ACR urges inclusion of self-referral prohibition in healthcare reform

The American College of Radiology (ACR) is asking its members to contact their Representative to request that a recent bill prohibiting physician self-referral be rolled into the healthcare reform bill introduced last week in the U.S. House of Representatives.

Rep. Jackie Speier, D-Calif., has introduced HR 2962, the Integrity in Medicare Advanced Diagnostic Imaging Act of 2009, to the House. The bill would seek to close the in-office ancillary service exemption for MRI, CT and PET services currently allowed under the Stark self-referral law, and end the practice of self-referral for those modalities under Medicare. The ACR has long-advocated for the closure of this loophole which allows physicians to refer their patients to imaging equipment they own within their office.

As supporters of the Speier legislation and members who sit on the Energy and Commerce Committee, Reps. Anthony D. Weiner, D-N.Y., and Bruce Braley, D-Iowa, have decided to offer HR 2962 as an amendment to the Healthcare Reform Package currently being debated in their committee.

The House Energy and Commerce Committee is one of the three jurisdictional committees marking up healthcare reform legislation this week.

In its advocacy of HR 2962, the ACR noted that:

• The over utilization of imaging services through the practice of self-referral places a burden on an already cash strapped Medicare system.
• Independent studies estimate that reducing unnecessary exams by self-referrers can generate between $500 million and $1.5 billion in savings to Medicare, annually.
• Advanced imaging modalities such as MR, CT and PET should not be considered in-office ancillary services along with blood and urine tests.

Two federal government research agencies have acknowledged the problem of self-referral:

1. The Government Accountability Office in June 2008 said that "physicians in specialties other than radiology who billed Medicare for in-office imaging services obtained an increasing share of their Medicare revenue from imaging services from 2000 to 2006."
2. The Medicare Payment Advisory Commission (MedPAC) added in its June 2009 report, "Several studies have found that physicians who furnish imaging services in their offices refer patients for more tests than other physicians."