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    MedPAC's self-referral suggestions under fire

    Related provision of health reform law to take effect soon

    Bob Gatty
    Washington—The debate over questions of self-referral and inappropriate utilization of medical imaging services by physicians is continuing in Washington, with possibly restrictive recommendations looming from the Medicare Payment Advisory Commission (MedPAC) and provisions of the health reform law being implemented.

    In late September, the AUA and the American Association of Clinical Urologists joined a group of other physician organizations in a letter to MedPAC expressing concerns about options being considered by MedPAC to control "inappropriate growth in diagnostic imaging services performed in physician offices."

    In its June 2010 report to Congress, entitled "Addressing the growth of ancillary services in physicians' offices," MedPAC suggested several policy options, including:

    • Limit the "group practice" exemption under the federal self-referral law to physician practices that are "clinically integrated." Each physician in the group could be required to provide a substantial share of services, such as 90%, through the group.
    • Exclude imaging services that are not provided with office visits from the in-office ancillary services exemption.
    • Further reduce Medicare payments for diagnostic imaging.
    • Require pre-authorization of self-referred advanced diagnostic imaging services.

    Letter protests MedPAC suggestions

    Fast Facts
    In an Aug. 27 letter to MedPAC, the groups took issue with each of those recommendations and urged the commission to "refrain from recommending" any of those options. They said the analysis and policy recommendations by MedPAC rest on several "faulty and out of date assumptions," including:
    • Imaging continues to grow faster than physician services generally.
    • Self-referred services account for a large proportion of imaging services, particularly inappropriate imaging services.
    • The major benefit of the in-office ancillary service exception is patient convenience.
    • Excess profits built into payment rates drive overutilization of imaging by self-referring physicians.

    In a follow-up letter to the commission, the groups said they were encouraged that some commissioners, during a Sept. 14 meeting, echoed some of their concerns, expressing "a strong preference for a focused approach to this issue."

    "We urge the Commission to carefully consider the effect these options would have on beneficiary access to quality, coordinated, and convenient care and to take an approach that retains the patient-centered focus intended by the original exception for in-office ancillary services," the letter said.

    Meanwhile, the Patient Protection and Affordable Care Act (PPACA), the new health reform law, includes provisions intended to address "widely recognized areas of overutilization, such as advanced imaging services," according to a report by the Office of the Actuary (OAct) at the Centers for Medicare & Medi­caid Services.

    Such services, OAct said, "not only waste resources but may also pose a danger to beneficiaries from needless exposure to radiation." OAct estimated that this provision of the law, "which more accurately pays for imaging, will save Medicare almost $2 billion over 10 years."

    The provision in PPACA requires physicians who perform advanced imaging services in their offices and rely on the in-office exception to the physician self-referral law to disclose information to patients, including notifying them that they have a right to receive these services elsewhere. A list of alternative providers in the area must be given to the patient. The requirement takes effect Jan. 1, 2011.

    The requirement is limited to magnetic resonance imaging, computed tomography, and positron emission tomography services, although CMS has the power to expand it to other radiology services. The disclosure notification must include the patient's signature and be kept in the patient's medical record as documentation of compliance.

    AUA working to get PCa bill passed

    Meanwhile, the AUA and other advocates of prostate cancer awareness are working for passage of legislation introduced in both the House and Senate in September that would streamline and expand the prostate cancer research under way at the departments of Defense, Health and Human Services, and Veterans' Affairs.

    Sponsored by Rep. Edolphus "Ed" Towns (D-NY) and Sen. Jon Tester (R-MT), the bill would strengthen research on improvements or alternatives to current screening tests and help develop methods to distinguish between different forms of prostate cancer. The bill would also establish an interagency task force, led by the Department of Veterans' Affairs, to eliminate duplication of work between agencies in the field of prostate cancer research and treatment.

    The AUA, the AUA Foundation, and the National Football League jointly sponsored a Capitol Hill reception in mid-September that featured pro football Hall of Fame cornerback Mike Haynes, the official spokesman for the Know Your Stats About Prostate Cancer awareness campaign.

    The event was part of an initiative in September that brought hundreds of prostate cancer researchers, advocates, and supporters to participate in an "Advance on Washington," during which they pushed for more progress in fighting the disease.

    Bob Gatty, a former congressional aide, covers news from Washingtonfor Urology Times.

    Bob Gatty
    Bob Gatty, a former congressional aide, covers news from Washington for Urology Times.


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