A
report
issued yesterday by the Government Accountability Office (GAO) based on Part B
claims data found that self-referred magnetic resonance imaging (MRI) services
increased by approximately 84% from 2004 to 2010, 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
"providers who self -referred made 400,000 more referrals for advanced
imaging services that 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 the nation, GAO also highlighted the
"unacceptable risks for beneficiaries" resulting from additional
radiation exposure, particularly in the case of CT services, associated with
these unnecessary referrals.
Yesterday's
report is the first of a series from GAO on self-referral. Additional reports
are expected on self-referral in physical therapy, anatomic pathology, and
radiation therapy.
Upon
release of the report, the Alliance for Integrity in Medicare (AIM)—a coalition
of provider organizations, including APTA, committed to ending the practice of
inappropriate physician self-referral—applauded the findings. AIM said the
report "substantiates our ongoing concerns with the misapplication of the
in-office ancillary service (IOAS) exception to the physician self-referral
law." The coalition urged 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."
APTA
will issue a separate statement, which will be highlighted in an upcoming News Now article, on GAO's report.
Eliminating
physician referral for profit
in physical therapy is one of APTA's public policy priorities. The Foundation for Physical
Therapy recently awarded a $300,000 high-impact research grant to Jean
Mitchell, PhD, to investigate the influence of physical therapy referral characteristics and practices
on quality, cost effectiveness, and utilization.
While I can agree that the potential for fraudulent or excessive services exists with physician self-referral for ancillary services. Physical therapy is not truly an "ancillary service" is it?
With imaging studies and other ancillary services, "technicians" are performing the service and most of the time they are unlicensed. They do no evaluation or assessment, nor do the produce a report with their signature on it for billing purposes. They, individually, have no stake in the proper documentation or performance of the service except to simply do it. The doctor documents the service and bills for it.
A person is entitled to an opinion on just about everything. Their opinion doesn't make them a good or bad person.
I'd just submit for the purposes of discussion that we enjoy a degree of autonomous practice with regard to self-referral. The argument has been put forth that we're unable to ethically handle that responsibility. In fact, private practice generally has the potential for excessive charges and longer courses of treatment. But the proof is in the pudding, because private practice and direct access have proven less expensive than other methods.
I run the PT department here. I do the evaluations and send the treatment plans to the physicians for signature. I often see people in the setting of an office consult for an orthopedic case. I can safely make a determination for the physician regarding whether imaging or referral to an orthopedist is indicated in a short period of time. I work with general practitioners, who recognize the skill and knowledge set I bring with me to their practice.
Where do you want to draw the line? Either we're professionals who will act ethically, or we're not. If we're not, then we're in an untenable position, regardless of the level of temptation one wishes to expose the profession to.
Posted by Leon Richard
on 1/7/2013 4:11 PM