‘Enough is enough’

Leg­is­la­tors want ban on ra­di­a­tion self-re­fer­ral

Modern Healthcare - - LATE NEWS - Andis Robeznieks

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.

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