‘Enough is enough’
Legislators want ban on radiation self-referral
Federal legislators are pushing a ban on self-referral in radiation therapy in the wake of a U.S. Government Accountability Office report finding a massive jump in advanced radiation treatments for prostate cancer conducted at facilities owned by the referring physicians.
The GAO report found that the number of prostate cancer-related intensity-modulated radiation therapy, or IMRT, services performed by self-referring groups increased from about 80,000 to 366,000 between 2006 and 2010 while declining among non-self-referring groups. The report noted that self-referrers were less likely to refer patients for less-costly treatments such as radical prostatectomy or brachytherapy. It adds that the bill for prostate cancer-related IMRT services accounted for about 55% of the $1.27 billion Medicare spent on IMRT treatments in 2010.
“Factors such as age, geographic location and patient health did not explain the large differences between self-referring and non-self-referring providers,” the report concluded. “These analyses suggest that financial incentives for self-referring providers—specifically those in limited specialty groups—were likely a major factor driving the increase in the percentage of prostate cancer patients referred for IMRT.”
The report was requested by Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa) and Reps. Henry Waxman (D-Calif.) and Sander Levin (D-Mich.).
“Cancer patients should never have to question their doctors’ motives,” Baucus said in a news release. “Unfortunately, when you look at the numbers in this report, you start to wonder where healthcare stops and where profiteering begins. We have a law on the books designed to prevent these conflicts of interest, but an increasing number of physicians are skirting the law for their own personal gain. Enough is enough.”
House Resolution 2914, titled the “Promoting Integrity in Medicare Act of 2013,” would ban self-referral for advanced imaging, anatomic pathology, radiation therapy and physical therapy.
“This is a golden opportunity to choose patients over profit,” bill sponsor Rep. Jackie Speier (D-Calif.) said in a news release. “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.”
The bill, co-sponsored by Reps. Jim McDermott (D-Wash.) and Dina Titus (D-Nev.), is supported by the 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 and the Radiology Business Management Association.
The GAO report was the third in a series on self-referral issues. A report on selfreferral for physical therapy services is expected this year.
The findings of the latest report were challenged in a joint news release from three urological organizations. They blasted the report and said, “The GAO provided no evidence that patients were being provided radiation therapy inappropriately by integrated urology practices that had acquired IMRT.”
The release was issued by the American Association of Clinical Urologists, American Urological Association and the Large Urology Group Practice Association, which argued that “the GAO failed to properly account for the fact that the increase in the overall number of IMRT treatments performed by urology groups is directly related to the number of urologists in group practices that now incorporate radiation therapy as part of their comprehensive, integrated strategy to treat prostate cancer.”
The American Society for Radiation Oncology, or ASTRO, issued news releases praising both the GAO report and Speier’s bill, and stated that the “GAO’s report confirms that these practices are not truly integrated healthcare centers,” but are instead profit-driven limited specialty groups.
“We are extremely concerned that many older male patients are receiving such vigorous, possibly unnecessary treatment by urology groups,” Dr. Michael Steinberg, ASTRO chairman, said in a release. “Clearly, these self-referring urology groups are steering patients to the most lucrative treatment they offer, depriving them of their full range of treatment choices, including potentially no treatment at all.”
Patrice Winter of the American Physical Therapy Association speaks at the news conference on the self-referral ban bill.