President Obama's federal budget proposal would close the loophole that allows physician self-referrals for physical therapy services—a change long supported by APTA that would improve quality of care and lower Medicare costs.
If adopted by Congress, the FY 2015 budget would eliminate exceptions that now apply to physical therapy, radiation therapy, anatomic pathology, and advanced imaging. The Office of Management and Budget estimates that closing the loophole for these services would provide a savings of just over $6 billion over 10 years.
APTA has held that in addition to fostering costly overuse, the exceptions compromise patient care and choice. In a press release, APTA President Paul A. Rockar Jr, PT, DPT, MS, said that APTA "fought long and hard" for the elimination of the exceptions. Rockar added that the Obama proposal "would save the country billions in unnecessary Medicare expenses and, more important, protect patients from being used as pawns for profit."
APTA Private Practice Section President Tom DiAngelis, PT, DPT, was quoted in the same press release saying that self referral has an "abusive financial impact," and that "as health care providers we work and interact with patients every day. When physicians self-refer, patients feel as though they aren’t in the driver’s seat when it comes to their own care.”
The specific exceptions would be eliminated from the Stark self-referral law, a policy that was intended to prevent physicians from making referrals for certain health services payable by Medicare to an entity with which he or she, or an immediate family member, has a financial relationship. The exceptions to the law were carved out for in-office ancillary services (IOAS) that could be quickly administered for patient convenience, such as routine lab tests or x-rays. The problem, according to APTA and other groups, is that the exceptions have been broadly applied and now include self-referral for physical therapy services well beyond original intent.
APTA has advocated for the elimination of physical therapy from the exceptions for years and is a founding member of the Alliance for Integrity in Medicare (AIM), a consortium of organizations focused on eliminating the IOAS loophole. In addition to APTA, the consortium includes laboratory, radiation oncology, and medical imaging groups.
APTA strongly urges Congress to follow the recommendations laid out in the Administration's budget and pass legislation to remove physical therapy, advanced diagnostic imaging, anatomic pathology, and radiation therapy from the IOAS exception. Find out more about this issue at APTA's self-referral webpage, and take action now by asking your legislators to close the self-referral loophole. Contact the APTA advocacy staff for more information.
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