GAO Reports Self-Referrals for Imaging Are Costly: Part II

Part 2: Don't Blame Diagnostic Imaging, Blame the Abuse of Utilization

In a newly-released study, the Government Accountability Office (GAO) concluded that in 2010, physician self-referrals rose 80 percent for physicians who purchased diagnostic imaging equipment in 2009.

During the fiscal year of 2010, self-referrals amounted to over $109 million dollars in extra payments from Medicare, which equates to approximately 400,000 diagnostic imaging examinations for seemingly arbitrary purposes. These self-referred examinations enable medical practices to pay for costly imaging equipment and enhance their bottom line.

In response to helping curtail this unsustainable growth, one of the proposals of the Centers for Medicare and Medicaid Services (CMS) is reinstating its 2012 Medicare Physician Fee Schedule (MPFS) policy and applying the multiple-procedure payment reduction (MPPR) of 25 percent in the professional component (PC) in payment to physicians who order multiple imaging tests on the same day, for the same patient, at the same facility. (Read the full statement here.)

The American College of Radiology (ACR) states that these proposed Medicare cuts are unnecessary, unfounded, and dangerous. The ACR points out that multiple diagnostic imaging tests done during one visit for the same patient has become standard procedure for victims of trauma or acute illness. MRIs, CT scans, and ultrasound findings can provide crucial evidence in determining levels of internal bodily damage and in diagnosing problems before they become fully symptomatic. Dr. Paul Ellenbogen, chair of the ACR's Board of Chancellors, recently pointed out, "These cuts primarily affect care for people with immediately life-threatening illnesses or injuries -- those suffering from multiple trauma or heart attacks, stroke patients, and people fighting cancer -- all of whom often need multiple imaging exams to survive." (See full statement here.)

Multiple imaging in certain instances is diagnostically warranted; however, 400,000 patients being subjected to unnecessary and expensive procedures performed by non-radiology physicians/greedy businessmen is a problem, and the imaging tests -- multiple or singular -- are not the appropriate target. Abuse from self-referral is! (Read more about what I've written on physician self-referrals: here and here.)

As previously stated, the Congressional Budget Office (CBO) is discussing potential cost savings by eliminating the In-Office Ancillary Services (IOAS) exception to the Stark Law, which would ban physicians from owning ancillary devices such as advanced imaging and physical therapy services. Unfortunately, there will be resistance: strong lobbying by various special-interest groups, including the Coalition for Patient Centered Imaging (CPCI) along with physician societies, which are united for the sole purpose of maintaining their lucrative self-referral practice patterns.

Ask Questions!

As I continually stress, when your physician suggests diagnostics imaging, ask why. Ask how the results will influence treatment? Ask how the results or findings on the image examination will change your treatment, and if it will not, then why have the examination? Ask who owns the imaging equipment? Is the equipment in the same facility? Will the test results be interpreted by the physician taking care of you or one of the physician's partners, or by an independent radiologist? This equates to your doctor seeing you, testing you on his/her equipment (for another fee, of course), interpreting the test for a fee often included in their technical fee, and then -- more likely than not -- scheduling multiple follow-up appointments with you. You may be surprised to realize your physician is often the main beneficiary of these examinations.

Just Say "No" to Unnecessary Testing

Your duty as the patient is to control what happens to your body. If you want to know or feel that your symptoms warrant further testing, then go for it, however, you should still question the subspecialty expertise and training of the physician who is interpreting your examination.

Know the Risks and Be Informed

Diagnostic imaging technologies are increasingly enabling earlier and more sensitive and more specific information. Some examinations like CT and X-rays, despite recent advances in lower-dose techniques, are still dangerous. Pregnant women and children must proceed with caution when it comes to ionizing radiation. Be rational and firm with your physician. Do your homework. If you're uncomfortable with the number of imaging examinations your physician has ordered over the past several years, question your physician.

Transparency can make or break any patient-physician relationship. If your physician is not attentive to your concerns, then do not continue to feed the practice. While Medicare may be trying to squelch unsavory practices, ultimately the informed consumer (patient) has the greatest power to facilitate changes. If your physician cannot be questioned or will not provide you with satisfactory answers to your questions, find another physician.

For more information on Medicare in 2013 click here.

For more by Helene Pavlov, M.D., click here.

For more healthy living health news, click here.