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Special Report: September 25, 2015
New Research Supports Closing the Self-Referral Loophole
The Alliance for Integrity in Medicine (AIM), a coalition of medical associations that includes the CAP, applauded the release of a new study showing physicians who self-referred services for physical therapy led to health care costs than non self-referring physicians.
The study led by prominent Georgetown University economist, professor, and health policy researcher Jean Mitchell, PhD, offers a new look at self-referral in physical therapist services following a 2014 Government Accountability Office (GAO) report. Similar research by Dr. Mitchell and the GAO showed increased utilization of pathology, advanced imaging, and radiation oncology services by self-referring providers. The CAP and other members of the AIM coalition support closing a loophole under the in-office ancillary services (IOAS) exception to the federal Stark self-referral law that leads to increased utilization of pathology services.
The new research published in the July 2015 issue of Forum for Health Economics and Policy examined 158,151 low back pain episodes for patients covered by Blue Cross Blue Shield of Texas. They found that self-referring physicians referred 26% of their patients for physical therapy while non-self-referring physicians referred 10% of their patients. The study also found that non-self-referred episodes of care were far more likely, 52% as opposed to 36% for self-referrers, to provide "active" physical therapy services. This, according to the study's authors, suggests the care delivered by PTs in non-self-referred episodes is more tailored to promote patient independence and a return to performing routine activities without pain.
"AIM hopes that, combined with the GAO report from August 2014, this study will once again underscore for policymakers the fact that self-referral is a real and serious problem that drives up costs with no benefit to patients," the coalition said in a statement. "The ongoing misapplication of the IOAS exception for physical therapy, anatomic pathology, advanced diagnostic imaging, and radiation oncology services continues to be of grave concern to AIM. Furthermore, the coalition's position has been corroborated by independent evidence, including GAO reports and peer reviewed published research, which consistently demonstrates that the existing IOAS physician self-referral loophole results in increased spending, unnecessary utilization of medical services, and potentially compromised patient choice and care, which erodes the integrity of the Medicare program."
The Alliance for Integrity in Medicare is a coalition of medical societies focused on improving patient care and preserving valuable Medicare resources by ending the practice of inappropriate physician self-referral. In addition to the CAP, coalition members include 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, and Radiology Business Management Association.
CAP Launches Survey With Goal to Improve Pathology Workforce Training
The CAP's Policy Roundtable is conducting a survey to gather input on new-in-practice pathologists' preparation for the practice. The survey's results will be used to inform recommendations for residency program requirements.
The CAP is sending the survey only to pathologists who may be responsible for the hiring and supervision of other pathologists. Pathologists with these responsibilities will receive an invitation to take the survey on September 1.
The survey should take approximately 10 to 20 minutes to complete and answers submitted will be kept confidential and anonymous. All data will be aggregated into one common data file for data analysis purposes.
Candid feedback is critical to the success of this effort and will help strengthen recommendations for how we train pathologists to build a stronger workforce for the future. To express the CAP's appreciation, all respondents will be entered in a drawing for a $100 Amazon.com gift card. The CAP will give out one card for each of the three weeks that the survey is open.
Download the CAP's Regulatory Compliance Resources
The CAP has assembled a collection of key regulatory and compliance matters for pathologists and their laboratories. These member-only documents are available to download for your use and share at your practice.
The CAP's regulatory compliance webpage features information on advanced beneficiary notices, Medicare's reassignment rule, Part A compensation, and professional component billing. The CAP also provides a document with key terms pathologists and laboratory administrators may encounter when confronting regulatory issues.
Complete Our STATLINE Readership Survey
The CAP invites CAP members to participate in a quick survey regarding our STATLINE newsletter. Your valuable feedback will allow us to evaluate and improve the e-newsletter to best meet your needs. Please click the following link to participate in our STATLINE readership survey.
The survey should take approximately 5-10 minutes to complete. As a thank you for your time and feedback, we also invite you to enter into a drawing to win one of three $100 Amazon.com gift cards. If you would like to enter, please submit your name and information at the end of the study.
The CAP recognizes the value of your time and privacy. Please be assured that your individual information will be kept strictly confidential and your email address will not be distributed to anyone. All results are reported in aggregate format.