Thursday, November 01, 2012 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.