A new study that links urologists' self-referral to increased use of tests to detect prostate cancer without better outcomes is being hailed by the Alliance for Integrity in Medicare (AIM) because it provides independent, peer-reviewed evidence that self-referral is a serious problem that drives up costs with no benefit to patients. AIM is a broad coalition that includes APTA and other medical specialty, laboratory, radiation oncology, and medical imaging groups.
The study, published this month in Health Affairs, found that urologists involved in self-referral arrangements bill Medicare for 72% more specimen evaluations for patients with suspected prostate cancer than urologists who send specimens to independent providers of pathology services. Despite the increased billing, the study found that self-referring urologists usually detect cancer at a much lower rate than do urologists who do not self-refer. The per-patient cancer detection rate for self-referring urologists in 2007, according to the study, was 12 percentage points lower than that for non-self-referring urologists.
AIM is urging Congress to revise the physician self-referral law's in-office ancillary services exception that allows urologists to self-refer patients to pathology labs they own directly or in which they have an ownership interest. "Other medical services, including advanced diagnostic imaging, physical therapy, and radiation oncology, are also prone to significant abuse through this exception," says AIM.
AIM's press release has been featured in The Wall St Journal and Politico.