More on Reimbursement

Medicare imaging self-referrals cost $109 million in 2010

The Government Accountability Office (GAO) has found that Medicare-covered advanced imaging services increased between 2004 and 2010, and that unecessary provider self-referrals cost $109 million in 2010.

The use of imaging services at clinics where the referring doctor has a financial stake increased by 80 percent for MRIs between 2004 and 2010, the GAO found, much higher than non-self-referred MRIs, which grew at a rate of 12 percent. The use of CT scans through self-referrals and independent referrals grew at similar rates.

The GAO also found that providers' referrals of MRI and CT services increased significantly after self-referrals began, usually after the provider purchased or started leasing imaging equipment, or joined a group practice that already self-referred. Providers that began self-referring in 2009 increased their MRI and CT referrals on average 67 percent in 2010 compared to 2008.

In 2010, the government agency found, self-referring providerrs made about 400,000 more advanced imaging referrals than they would have if they were not self-referring, costing Medicare about $109 million. 

The findings "suggest that financial incentives for self-referring providers were likely a major factor driving the increase in referrals," the GAO wrote.  

[See also: Proposed lawsuit settlement will alter home health Medicare reimbursements]

The findings come amid broader discussions in Washington D.C. about Medicare's financial sustainability and ways to trim waste.

"Self-referrals offer an incentive for providers to order more tests than they would otherwise," Senator Max Baucus, chairman of the Senate Finance Committee, said in a news release. "It's clear they are driving up costs. Providers' bottom lines shouldn't be getting in the way of their patients' care and best interests."

Iowa Senator Charles Grassley added: "The challenge is to develop a payment system that safeguards beneficiary access to services while preventing self-referrals by physicians who abuse the system."

But the American Association of Orthopedic Surgeons (AAOS) warns that limiting self-referrals may not be the right path and contends that in-office imaging can help patient adherence to treatment regimens and improve health outcomes.

"Like the GAO, the AAOS believes that wasteful spending in Medicare should be addressed.  The AAOS is invested in quality initiatives to ensure that only medically necessary services are performed on orthopaedic patients," said John R. Tongue, MD, president of AAOS in a prepared statement. "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."

Show All Comments