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  • GAO Report on Self-Referral and Physical Therapy Adds to Evidence Questioning the Practice – Joint Congressional Statement

    The Government Accountability Office (GAO) report on self-referral in physical therapy released June 2 shows that there "does appear to be a relationship between self-referring providers and the overall number of individuals referred for physical therapy," according to a joint Congressional statement issued soon after the report was made public.

    In the joint statement on the physical therapy report, members of the Senate Judiciary, House Ways and Means, and House Energy and Commerce Committee leadership characterized the most recent GAO report as "showing self-referring providers refer more individual patients for physical therapy in Medicare than non-self-referring providers."

    The report, the fourth and final in a GAO series on medical self-referral, was less conclusive in its findings than previous investigations—a shortcoming that APTA largely attributes to methodological limitations, according to a recent association statement.

    Members of the House and Senate committees acknowledged the differences from previous reports, but described the findings as part of a larger body of evidence showing that "financial incentives, not patients' needs, are driving some referral patterns," according to House Ways and Means Committee Ranking Member Sander Levin (D-Mich).

    Senate Judiciary Ranking Member Chuck Grassley (R-Iowa) described the report's findings as "less clear" than previous reports, but he said that "we need to continue to monitor this area to be sure doctors aren’t unnecessarily referring patients for physical therapy when they have a financial interest."

    “Along with my colleagues, I remain concerned about the effect of physician self-referral driving unnecessary use of health care services,” said Henry Waxman (D-Calif), ranking member of the House Energy and Commerce Committee. “The findings in today’s report, while not as direct as other reports on this topic, raise additional questions for exploration.”

    The APTA statement calls for a more informed analysis, and urges policy makers to require all self-referring providers to notify patients of their right to see the provider they choose, and share lists of a variety of local physical therapists with patients. The association also recommends that Medicare claim forms require a unique modifier that identifies when any service is being received through self-referral.

    APTA also continues to advocate for H.R. 2914, federal legislation that would remove physical therapy from the in-office ancillary services exception to the Stark law.


    • The purpose of direct access comes to mind. If we as PTs educate the general public on when, why, and how to seek treatment, it will negate the scrutiny on referral patterns. People have the right to seek treatment from a chiropractor, a physician, a PT, and a number of other healthcare providers. However, the general public in my state of Indiana is unaware of this right.

      Posted by Sarah Holmes on 6/6/2014 4:44 PM

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