A new study published in the Oct. 24 issue of the New England Journal of Medicine (NEJM) concludes that urologists with an ownership interest in intensity-modulated radiation therapy (IMRT) for prostate cancer had a higher treatment rate than those without an ownership interest. The study corroborates the increased IMRT treatment rates among self-referrers reported by the Government Accountability Office (GAO) in its August 2013 report, “Medicare: Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny.” The study, authored by Jean Mitchell, Ph.D., an economist and professor at the McCourt School of Public Policy at Georgetown University, reviewed Medicare claims for more than 45,000 patients from 2005 through 2010 and found that nearly all of the 146 percent increase in IMRT among urologists with an ownership interest in treatment was due to self-referral. The NEJM report concludes that “men treated by self-referring urologists, as compared with men treated by non-self-referring urologists, are much more likely to undergo IMRT, a treatment with a high reimbursement rate, rather than less expensive options, despite evidence that all treatments yield similar outcomes.” The physician self-referral law prohibits physicians from referring a patient to a medical facility in which he or she […]
A new study published in the Oct. 24 issue of the New England Journal of Medicine (NEJM) concludes that urologists with an ownership interest in intensity-modulated radiation therapy (IMRT) for prostate cancer had a higher treatment rate than those without an ownership interest.
The study corroborates the increased IMRT treatment rates among self-referrers reported by the Government Accountability Office (GAO) in its August 2013 report, “Medicare: Higher Use of Costly Prostate Cancer Treatment by Providers Who Self-Refer Warrants Scrutiny.”
The study, authored by Jean Mitchell, Ph.D., an economist and professor at the McCourt School of Public Policy at Georgetown University, reviewed Medicare claims for more than 45,000 patients from 2005 through 2010 and found that nearly all of the 146 percent increase in IMRT among urologists with an ownership interest in treatment was due to self-referral.
The NEJM report concludes that “men treated by self-referring urologists, as compared with men treated by non-self-referring urologists, are much more likely to undergo IMRT, a treatment with a high reimbursement rate, rather than less expensive options, despite evidence that all treatments yield similar outcomes.”
The physician self-referral law prohibits physicians from referring a patient to a medical facility in which he or she has a financial interest. However, the law includes an exception that allows physicians to refer for so-called “ancillary services,” including radiation therapy, anatomic pathology (AP) services, and physical therapy. To date, the GAO has issued three reports in a four-part series on physician self-referral. The final report, expected by the end of this year, will detail self-referral for physical therapy services. A report issued July 16 by the GAO estimated that in 2010, providers who self-referred AP services cost Medicare about $69 million.
Legislation introduced in early August to close the in-office ancillary services (IOAS) exception to the Stark law would exclude AP, advanced diagnostic imaging, physical therapy, and radiation services from the IOAS exception. If passed, the measure could save the federal government almost $7 billion over a 10-year period.
Takeaway: Multiple reports from the government and medical societies conclude that physician self-referral is driving up medical costs and provide ammunition for the fight to close the so-called self-referral loophole.
