News | July 21, 2009

ACR Sends Out “Action Alert” to Support Self-Referral Amendment

James H. Thrall, MD, FACR, chair, Board of Chancellors, American College of Radiology

July 21, 2009 – The American College of Radiology’s (ACR) chair, James H. Thrall, M.D., FACR, sent out an “Action Alert” to 7,000 ACR members who are constituents of Energy and Commerce with background and talking points urging phone calls of support for the Weiner/Braley self-referral amendment.
The bill would close the in-office ancillary service exemption for MRI, CT and PET currently allowed under the Stark self-referral law and end the practice of self-referral for those modalities under Medicare. 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.
“An amendment of supreme importance to diagnostic radiology will be offered in the next few days by Congressmen Weiner (D-NY) and Braley (D-IA) that would close loopholes in the Stark self-referral law and, if enacted into law, ban in-office self-referral of CT, MR and PET scans,” said Dr. Thrall.
In a letter posted on the ACR Web site, Dr. Thrall asked ACR members to turn their attention to the Energy and Commerce Committee, which is in the process of doing its mark-up, which will go through mid-next week.
Dr. Thrall stressed that “the passage of this amendment will be extremely difficult. There is no issue in medicine that is as divisive as ownership within a physician’s office. We can expect the full force of organized medicine to fight this amendment.”
He addedk, "Even if the self-referral amendment should pass, Speaker Pelosi and House leadership could choose not to hold a floor vote on this Energy and Commerce bill if they feel too many amendments are added to it (remember the 200 amendments mentioned above). They could instead schedule a floor vote on the health care bill from the Ways and Means Committee, who’s Health Subcommittee Chairman (Cong. Pete Stark, D-CA) opposes amending the Stark law. If that happens, the ability to offer a self-referral amendment to that bill on the House floor is doubtful."
The "talking points" are the following:
- 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 the Medicare program.
- 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:
- The Government Accountability Office’s June, 2008 stated, "…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."
- 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."
- The health risks to patients of these practices cannot be ignored. Nonradiologist providers often lack even basic radiation safety training and may not be aware of potential repercussions to patients of ordering and often administering high volumes of scans.

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