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=282340000 AND published='1' LIMIT 1

162 (319.00405883789): select jos_twitters.link from jos_twitters where cat=10

163 (208.85467529297): select jos_facebook.link from jos_facebook where cat=10

164 (!!!!! 1637.9356384277): select jos_google_plus.link from jos_google_plus where cat=10

165 (452.99530029297): select jos_linkedin.link from jos_linkedin where cat=10

166 (788.21182250977): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

167 (!!!!! 1376.8672943115): insert into jos_banners_delta values (14202,'2025-08-19 10:43:22','216.73.216.0','view'),(14203,'2025-08-19 10:43:22','216.73.216.0','view')

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