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    Congress seeks reform of self-referral law

    AUA, AACU, LUGPA urge preservation of IOAS exception

    Bob GattyBob GattyWashingtonA serious effort to reform the federal physician self-referral law (the Stark law) to reduce the regulatory burden imposed by the statute on medical practices is underway in Congress, and organizations representing urology are encouraging lawmakers to take action. But there is a key component of the law that the AUA and others want to be sure is not changed.

    Also by Bob Gatty: AUA, others continue blitz on USPSTF reform

    “We want to protect the in-office ancillary services exception,” explained Jeffrey M. Frankel, MD, a Seattle-based urologist who chairs the American Academy of Clinical Urologists’ (AACU) Health Policy Committee. “That is extremely important, especially for independent practices.”

    The AACU, the AUA, and LUGPA all have submitted comments to the Senate Finance Committee, which has been considering Stark law reform and whose chairman, Sen. Orrin Hatch (R-UT), has said he hopes to introduce reform legislation by the end of the year.

    Changes would clarify provisions

    Hatch made the comments at a July 12 hearing during which he proposed changes to address issues such as excessive penalties for technical violations and a lack of clarity over provisions of the law, adding that the statute and its subsequent regulatory interpretations have become exceedingly complex and actually create obstacles to new health care reimbursement arrangements promoted by the Affordable Care Act.

    What gives the initiative legs is the support provided by some Democrats. Ron Wyden (D-OR), the top Democrat on the committee, noted that the health care system today is moving toward coordinated care—encouraged by the government—and that can result in violations of Stark. The law essentially prohibits physicians from referring patients to facilities where they have ownership interests.

    The in-office ancillary services exception (IOAS) to Stark allows physicians to provide specific services in their offices, like imaging and physical therapy, that normally would be prohibited by Stark. Organized urology supports maintaining that exception, arguing that Congress’ primary objective was to make imaging services convenient for patients during their visits, rather than requiring them to go elsewhere.

    “Without the current in-office ancillary services exception and list of in-office ancillary services, patients would be required to schedule follow-up tests and treatments with a second medical provider,” the AUA wrote in its submission to the Finance Committee. “Were this to occur, AUA submits that compliance with follow-up tests or treatment would fall off dramatically, harming care coordination efforts.”

    Thus, the AUA concluded, “Because in-office ancillary services, as currently conceived by Congress and implemented by CMS, benefit patients in terms of coordinating care, convenience, and efficiency, AUA believes the current list of ‘in-office ancillaries’ should not be changed.”

    Next: ASTRO's position

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


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