The president’s budget request for fiscal year 2014 proposes to save $6.1 billion by excluding certain services, but not anatomic pathology, from the in-office ancillary services (IOAS) exception to the Stark physician self-referral law.In response, the Alliance for Integrity in Medicare (AIM) advocates increased savings by removing anatomic pathology services from the exception. And it is urging Congress and the Centers for Medicare and Medicaid Services to remove anatomic pathology as well as other services from the IOAS exception. The budget recommends exclusion of radiation therapy, advanced imaging, and therapy services, except in cases where a practice meets “certain accountability standards, as defined by the secretary of the Department of Health and Human Services.” AIM said it has long supported restrictions on physician self-referral, “and we would strongly recommend adding anatomical pathology services to the proposed list of excluded services, as the same overutilization and patient care concerns exist.” Critics charge that the current IOAS exception is being exploited by physician specialists who have brought their pathology work in house, setting up their own histology labs for whose work the physicians can bill. “We believe this loophole results in increased spending, unnecessary utilization of medical services, and potentially compromised patient…
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