At the request of the American College of Radiology (ACR), Reston, Va., a Congressional committee has asked the non-partisan General Accountability Office (GAO) to study the effects of physician self-referral.
In addition to excessive radiation concerns, advanced imaging and radiology is getting another look from Congress. This time the House Energy & Commerce Chair, Rep. Henry Waxman (D-CA), Ways & Means Committee Chair, Rep. Sandy Levin (D-MI), and Ways & Means Subcommittee on Health Chair, Rep. Pete Stark (D-CA) are asking the GAO to study how physician self-referral affects Medicare spending.
Representative Stark is well known for his anti-self-referral legislation. Current self-referral laws are widely known as “Stark laws.”
Congressman Stark often refers to past studies that show that self-referral may contribute to the increase in imaging exams. The GAO and the Journal of the American Medical Association have both shown studies that show how utilization is significantly increased when physicians have a financial interest in a referred imaging facility. In addition, the National Council on Radiation Protection and Measurement (NCRP) has cited self-referral as a primary, preventable driver of a six-fold increase to Americans’ radiation exposure from scans since 1980.
One concern in current Stark law is the popular advanced imaging leasing arrangement. In these “time share” arrangements, private physicians lease a time slot at an imaging center and refer their own patients during those times, thereby capturing the revenue from those exams. Existing Stark laws already restrict some of these arrangements, but there are certain loopholes for imaging centers that are owned and operated within the same building. This provision is known as the “in-office exception.”
The ACR believes that wider adoption of its evidenced based Appropriateness Criteria® and new advanced imaging facility accreditation will also contribute to at least slowing the growth rate of imaging utilization.
However, in a press statement, the ACR commented that “government regulation needs to address financially driven self-referral, which may not be rectified by quality measures. Congress and the regulatory agencies must do so by measures other than across the board reimbursement cuts, which only encourage more self-referral and restrict patient access to quality care by driving those who do not self-refer out of practice or forcing them to limit the number of Medicare patients they receive.”
Read the full letter to the GAO from Congressional leaders here.
