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    Govt. panel criticizes physician self-referral

    A recent report from the Government Accountability Office (GAO) is highly critical of physician self-referral for advanced imaging services, indicating that it significantly raises Medicare costs.

    Using Medicare claims data from 2004-2010, the report found that in 2010 alone, "Providers who self-referred made 400,000 more referrals for advanced imaging services than they would have if they were not self-referring." The GAO estimated the fiscal impact of these 400,000 referrals on the Medicare program was more than $100 million in 2010.

    As a result, the report concluded, "Financial incentives for self-referring providers were likely a major factor driving the increase in referrals."

    The GAO's analysis showed that providers' referrals of magnetic resonance imaging and computed tomography services substantially increased the year after they began to self-refer—that is, they purchased or leased imaging equipment, or joined a group practice that already self-referred. Providers that began self-referring in 2009—which the GAO terms "switchers"—increased MRI and CT referrals on average by about 67% in 2010 compared to 2008.

    In the case of MRIs, the average number of referrals made by switchers increased from 25.1 in 2008 to 42.0 in 2010. In contrast, the average number of referrals made by providers who remained self-referrers or non-self-referrers declined during this period. This comparison suggests, the GAO said, that the increase in the average number of referrals for switchers was not due to a general increase in the use of imaging services among all providers.

    The American Society for Radiation Oncology, along with partners in the Alliance for Integrity in Medicare (AIM) coalition, applauded the findings and urged Congress to pass legislation this year to close the self-referral "loophole." The coalition, a vocal critic of urologists who own radiation therapy facilities, thanked Representatives Pete Stark (D-CA) Sandy Levin (D-MI), and Henry A. Waxman (D-CA), who joined with Senators Max Baucus (D-MT) and Chuck Grassley (R-IA) to unveil the report on Oct. 31.

    Donald W. Fisher, PhD, of the American Medical Group Association, called the report "yet more evidence of a fractured federal health care program that does little to recognize the value of integrated systems of care, such as those offered in our nation’s multispecialty medical groups."

    "At a time when the federal government is providing incentives for health care providers to integrate care delivery, such as in the Medicare Shared Savings Program, I would strongly urge federal policymakers to not rush to judgment based on a single report. Patients deserve to have access to coordinated care, which is most effectively delivered by multispecialty medical groups and other organized systems of care."

    Go back to this issue of Urology Times eNews.

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