Laboratory and pathology groups are applauding the latest scoring of potential Medicare savings that could be achieved if lawmakers exclude anatomic pathology (AP), advanced diagnostic imaging, physical therapy, and radiation therapy from the in-office ancillary services (IOAS) exception to the federal self-referral statute. The Congressional Budget Office (CBO) estimates that excluding these services from the IOAS exception would generate $3.4 billion in savings for the Medicare program, an increase of $1.6 billion from an earlier score of $1.8 billion. The latest figure is included in the April 17 CBO score of President Obama’s 2015 budget proposal. The Alliance for Integrity in Medicare (AIM), which includes the American Clinical Laboratory Association and the College of American Pathologists (CAP), said in a statement released the same day that it commends the administration not only for including IOAS reform for a second year in its budget proposal, but also for adding AP services to the proposed list of excluded services in fiscal 2015. “The savings estimate released by CBO for narrowing the IOAS exception definitively validates that unnecessary expenditures by the Medicare program would be reduced if Congress would enact the President’s recommendation,” said the statement. Several studies from the Government Accountability Office […]
Laboratory and pathology groups are applauding the latest scoring of potential Medicare savings that could be achieved if lawmakers exclude anatomic pathology (AP), advanced diagnostic imaging, physical therapy, and radiation therapy from the in-office ancillary services (IOAS) exception to the federal self-referral statute.
The Congressional Budget Office (CBO) estimates that excluding these services from the IOAS exception would generate $3.4 billion in savings for the Medicare program, an increase of $1.6 billion from an earlier score of $1.8 billion. The latest figure is included in the April 17 CBO score of President Obama’s 2015 budget proposal.
The Alliance for Integrity in Medicare (AIM), which includes the American Clinical Laboratory Association and the College of American Pathologists (CAP), said in a statement released the same day that it commends the administration not only for including IOAS reform for a second year in its budget proposal, but also for adding AP services to the proposed list of excluded services in fiscal 2015.
“The savings estimate released by CBO for narrowing the IOAS exception definitively validates that unnecessary expenditures by the Medicare program would be reduced if Congress would enact the President’s recommendation,” said the statement.
Several studies from the Government Accountability Office and independent research have shown that the existing IOAS physician self-referral loophole results in increased spending and unnecessary utilization. AIM is urging lawmakers to pass legislation such as H.R. 2914 that would remove AP, advanced diagnostic imaging, radiation therapy, and physical therapy from the IOAS exception.
Separately, a coalition of 31 provider associations has called on Congress to keep the exception the way it is, arguing that any limits would force patients to receive ancillary services in a new and unfamiliar setting, increase inefficiencies, and present significant barriers to appropriate screening and treatment.
Lab and pathology groups have long been at odds with physician specialists over the IOAS exception. CAP has argued that the exception was never intended to include AP services that involve a complex multistep process and analysis of a tissue specimen produced as part of a procedure to diagnose cancer or other diseases and conditions.
Takeaway: The latest scoring by the Congressional Budget Office of savings associated with removing anatomic pathology and other services from the in-office ancillary services exception helps support arguments made by lab and pathology groups that the exception should be narrowed.
