GAO report the latest shot fired in imaging self-referral war

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The Government Accountability Office report on imaging self-referral released last week has created quite a stir. Among its findings was that in 2010, providers who self-referred made more than 400,000 more referrals for advanced imaging (at a cost to Medicare of more than $100 million) than they would have if they weren't self-referring.

It's not a new argument. Critics of self-referral have long argued that it increases the number of imaging studies performed, raises costs and exposes patients to risks associated with unnecessary testing. To the latter point, for instance, a paper delivered by a group of Duke University Medical Center radiologists at last year's Radiological Society of North America annual meeting concluded that self-referral leads to more negative exams.

For their study, the researchers reviewed 500 MRIs ordered by two physician groups--one with a financial interest in the imaging equipment and one without. They found that there were more than 86 percent more negative scans performed by the group that self-referred, suggesting that self-referral was less likely to yield clinically useful information and led to unnecessary to unnecessary testing.

The GAO made several recommendations it believes can help deal with the issue, including:

  • Insert a self-referral flag on its Medicare Part B claims forms and require providers to indicate whether their advanced imaging services are self-referred or not
  • Implement a payment-reduction system for self-referred advanced imaging services to recognize efficiencies when the same provider refers and performs a service
  • Determine an approach to ensure the appropriateness of advanced imaging services referred by self-referring providers.

The Alliance for Integrity in Medicine, which includes the American College of Radiology and the American Society for Radiation Oncology, released a statement applauding the GAO report. The Medical Imaging & Technology Alliance, however, called two of the GAO's recommendations "unworkable and unnecessary."

What's more, the American Group Medical Association urged federal policymakers to "not rush to judgment based on a single report."

The debate has been has been ongoing on for years. If there's even a possibility that self-referral is leading to unnecessary imaging--and that imaging is driving up costs while putting patients at risk for potential adverse consequences--hopefully the GAO report will spur the appropriate reaction from federal policymakers. - Mike