Mounting evidence that physician self-referral encourages unnecessarily higher use of certain services more than justifies the introduction of the Promoting Integrity in Medicare Act today in Congress.
Rep Jackie Speier (D-CA) introduced the bill, announcing during a press conference that it is intended to remove physical therapy and other health care services from the in-office ancillary services (IOAS) exception, which allows for self-referral.
APTA and its partners in the Alliance for Integrity in Medicare, or AIM Coalition, strongly support this move to exclude these services from the IOAS exception. The exception—originally intended for same-day services, such as x-rays or blood draws, that are integral to the physician's services and convenient for the patient—has instead encouraged misapplication for financial self-interest. The result is overuse and hundreds of millions of Medicare dollars in unneeded treatments.
A series of reports from the Government Accountability Office (GAO) is but one source of evidence that supports this claim. Two published reports have concluded that when physicians provide certain services in their own facilities instead of referring the service to an outside lab, the number of procedures increases, and costs go up. GAO so far has investigated self-referral in advanced imaging services and anatomic pathology. GAO is expected to release a third report, on radiation oncology, any day now, and APTA anticipates the last—and most telling for our profession—report in the series, on physical therapist services, later this year.
"APTA strongly supports all efforts to eliminate self-referral situations and relationships that compromise patient access and quality or add cost," said APTA President Paul A. Rockar Jr, PT, DPT, MS. "APTA has worked hard to reach a solution to close this loophole, and we are pleased to see this important legislation introduced."
View APTA's Self-Referral webpage for more information and background.
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