A recently released U.S. Government Accountability Office study says providers with their own advanced imaging equipment in-house are far more likely to refer Medicare patients for imaging services, costing the federal government millions of dollars.
The GAO tracked what it calls “self-referral" nationally from 2004 to 2010. It created its own methodology to do so, since Medicare doesn’t track it. In a summary of its report, the GAO estimates that self-referrals cost Medicare more than $109 million in 2010 alone.
It concludes that “financial incentives for self-referring providers were likely a major factor driving the increase in referrals."
Advanced imaging services include MRI and CT scans. The GAO notes that CT scans in particular are a concern for patients, since they involve radiation that can contribute to the risk of cancer.
During the period of study, the GAO says the number of self-referred MRI services increased 80 percent, while the number of non-self-referred grew 12 percent. Also, providers that began self-referring increased the number of CT and MRI services referred by 67 percent between 2008 and 2010.
Medicare Part B covers payment for advanced imaging services. The GAO was asked to examine self-referral to assess its effect on Medicare spending.
In its recommendations, the GAO says the Centers for Medicare and Medicaid Services should insert a box on forms to indicate whether a test was a self-referral; that the agency should consider reducing the average payment given the efficiencies created by in-house service; and that the agency should come up with an approach to ensure the appropriateness of advanced imaging services from self-referring providers.
— Heidi Hagemeier, The Bulletin