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  • GAO Self-referral Study on Imaging Finds Excessive Costs, 'Unacceptable Risks for Beneficiaries'

    A report issued yesterday by the Government Accountability Office (GAO) based on Part B claims data found that self-referred magnetic resonance imaging (MRI) services increased by approximately 84% from 2004 to 2010, whereas non-self-referred MRI services only increased by roughly 12%.  

    For computed tomography (CT) over the same time period, the number of services performed by self-referrers increased by approximately 107%, in contrast to an increase of roughly 30% by non-self-referrers. GAO also found that in 2010 "providers who self -referred made 400,000 more referrals for advanced imaging services that they would have if they were not self-referring." As a result, GAO concluded that "financial incentives for self-referring providers were likely a major factor driving the increase in referrals."

    Further, GAO estimated the fiscal impact of the 400,000 improper referrals on the Medicare program was "more than $100 million" just in 2010. However, aside from the monetary cost to the nation, GAO also highlighted the "unacceptable risks for beneficiaries" resulting from additional radiation exposure, particularly in the case of CT services, associated with these unnecessary referrals.

    Yesterday's report is the first of a series from GAO on self-referral. Additional reports are expected on self-referral in physical therapy, anatomic pathology, and radiation therapy. 

    Upon release of the report, the Alliance for Integrity in Medicare (AIM)—a coalition of provider organizations, including APTA, committed to ending the practice of inappropriate physician self-referral—applauded the findings. AIM said the report "substantiates our ongoing concerns with the misapplication of the in-office ancillary service (IOAS) exception to the physician self-referral law." The coalition urged Congress to "heed these critical findings and pass legislation to remove advanced diagnostic imaging, anatomic pathology, radiation therapy, and physical therapy from the IOAS exception, while preserving the ability of truly integrated multispecialty practices to continue providing high-value, high-quality care for Medicare beneficiaries under the self-referral law."

    APTA will issue a separate statement, which will be highlighted in an upcoming News Now article, on GAO's report.

    Eliminating physician referral for profit in physical therapy is one of APTA's public policy priorities. The Foundation for Physical Therapy recently awarded a $300,000 high-impact research grant to Jean Mitchell, PhD, to investigate the influence of physical therapy referral characteristics and practices on quality, cost effectiveness, and utilization.


    • It's about time that self-referral stops!! It is the biggest conflict of interest in medicine but yet, it continues to happen like it's "good for quality care." it's not good. It's self profiting and unethical and no idea why it's allowed to happen

      Posted by D. Taha on 11/2/2012 7:51 PM

    • This is exactly why I send patients who need further medical evaluation to a sports medicine physician who is not a surgeon, who does not own his own MRI equipment, and who has no vested interest in paying off equipment or weather a patient gets surgery or a procedure. The other trouble now is patients think the "need an MRI" to know what's going on.

      Posted by Greensboro Physical Therapist on 11/3/2012 12:10 PM

    • While I can agree that the potential for fraudulent or excessive services exists with physician self-referral for ancillary services. Physical therapy is not truly an "ancillary service" is it? With imaging studies and other ancillary services, "technicians" are performing the service and most of the time they are unlicensed. They do no evaluation or assessment, nor do the produce a report with their signature on it for billing purposes. They, individually, have no stake in the proper documentation or performance of the service except to simply do it. The doctor documents the service and bills for it. A person is entitled to an opinion on just about everything. Their opinion doesn't make them a good or bad person. I'd just submit for the purposes of discussion that we enjoy a degree of autonomous practice with regard to self-referral. The argument has been put forth that we're unable to ethically handle that responsibility. In fact, private practice generally has the potential for excessive charges and longer courses of treatment. But the proof is in the pudding, because private practice and direct access have proven less expensive than other methods. I run the PT department here. I do the evaluations and send the treatment plans to the physicians for signature. I often see people in the setting of an office consult for an orthopedic case. I can safely make a determination for the physician regarding whether imaging or referral to an orthopedist is indicated in a short period of time. I work with general practitioners, who recognize the skill and knowledge set I bring with me to their practice. Where do you want to draw the line? Either we're professionals who will act ethically, or we're not. If we're not, then we're in an untenable position, regardless of the level of temptation one wishes to expose the profession to.

      Posted by Leon Richard on 1/7/2013 4:11 PM

    • While on the subject of ordering MRIs and other images, research has shown the two most appropriate practioners to order advanced images for musculoskeletal issues are orthopedic surgeons first then PTs (over all other physicians even); yet every Nurse Practitioner orders them as if they are ordering an aspirin. I personally do not mind referring to an orthopedic surgeon to make the final call, but what in the world is going on - PTs continually get cuts and NPs are getting more and more freedom and they even have less education than we do (currently anyway).

      Posted by Jerry Yarborough on 1/9/2013 10:39 PM

    • Limiting self refferal in medicine is seen and checked a couple ways. Physicians have long been restricted from owning pharmacies and labs due to the predictable tendency to use them to generate inappropriate revenues.Acceptable right? As the line between the reffering and rendering provider blends into a blur the self referral revenues made on PT and Imaging becomes staggering. This is a growing source of unearned income for many reffering specialty physicians and helps mitigate losses in other areas. It is time these privleged money making practices are eliminated in the interest of cost and quality.Concerned for the impact on PTs that work in phycians offices? Well doctorate trained professionals should be able to stand alone! Those who can't who chose to work in phsician offices just must convert to bonifide timeshares paying the local resonable rent/fees but otherwise bill and keep the revenues earned.Radiologists and other dedicated sub- specialists should basically own and operate imaging as a free standing entity competing with hospitals on the basis of cost and quality. Just my 35 yrs experience and a couple thoughts on how to end the practice of physicians writing checks to themselves in the form of PT and imaging scripts! Perhaps a raise in physician fees would also keep them out of ancillary service...well lets not get too crazy !

      Posted by J Palazo on 1/10/2013 1:08 AM

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