Congresswoman Speier Unveils “Promoting Integrity in Medicare Act of 2013"



August 1, 2013

WASHINGTON, DC – Today, Congresswoman Jackie Speier (D-San Francisco/San Mateo), along with Rep. Jim McDermott (D-WA), Ways and Means Health Subcommittee Ranking Member, and Dina Titus (D-NV), introduced HR 2914, the “Promoting Integrity in Medicare Act of 2013” (PIMA) in the House of Representatives. The bill would cut unnecessary Medicare spending by hundreds of millions annually without reducing the essential care that seniors rely on.

“This is a golden opportunity to choose patients over profit,” says Speier. “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.”

Current law—also known as the Stark Law—bars physicians from referring Medicare patients for certain health care services in which they have a financial interest, but includes an “in-office ancillary services exception.” PIMA would restore the original intent of the self-referral law by prohibiting self-referral for four complex services—advanced imaging, anatomic pathology, radiation therapy and physical therapy, which are not typically performed at the time of the patient’s initial office visit.

“Over the years, use of the in-office ancillary services exception has dramatically increased, resulting in increased costs to the Medicare program,” says McDermott. “Patient convenience and streamlined services are important, but improper use of the exception creates unnecessary costs. This legislation will preserve the exception but narrow it to better reflect congressional intent in the Self-Referral law.”

Three recent Government Accountability Office (GAO) reports have examined the self-referral problem, including one released today on radiation oncology services. All three reports have found a significant and inappropriate increase in referrals when a physician switches to self-referral, costing Medicare millions. A fourth report on self-referral in physical therapy services is expected later this year. 

The bill has the support of the Alliance for Integrity in Medicare (AIM), a broad coalition of medical societies committed to ending the practice of inappropriate physician self-referral and focused on improving patient care and preserving valuable Medicare resources.

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About the Promoting Integrity in Medicare Act of 2013

What It Does
PIMA restores the original intent of the self-referral law by prohibiting self-referral for four complex services—advanced imaging, anatomic pathology, radiation therapy and physical therapy, which are not typically performed at the time of the patient’s initial office visit. This will ensure that incentives driving medical decisions are solely in the patients’ best interests, thereby reducing unnecessary and inappropriate services and costs to the Medicare program.

The bill also enhances enforcement of the self-referral law by increasing penalties for improper referrals and creating new compliance review procedures involving Medicare and the HHS Office of Inspector General. Finally, the bill clarifies that physician groups participating in Accountable Care Organizations in the Medicare Shared Savings Program can continue to provide integrated services and maintains access to care for rural beneficiaries.

Research
A 2012 GAO report confirmed that physician self-referral for advanced imaging services is costing Medicare more than $109 million in unnecessary spending each year. According to the GAO: “in 2010, providers who self-referred likely made 400,000 more referrals for advanced imaging services than they would have if they were not self-referring.”

Recently, the GAO issued another report that found that “referrals for anatomic pathology services by dermatologists, gastroenterologists and urologists substantially increased the year after they began to self-refer.” The GAO identified more than 918,000 more anatomic pathology services as a result of self-referral, costing Medicare at least $69 million in 2010.

Doctor-owned imaging machines have been used four times more than those used by radiologists since 2000. Medicare data shows that 2/3 of these machines are now within physician offices.

Self-referring non-radiologist physicians perform up to eight times as many imaging studies as physicians who refer their patients to radiologists.

Only 10% of advanced imaging services are performed on the same day as an office visit.

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