Proposed bill sparks debate over physician self-referrals

Several professional medical societies have now weighed in on a bill introduced to Congress on April 9 which seeks to prevent physicians from self-referring Medicare patients to in-office “ancillary services” including advanced imaging, anatomic pathology, radiation therapy and physical therapy.

The societies fall on both sides of the debate, with some suggesting the legislation would promote value-based care and curb healthcare costs while others said it wouldn’t serve those goals and could also harm patients’ access to care.

HR 2143, dubbed the Promoting Integrity in Medicare Act (PIMA), was introduced by Reps. Jackie Speier (D-California) and Dina Titus (D-Nevada), who cited studies from the Government Accountability Office (GOA) which linked self-referrals to increased utilization of services that are medically unnecessary. The lawmakers classified the in-office ancillary services exception to the Stark Law as “a loophole” that has been exploited by physicians eager to cash in on Medicare reimbursement.

“Multiple GAO studies have outlined the rampant abuse and waste of more than $3 billion of taxpayer money through Medicare reimbursement for unnecessary services that are driven purely by greed for personal profit,” Speier said in a statement. “Now is the time to improve the quality and cost-effectiveness of Medicare.”

“Seniors should have full confidence that their doctors are making medical decisions based on each patient’s health care needs, not the physician’s financial interests,” Titus said in the same statement. “This legislation will save taxpayer dollars, strengthen Medicare, and help ensure that our seniors receive the care they deserve.”

As reported by Radiology Business last week, the American Society of Radiology Oncology (ASTRO) quickly came out with a press release applauding the introduction of the new bill. In the statement, ASTRO said the Ethics in Patient Referrals Act—enacted in 1989—was designed to prohibit “physicians from referring a patient to a medical facility in which the physician has a financial interest.” But the exceptions for in-office ancillary services have “diluted the self-referral law and created a pathway for physicians to avoid its prohibitions and intent.”

“Inappropriate self-referral undermines ASTRO-supported efforts to move Medicare toward quality- and value-based reimbursement,” ASTRO Chair Paul Harari, MD, said in the press release. “Alternative payment models (APMs), for example, will not be successful if incentives remain for overutilization of medical services.”

The Congresswomen noted The Alliance for Integrity in Medicare, which includes professional societies related to imaging and physical therapy, also supports the legislation.

But AMGA—formerly the American Medical Group Association—released its own statement April 16 expressing concern with the proposed bill. The association said the legislation could restrict physicians in multispecialty groups from referring patients for advanced imaging services within their groups, which AMGA believes could actually drive up healthcare costs and impede care coordination and integration.

It also raises the possibility that rural patients could have gaps in care if they can’t receive imaging services within the same practice, according to the statement.

“This legislation not only will impact the timeliness of diagnosing our patients,” said Jerry Penso, MD, MBA, president and CEO of AMGA. “It also will negatively affect population health efforts and create more access burdens for patients seeking efficient, cost-effective treatment.”