AIM Coalition Welcomes New Study On Self Referral in Surgical Pathology Services

Twitter icon
Facebook icon
LinkedIn icon
e-mail icon
Google icon

A new study by Georgetown's Dr. Jean Mitchell shows that self-referral for prostate biopsy pathology evaluations has increased Medicare billing, but has not improved cancer detection.

The Alliance for Integrity in Medicare (AIM)--a coalition of medical specialty, laboratory, radiation oncology, and medical imaging groups--issued a press release on Wednesday, applauding the study's findings on the practice of self-referral among urologists who conduct prostate biopsy evaluations in their own labs. The research supports AIM's assertion that the practice of self-referral provides no extra benefit to patients and only serves to increase Medicare costs.

The study, published in the April 2012 issue of Health Affairs, found that urologists involved in self-referral bill Medicare for 72% more specimen evaluations than urologists who use independent pathology services. Despite the increased billing, the study found that self-referring urologists usually detect cancer at a lower rate compared to non-self-referring urologists. According to the study, the per-patient cancer detection rate for self-referring urologists in 2007 was 12 percentage points lower than that for non-self-referring urologists.

"This suggests that financial incentives prompt self-referring urologists to perform prostate biopsies on men who are unlikely to have prostate cancer. These results support closing the loophole that permits self-referral to ‘in-office’ pathology laboratories," said the study.

AIM is urging Congress to revise physician self-referral laws to address exemptions that allow medical specialists to self-refer patients to labs they own or have an ownership interest in. Abuse of this exemption is not limited to urologists, but is also a problem in advanced diagnostic imaging, physical therapy, and radiation oncology fields.

AIM said it hoped that the publication of the study in a respected peer-reviewed journal could force policymakers into action.

The coalition includes the following organizations: The American College of Radiology; American Clinical Laboratory Association; American Physical Therapy Association; American Society for Clinical Pathology; American Society for Radiation Oncology; Association for Quality Imaging; College of American Pathologists; and Radiology Business Management Association.