Congresswoman Jackie Speier (D-San Francisco/San Mateo), along with Rep. Jim McDermott (D-WA), Ways and Means Health Subcommittee Ranking Member, and Dina Titus (D-NV), introduced HR 2914, the “Promoting Integrity in Medicare Act of 2013” (PIMA) in the House of Representatives. The bill would cut unnecessary Medicare spending by hundreds of millions annually without reducing care.
Three recent Government Accountability Office (GAO) reports have examined the self-referral problem, and all three reports found a significant and inappropriate increase in referrals when a physician switches to self-referral, costing Medicare millions. The GAO reported that:
- Physician self-referral for advanced imaging services is costing Medicare more than $109 million in unnecessary spending each year.
- In 2010, providers who self-referred likely made 400,000 more referrals for advanced imaging services than they would have if they were not self-referring.
- Self-referring non-radiologist physicians perform up to eight times as many imaging studies as physicians who refer their patients to radiologists.
“This is a golden opportunity to choose patients over profit,” says Speier. We can be smarter and more cost-effective and still deliver convenient and quality services to seniors who depend on Medicare for their quality of life.”
Current law—also known as the Stark Law—bars physicians from referring Medicare patients for certain health care services in which they have a financial interest, but includes an “in-office ancillary services exception.” PIMA would restore the original intent of the self-referral law by prohibiting self-referral for four complex services—advanced imaging, anatomic pathology, radiation therapy and physical therapy, which are not typically performed at the time of the patient’s initial office visit.
“Over the years, use of the in-office ancillary services exception has dramatically increased, resulting in increased costs to the Medicare program,” says McDermott. “Patient convenience and streamlined services are important, but improper use of the exception creates unnecessary costs. This legislation will preserve the exception but narrow it to better reflect congressional intent in the Self-Referral law.”
ADVOCATE will continue to provide updates as information becomes available.
Kirk Reinitz, CPA