The GAO conducted an analysis to answer questions about self-referral’s role in the rapid increase in cancer-related, intensity-modulated radiation therapy services performed by provider groups who self-referred. Self-referrals occur when a healthcare provider refers patients to entities the provider or the provider’s family members have a financial interest in, according to the report.
From 2006 to 2010, the GAO found the number of IMRT services for patients with prostate cancer increased from 80,000 to 366,000 for self-referring provider groups. By contrast, the number of IMRT services performed for prostate cancer provided by non-self-referring groups in physician offices decreased from 490,000 to 466,000 over the same time period.
IMRT is one of the most costly treatment options for prostate cancer, and spending for IMRT services for prostate cancer accounted for 55 percent of the $1.27 billion the federal government paid for IMRT under Medicare Part B in 2010, according to the report.
Medicare currently doesn’t require providers to tell patients they self-refer IMRT services, and therefore beneficiaries may not be aware of physicians’ potential financial incentives for prescribing IMRT over alternative treatments, according to the report. The GAO has advised Congress to consider directing HHS to require providers to tell patients about any financial interests in IMRT services. The GAO has also suggested that CMS monitor self-referral for such services.
More Articles on Physician Self-Referral:
GAO: CMS Should Keep Closer Eye on Physicians’ Self-Referrals
OIG Releases Updated Provider Self-Disclosure Protocol
GAO: Additional Imaging Self-Referrals in 2010 Cost Medicare $109M
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