Alliance for Integrity in Medicare (AIM) Applauds Government Accountability Office Report Findings On Self-Referrals

Tools

GAO Report Titled: "HIGHER USE OF ADVANCED IMAGING SERVICES BY PROVIDERS WHO SELF-REFER COSTING MEDICARE MILLIONS"

WASHINGTON, Nov. 1, 2012 /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— applauds the findings of the Government Accountability Office (GAO) published yesterday: "Higher Use of Advanced Imaging Services by Providers Who Self-Refer Costing Medicare Millions (GAO-12-966)."

The GAO findings focus on advanced imaging services performed by self-referring and non-self-referring providers from 2004 to 2010. Using Medicare Part B claims data, GAO found that self-referred magnetic resonance imaging (MRI) services increased by approximately 84%, whereas non-self-referred MRI services only increased by roughly 12%. For computed tomography (CT) over the same time period, the number of services performed by self-referrers increased by approximately 107%, in contrast to an increase of roughly 30% by non-self referrers. GAO also 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." As a result, GAO concluded that "financial incentives for self-referring providers were likely a major factor driving the increase in referrals."

Further, GAO estimated the fiscal impact of the 400,000 improper referrals on the Medicare program was "more than $100 million" just in 2010. However, aside from the monetary cost to our nation, GAO also highlighted the "unacceptable risks for beneficiaries" resulting from additional radiation exposure associated with these unnecessary referrals.

AIM applauds these findings, which substantiate our ongoing concerns with the misapplication of the in-office ancillary service (IOAS) exception to the physician self-referral law. We believe the integrity of the Medicare program continues to be eroded through the use of the IOAS loophole. Not only does the exploitation of the IOAS exception by self-referrers result in increased program spending and unnecessary utilization of medical services, but also higher treatment risks for patients.

The organizations comprising the AIM Coalition remain steadfastly committed to improving patient care and preserving valuable Medicare resources. Therefore, AIM applauds Representatives Pete Stark (D-CA), Sandy Levin (D-MI), and Henry A. Waxman (D-CA) and Senators Max Baucus (D-MT) and Chuck Grassley (R-IA) for releasing this groundbreaking report as well as their strong condemnation of self-referral abuse.

AIM urges Congress to heed these critical findings and pass legislation to remove advanced diagnostic imaging, anatomic pathology, radiation therapy, and physical therapy from the IOAS exception, while preserving the ability of truly integrated multispecialty practices to continue providing high value, high quality care for Medicare beneficiaries under the self-referral law. This policy reform will benefit Medicare patients and the public alike, since beneficiaries will receive the highest quality and safest health care most appropriate to their needs, and substantial savings to the Medicare program will be achieved.

AIM also looks forward to additional GAO reports expected soon on self-referral in anatomic pathology, physical therapy, and radiation therapy. We hope Congress will use anticipated Medicare savings generated by ending self-referral as it works to offset the costs of preventing massive scheduled cuts to Medicare provider payments.

The Alliance for Integrity in Medicare includes the following members:
American Clinical Laboratory Association
American College of Radiology
American Physical Therapy Association
American Society for Clinical Pathology
American Society for Radiation Oncology
Association for Quality Imaging
College of American Pathologists
Radiology Business Management Association

Contact:
Francesca Fierro O'Reilly
American Clinical Laboratory Association
202-637-9466

SOURCE Alliance for Integrity in Medicare