GAO: Self-Referring Docs Make Questionable Imaging Orders
Between 2004 and 2010, utilization of advanced medical imaging services (CT and MRI) increased by 80 percent for self-referred services, compared with 12 percent for non-self-referred services, according to a new report from the Government Accountability Office.
Between 2004 and 2010, utilization of advanced medical imaging services (CT and MRI) increased by 80 percent for self-referred services, compared with 12 percent for non-self-referred services, according to a new report from the Government Accountability Office.
GAO, a congressional watchdog agency, found that providers’ referrals substantially increased the year after they acquired imaging equipment and began to self-refer. “Providers that began self-referring in 2009--referred to as switchers--increased MRI and CT referrals on average by about 67 percent in 2010 compared to 2008,” according to the report.
During the same period, the average number of referrals made by other providers--remaining as self-referrers or non-self-referrers--declined. “This comparison suggests that the increase in the average number of referrals for switchers was not due to a general increase in the use of imaging services among all providers,” GAO asserts.
All total, GAO estimates self-referring providers in 2010 made 400,000 more referrals for advanced imaging than they would have if not self-referring, costing Medicare $109 million. Over-referring also raises radiation risks, the agency notes.
GAO recommended the Centers for Medicare and Medicaid Services implement a self-referral flag on its Medicare Part B claims form to understand if an advanced imaging claim is from a self-referring physician. CMS is in the process of adopting the recommendation. GAO also recommended CMS implement a payment reduction for self-referred imaging services that recognizes efficiencies when the same provider refers and performs a service, and develop ways to ensure the appropriateness of the services when done by self-referring providers. CMS is adopting both recommendations.
The GAO report is available here.
GAO, a congressional watchdog agency, found that providers’ referrals substantially increased the year after they acquired imaging equipment and began to self-refer. “Providers that began self-referring in 2009--referred to as switchers--increased MRI and CT referrals on average by about 67 percent in 2010 compared to 2008,” according to the report.
During the same period, the average number of referrals made by other providers--remaining as self-referrers or non-self-referrers--declined. “This comparison suggests that the increase in the average number of referrals for switchers was not due to a general increase in the use of imaging services among all providers,” GAO asserts.
All total, GAO estimates self-referring providers in 2010 made 400,000 more referrals for advanced imaging than they would have if not self-referring, costing Medicare $109 million. Over-referring also raises radiation risks, the agency notes.
GAO recommended the Centers for Medicare and Medicaid Services implement a self-referral flag on its Medicare Part B claims form to understand if an advanced imaging claim is from a self-referring physician. CMS is in the process of adopting the recommendation. GAO also recommended CMS implement a payment reduction for self-referred imaging services that recognizes efficiencies when the same provider refers and performs a service, and develop ways to ensure the appropriateness of the services when done by self-referring providers. CMS is adopting both recommendations.
The GAO report is available here.
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