Study in NEJM Adds to Pressure to End Self-Referral

Citing the findings of a study of urologists’ use of intensity modulated radiation therapy (IMRT) to treat prostate cancer, the Alliance for Integrity in Medicare (AIM) reiterated its call for a law to close the self-referral loophole for radiation therapy, advanced diagnostic imaging, anatomic pathology, and physical therapy services. In a New England Journal of Medicine (NEJM) article, Georgetown University health care economist Jean M. Mitchell, Ph.D., examined how frequently urologists who had a a financial stake in IMRT services prescribed the therapy compared to urologist who were not self referrers. Among other finding’s, the data Mitchell presented in the article showed that the urologists use of IMRT increased 46% from 13.1% to 32.3% once they became self-referrers. In addition, men with prostate cancer whose urologists self referred were 2.79 times as likely (179% more likely) to receive IMRT than men seen by non-self-referring private practice urologists. When compared to prostate cancer patients who went to urologists at National Comprehensive Cancer Network (NCCN)-designated cancer centers (also non-self-referrers), the men whose urologists self referred were 6.18 times as likely (518% more likely) to receive IMRT. AIM — which includes the ACR, ASTRO and RBMA — pointed to the findings as additional evidence that the Promoting Integrity in Medicare Act of 2013 (H.R. 2914) should be made Federal law. Introduced by Rep. Jackie Speier (D-Calif) along with Rep. Dina Titus (D-Nev) and Rep. Jim McDermott (D-Wash) in August, H.R. 2914 seeks to curb abuses of the in-office ancillary services exception to current laws that prohibit physicians who treat Medicare and Medicaid patients from referring those patients to treatments and services in which they have a financial stake. If passed, the scope of what would count as an in-office ancillary service exempt from self-referral restrictions would be much narrower. The bill currently has 11 co-sponsors, of which all but one are Democrats. Read AIM's statement. (PDF)