Imaging self-referrals cost Medicare an extra $109 million

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A recent Government Accountability Office report estimates that doctors who self-referred advanced imaging services in 2010 made 400,000 more referrals for those services than they would have if they weren't self-referring. According to the GAO, those additional referrals cost Medicare about $109 million.

The GAO analysis found providers' referrals of MRI and CT exams increased "substantially" in the year after they began self-referring. For example, providers who began self-referring in 2009 increased MRI and CT referrals on average by about 67 percent in 2010 compared to 2009.

In the case of MRIs, the number of referrals (from those doctors who had only just started self-referring) increased from 25.1 in 2008 to 42 in 2010, the GAO reported, while the number of referrals from doctors who already self-referred or were non-self-referrers actually declined.

"This comparison suggests that the increase in the average number of referrals for switchers was not due to a general increase in the use of imaging services among all providers," according to the report. "GAO's examination of all providers that referred an MRI or CT service in 2010 showed that self-referring providers referred about two times as many of these services as providers who did not self-refer."

The analysis was requested by a group of five legislators, including U.S. Rep. Pete Stark (D-Calif.), ranking democrat on the House Ways and Means Health Subcommittee, and U.S. Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee.

"Today's report is the first objective analysis I've seen of the role that self-referral is playing in advanced imaging services," Stark said in a statement. "It should serve as a wakeup call to Congress that this is an arena where we can't afford to sit idly by and allow providers to continue these practices.  It's costing taxpayers millions of dollars, increasing costs on beneficiaries, and exposing patients to radiation that has real health consequences."

Baucus echoed Stark's comments, observing that, self-referrals are offering providers incentives to order unnecessary tests, which is driving up costs. "Providers' bottom lines shouldn't be getting in the way of their patients' care and best interests," Baucus added.

In response to the GAO report, the American Medical Group Association warned against a rush to judgment.

"AMGA member groups are committed to delivering the right care at the right time to patients," said AMGA President and CEO Donald Fisher, Ph.D., CAE in an announcement. "Many member groups utilize decision support tools to ensure that clinical decision-making is supported by evidence before ordering advanced diagnostic imaging for their patients.  At a time when the federal government is providing incentives for healthcare providers to integrate care delivery, such as in the Medicare Shared Savings Program, I would strongly urge federal policymakers to not rush to judgment based on a single report.  Patients deserve to have access to coordinated care which is most effectively delivered by multispecialty medical groups and other organized systems of care."                                                    

For more:
- read the GAO report
- see the statement from U.S. Rep. Pete Stark
- read the announcement from the AMGA

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