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%.
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."
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.
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
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
will issue a separate statement, which will be highlighted in an upcoming News Now article, on GAO's report.
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.
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