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  • Self-referral Study Finds Higher Costs, No Improvement in Cancer Detection

    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.


    • This is a group that deserves the backing of the apta and private practice section

      Posted by Mike on 4/15/2012 8:45 AM

    • Nearly every surgeon and podiatrist I speak with admit that referring patients for PT has multiplied by double digits in his/her practice once a financial incentive was introduced. I simply offer best practice and I stand out like a sore thumb. Will this study change anything? Perhaps in 10 years or so.

      Posted by Abraham on 4/15/2012 10:38 AM

    • Dreams of a novice: 10 or so years ago, a similar study with orthopedists revealed a (as I remember)27% increase in referrals following taking PT "in house". Starke came and got chipped away. Now, when the subject comes up, our congressmen have said, yes it is a terrible problem, these rises in medical costs... let's put more regulations on...on... the...uh... TANNING SALONS!!!!! Yeah, that's it!,they don't have the lobbists to protest. Recently, the auto insurance companies (read: trial lawyers goaded by the chiropractors) have decided that PTs can only do what is specifically prescribed by the physician, not develop a plan authorized by the physician. The chiropractors, however, can "diagnose" that a "subluxation" is the reason for a person having diabetes, cancer or asthma; and treat the patient accordingly...you guessed it...with manipulation, the only tool in the box...for every problem. Why are they a "physician"? They can diagnose "disease". Without that, they diagnose impairments, like PT's, who happen to have a better medical education than they. For this reason, the "law of the nerve" that gives them the ability to say a pinched nerve is the reason for their poor health; be it a pain, cancer, infertility or asthma, makes them a "physician", not a simple doctor of cult medicine. We can accept this "squeeze play" or stand up for who we are... the best primary care provider for primary care orthopedic injuries, with research studies to prove it!

      Posted by Don on 4/16/2012 8:08 PM

    • Self-referral is exactly what it means. SELF!! It is about greed and power to keep as much money as possible, for MRI, orthotics, lab, and now Physical therapy services. Stark was a good start to stop this disease, and it finally got beaten down to nothing. When MD's say they would not do anything illegal, it dosen't mean do anything immoral. Can't one make enough money doing surgery?

      Posted by Dr Stephen Dolan, DPT.ATC on 4/22/2012 2:31 PM

    • Self-referral is a critical issue when it comes to health care cost. What has been done in the case of the Stark laws to support POPST is a perfect example of the disregard for the knowledge and skills a Physical Therapists provides. Here is another example of how we are being undermined as a professional body: Upon review of CMS Medicare definition of Personnel Authorized to provide Outpatient Therapy Services there are listed "physician; non-physician practioner(NPP)(physician assistants, nurse practioners, clinical nurse specialists); qualified physical and occupational therapist and assistants working under the supervision of a qualified therapist; qualified personnel, WITH OR WITHOUT A LICENSE TO PRACTICE THERAPY UNDER DIRECT SUPERVISION INCIDENT TO A PHYSICIAN OR NPP. Now PT services are being offered in a family practioners office just as chemo therapy clinics are developing in oncologists offices. Does anyone else see a problem with this?

      Posted by Laura M. Stevens, PT, MA on 4/30/2012 1:36 PM

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