News | Radiology Business | April 28, 2016

ASTRO Supports Promoting Integrity in Medicare Act

Federal legislation would close loophole that still allows physicians to self-refer patients for certain services, including radiation therapy

April 28, 2016 — The American Society for Radiation Oncology (ASTRO) and radiation oncologists nationwide hailed the introduction of federal legislation that would drive alternative payment models, protect patients and reduce Medicare costs. The legislation would accomplish this by closing a costly loophole in the physician self-referral law.

ASTRO Chair Bruce D. Minsky, M.D., FASTRO, called on Congress to support healthcare delivery and payment reform by passing HR 5088, the Promoting Integrity in Medicare Act of 2016 (PIMA), introduced by Rep. Jackie Speier (D-Calif.) and Ways and Means Health Subcommittee Ranking Member Rep. Jim McDermott (D-Wash.).

The federal Ethics in Patient Referrals Act, also known as the physician self-referral law, prohibits physicians from referring a patient to a medical facility in which the physician has a financial interest. The law, which has been in effect since 1989, was designed to ensure that medical decisions are made in the best interest of patients without consideration of any financial gain that could be realized by the treating physician. Over the years, however, abuse of an exception to the law that allows physicians to self-refer for so-called “ancillary services,” including radiation therapy, has diluted the self-referral law and created a pathway for physicians to avoid its prohibitions and intent.

If passed, PIMA would restore the original intent of the Ethics in Patient Referrals Act, limiting the in-office ancillary services (IOAS) exception by prohibiting physician self-referral for four complex services — advanced imaging, anatomic pathology, radiation therapy and physical therapy. The bill also would increase penalties for improper referrals, create new compliance review procedures involving Medicare and the U.S. Department of Health and Human Services’ Office of the Inspector General, and strengthen provisions in the self-referral law that maintain access to care for rural beneficiaries.

Multiple studies, including reports published by the Government Accountability Office (GAO) and in the New England Journal of Medicine, have shown that physician self-referral leads to increased utilization of services that may not be medically necessary, poses a potential risk of harm to patients and costs the healthcare system millions of dollars each year.

Moreover, bipartisan groups including the Center for American Progress, the Bipartisan Policy Center and the AARP, have recommended closing the self-referral loophole. President Obama recommended closing the loophole in four consecutive budget proposals (FY 2013-FY 2017), and the Office of Management and Budget estimated this change would lead to Medicare program savings of $3.3 billion over 10 years.

Rep. Speier’s PIMA legislation would expedite delivery and payment system reform in a manner consistent with the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act (MACRA) passed in 2015.  While MACRA and other policy changes will increase the numbers of physicians participating in alternative payment models, many may still participate in a traditional fee-for-service model that incentivizes over-utilization of healthcare services through self-referral. PIMA would ensure that only physicians participating in approved alternative payment models and other truly integrated medical groups focusing on quality could self-refer under the IOAS exception, thereby rooting out abuse in the traditional fee-for-service system while accelerating participation in alternative payment models.

“Self-referral abuse is at the heart of what’s wrong with the traditional fee-for-service system, and it undermines ASTRO-supported efforts to move Medicare toward quality- and value-based payment. Closing the self-referral loophole will accelerate participation in alternative payment models and fulfill the vision of a high-value payment system,” said Minsky. “We applaud Reps. Speier and McDermott for their leadership introducing legislation that drives needed payment reforms, protects patients and reduces waste.”

ASTRO is a partner in the Alliance for Integrity in Medicare (AIM), a coalition of medical societies committed to ending the practice of inappropriate physician self-referral and improving patient care by preserving valuable Medicare resources. In addition to ASTRO, AIM partners include the American Clinical Laboratory Association, the American Physical Therapy Association, the American Society for Clinical Pathology, the Association for Quality Imaging, the College of American Pathologists and the Radiology Business Management Association.

For more information: www.astro.org

Related Content

Amar Kishan, M.D.

Amar Kishan, M.D.

News | Prostate Cancer | September 11, 2018
UCLA researchers have discovered that a combination of high doses of...
Videos | Radiation Therapy | September 07, 2018
A discussion with Ehsan Samei, Ph.D., DABR, FAAPM, FSPIE, director of the Duke University Clinical Imaging Physics Gr
Feature | Radiology Business | September 07, 2018 | By Marilyn M. Singleton, M.D., J.D.
“Disruptive innovation” is all the buzz. Repealing the Affordable Care Act (ACA) is so last year. Well, disrupt this:...
Boston Scientific to Acquire Augmenix Inc.
News | Patient Positioning Radiation Therapy | September 07, 2018
Boston Scientific has entered into a definitive agreement to acquire Augmenix Inc., a privately-held company which has...
GlobalData: Amazon Poised to Make Huge Strides in Healthcare
News | Radiology Business | August 31, 2018
A new report from data and analytics company GlobalData suggests that Amazon is poised to make huge strides in...
Non-Canonical Strategy May Improve Cancer Radiotherapy
News | Radiation Therapy | August 29, 2018
August 29, 2018 — Although the success or failure of...
Videos | Treatment Planning | August 28, 2018
A discussion with...
Sponsored Content | Webinar | Radiation Therapy | August 28, 2018
Respiratory tumor motion often complicates the delivery of precision radiation treatment.
Tsuyama Chuo Proton Beam Center Treats First Patients With RayStation
News | Treatment Planning | August 27, 2018
Tsuyama Chuo Hospital in Okayama Prefecture, southwest Japan, has commenced clinical use of RayStation to plan pencil...
Radiation Therapy Affects Event Recall for Children With Brain Tumors
News | Radiation Therapy | August 24, 2018
Children with certain types of brain tumors who undergo radiation treatment are less likely to recall the specifics of...
Overlay Init