Statement by APTA President on GAO Report: Self-referrals for Imaging Create 'Unacceptable' Costs and Patient Risks

November 6, 2012

American Physical Therapy Association Voices Its Support. 

APTA stands for fair and honest practice in health care and appreciates the work and findings of a recent report produced by the US Government Accountability Office (GAO). The report indicates that the number of self-referred imaging services has increased at shocking rates, compared with rises in non-self-referred services, over a period of 6 years, from 2004 through 2010. Unnecessary imaging referrals are not only costing Medicare untold millions in expenditures, in excess of $100 million in 2010 alone, according to GAO estimates, but also are putting patients at increased risk from excessive exposure to radiation. This is unacceptable.

The report, "Higher Use of Advanced Imaging Services by Providers Who Self-Refer Costing Medicare Millions (GAO-12-966)," focused on and compared the number of self-referred and non-self-referred advanced imaging services—magnetic resonance imaging (MRI) and computed tomography (CT)—provided from 2004 through 2010. What it found was an alarming increase in services originating from providers that self-refer. For example, the number of self-referred MRI services jumped during that 6-year period by more than 80 percent, compared with a rise of just 12 percent for non-self-referred MRI services. The growth rate for self-referred CT services was even higher. Also of significance is the finding that providers that began self-referring in 2009, known as "switchers," increased MRI and CT referrals by an average of 67 percent in 2010. The GAO concluded that "financial incentives for self-referring providers were likely a major factor driving the increase in referrals."

These findings represent a huge step forward in exposing abuse in the practice of self-referral. They bring to light a critical flaw in the health care system and confirm concerns APTA has long shared with our partners in the Alliance for Integrity in Medicare (AIM) about exploitation of the in-office ancillary service (IOAS) exception to the federal physician self-referral law. The expansive use of the IOAS exception in a manner not originally contemplated by the law undercuts the purpose of the law and substantially increases costs to the Medicare program and its beneficiaries. The GAO report, the first of a series that will scrutinize the use of the IAOS exception and self-referral, including in physical therapy, clearly shows that such practices only serve to exponentially increase spending and, more important, raise risks to beneficiaries.

In its role as a leading partner in AIM, a coalition of medical specialty, laboratory, radiation oncology, and medical imaging groups committed to ending the practice of inappropriate physician self-referral, APTA has long sought elimination of physical therapy as a designated health service under the IOAS exception.

This is costing the American people not just financially. It also hinders their right to appropriate and affordable health care. APTA joins our AIM partners in urging Congress to take a close look at this report and consider passing legislation that eliminates situations that do not put patients first.

APTA President Paul Rockar Jr, PT, DPT, MS