November 2012

Societies respond to GAO report on self-referral rates for imaging

In late October professional societies penned official responses to a report from the US Government Accountability Office (GAO) that found self-referral rates for magnetic resonance imaging (MRI) and computed tomography (CT) have skyrocketed in recent years, with MRI self-referral rates rising 80% from 2004 to 2010, compared with 12% for non-self-referred MRI services.

The GAO report estimated that additional referrals cost Medicare about $109 million and could pose “unacceptable risks” for patients, including an increased risk of cancer in patients exposed to ionizing radiation.

The GAO’s analysis, which accounted for differences in practice size, specialty, geography, and patient characteristics, showed that physician referrals of MRI and CT services substantially increased the year after they began to self-refer—that is, they purchased or leased imaging equipment or joined a group practice that already self-referred.

The GAO said its analysis suggests financial incentives for self-referring providers were likely a major factor driving the increase in referrals.

In its official statement American Association of Orthopedic Surgery (AAOS) President John R. Tongue, MD, noted, “The AAOS believes that the provision of in-office imaging services is critically important for musculoskeletal patients and can lead to greater patient adherence to treatment plans and improved outcomes. Like the GAO, the AAOS believes that wasteful spending in Medicare should be addressed. Significant technological advances have been made in our field so that patients can receive timely and accessible screenings from the comfort of their doctor’s office. We believe that any restriction on this convenience would threaten the quality of care being delivered to our patients.”

American Physical Therapy Association President Paul Rockar Jr, PT, DPT, MS, wrote, “These findings represent a huge step forward in exposing abuse in the practice of self-referral. They bring to light a critical flaw in the health care system and confirm concerns APTA has long shared with our partners in the Alliance for Integrity in Medicare (AIM) about exploitation of the in-office ancillary service (IOAS) exception to the federal physician self-referral law.…The GAO report, the first of a series that will scrutinize the use of the IAOS exception and self-referral, including in physical therapy, clearly shows that such practices only serve to exponentially increase spending and, more important, raise risks to beneficiaries.”

The entire report is available at

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