Bill Seeks End to In-Office Ancillary Services Exception for Advanced Imaging

H.R. 2914, the Promoting Integrity in Medicare Act of 2013 (PIMA), seeks to curb overutilization of advanced diagnostic imaging by significantly narrowing the types of medical services that would fall under "in-office ancillary services" exception to the Stark Law that prohibits physicians from ordering Medicare tests or procedures that they have a financial interest in. The self-referral of medical imaging and radiation therapy services drives up utilization of these services and costs Medicare millions each year, according to Government Accounting Office (GAO) figures says the American College of Radiology (ACR). The College has been advocating for an end to the extension for some time and is now part the Alliance for Integrity in Medicare (AIM) coalition of medical societies that support the bill. PIMA was introduced by Rep. Jackie Speier (D-Calif), Ways and Means Health Subcommittee Ranking Member Rep. Jim McDermott (D-Wash.) and Rep. Dina Titus (D-NV). It has been referred to the House Energy and Commerce Committee and the House Ways and Means Committee, but will likely need co-sponsors from the majority party (the Republicans) or inclusion in another bill to make it out of these committees and be voted on by Congress. Still, Rep. Speier sounded an upbeat note on her website. “This is a golden opportunity to choose patients over profit,” she said in her statement announcing the bill. “Not only is Medicare wasting hundreds of millions each year on unnecessary or inappropriate care, in some cases it is downright harmful, such as when patients receive unnecessary CT scans, which involve the use of ionizing radiation that has been linked to an increased risk of developing cancer. 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.” Earlier this year, the President’s proposed 2014 budget sought to end the exemption as a way to save taxpayer money. (Read the RBJ feature here.) The members of AIM include:

• The American Clinical Laboratory Association
• The American College of Radiology
• The American Physical Therapy Association
• The American Society for Clinical Pathology
• The American Society for Radiation Oncology
• The Association for Quality Imaging, the College of American Pathologists
• The Radiology Business Management Association