Yet another report from the Government Accountability Office (GAO) concludes 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 released "Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny" yesterday.
This third of 4 reports in GAO's self-referral investigation covered prostate cancer–related intensity-modulated radiation therapy (IMRT) services between 2006 and 2010. Among the findings are that self-referred services grew by 46% annually, from 80,000 in 2006 to 366,000 in 2010, while non-self-referred services decreased by 1% each year, from 490,000 to 466,000. In 2009, providers who self-referred Medicare patients with prostate cancer were 53% more likely to refer the patients for IMRT than for other less costly treatments. GAO estimated that, even including a $91 million decrease in expenditures by the non-self-referring provider groups, the higher rate of IMRT by self-referrers led to an overall increase in IMRT Medicare costs of $47 million between 2006 and 2010.
The report also suggested that financial interest in one type of treatment over other less costly procedures may negatively affect a provider's decision-making process and, ultimately, patient care. Additional findings and conclusions are in the report.
Studies such as this have prompted at least 1 member of Congress to act. Yesterday Rep Jackie Speier (D-CA) introduced the Promoting Integrity in Medicare Act, 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.
In its first 2 reports, GAO investigated self-referral in advanced imaging services and anatomic pathology, also concluding financial self-interest was driving the increases in referrals and spending.
APTA anticipates the last—and most telling for our profession—report in the series, on physical therapist services, later this year.
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