Last updated on April 16, 2014 at 21:24 EDT

Alliance For Integrity In Medicare (AIM) Applauds Government Accountability Office Report Findings On Self-Referrals In Radiation Therapy

August 2, 2013

WASHINGTON, Aug. 2, 2013 /PRNewswire-USNewswire/ — The Alliance for Integrity in Medicare (AIM) — a broad coalition of medical specialty, laboratory, radiation oncology, and medical imaging groups committed to ending the practice of inappropriate physician self-referral – strongly support the findings of the Government Accountability Office (GAO) report released today, entitled “Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny” (GAO-13-525).

The GAO report found “that financial incentives were likely a major factor” influencing self-referring physician behavior. Other GAO reports on advanced diagnostic imaging and anatomic pathology had similar findings. In addition, Medicare expenditures for intensity modulated radiation therapy (IMRT) services performed by self-referring groups “increased rapidly” from 2006 through 2010 by approximately $138 million, as compared to a $91 million decrease in the non-self-referral group. Also during the same time period, IMRT utilization among self-referring groups increased by 456 percent, while the number of IMRT services performed by non-self-referrers decreased by five percent. GAO could not attribute any of these findings to patient preferences, age, geographic location, or patient’s health status.

The report is the third in a series of four reports by GAO on self-referral. The aforementioned findings are significant as they substantiate the results of previous reports on advanced diagnostic imaging and anatomic pathology, as well as many other government and peer-reviewed academic studies on self-referral overall, which point directly to the need to narrow the in-office ancillary services (IOAS) exception to the self-referral law. Taking this action will save patients and the Medicare programs billions, as the existing perverse financial incentives to self-refer advanced diagnostic imaging, anatomic pathology, radiation therapy, and physical therapy services will be eliminated.

Indeed, U.S. Senate Finance Chairman Max Baucus (D-MT) commented on the release of the radiation therapy report in a recent statement: “Unfortunately, when you look at the numbers in this report, you start to wonder where health care stops and where profiteering begins. We have a law on the books designed to prevent these conflicts of interest, but an increasing number of physicians are skirting the law for their own personal gain. Enough is enough. Congress needs to close this loophole and fix the problem.”

In fact, GAO found with regard to advanced diagnostic imaging, “providers who self-referred made 400,000 more referrals for advanced imaging services than they would have if they were not self-referring” at a cost of “more than $100 million” just in 2010. Like the GAO report on anatomic pathology, the advanced imaging report concluded that “financial incentives for self-referring providers were likely a major factor driving the increase in [advanced imaging] referrals.” GAO will issue a report on self-referral in physical therapy in the near future.

The AIM Coalition and its member organizations continue to speak out against the current IOAS exception to the physician self-referral law, for we believe the existing loophole results in increased spending, unnecessary utilization of medical services, and potentially compromised patient choice and care, which erodes the integrity of the Medicare program. Numerous groups, such as the Moment of Truth Project and the Bipartisan Policy Group, in addition to the President’s FY 2014 Budget recommend narrowing the IOAS exception, which could save the Medicare program at least $1.8 billion over the standard 10-year budget window according to the Congressional Budget Office.

Furthermore, the repeated findings of GAO and others on self-referral discredit the self-serving arguments made by opponents of our position. To be clear, AIM supports the provision of the highest quality, safest, and most appropriate care to all patients by providers and believe that it is in the best interests of patients and taxpayers to narrow the IOAS exception and realign the incentives for self-referral. If this change is made, the ability of physicians to order x-rays and routine clinical laboratory tests in order to diagnose and treat patients during office visits will NOT be affected. In addition, AIM supports preserving the ability of truly collaborative and integrated multi-specialty group practices to operate as they do today through the IOAS exception. Indeed, many integrated group practices would not be affected by this change because they utilize other self-referral law exceptions to refer services within their health system. With regard to rural areas, access to care would not be limited, as existing rural exceptions to the self-referral law would be preserved.

The foremost goals of the AIM Coalition are patients continuing to receive the highest quality, most appropriate care and protecting limited Medicare resources. Narrowing the IOAS exception will ensure that both goals may be met, which is beneficial for seniors and health care providers, as well as taxpayers.

Finally, AIM applauds Senators Max Baucus (D-MT) and Charles Grassley (R-IA) and Representatives Sandy Levin (D-MI), Henry Waxman (D-CA) and former Rep. Pete Stark (D-CA) for their bipartisan efforts to investigate this important issue through the GAO reports and for their forceful comments condemning self-referral abuse.

SOURCE The Alliance for Integrity in Medicare (AIM)

Source: PR Newswire