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The Medical Professionalism Blog

Acts of Professionalism: Opposition to Self-Referrals by Specialty Societies

In September, the Government Accountability Office (GAO) released a report titled Higher Use of Advanced Imaging Services by Providers Who Self-Refer Costing Medicare Millions.

The report concluded that:

From 2004 through 2010, the number of self-referred and non-self-referred advanced imaging services—magnetic resonance imaging (MRI) and computed tomography (CT) services—both increased, with the larger increase among self-referred services. For example, the number of self-referred MRI services increased over this period by more than 80 percent compared with an increase of 12 percent for non-self-referred MRI services…These additional referrals cost Medicare about $109 million.

I was heartened by the response of the Alliance for Integrity in Medicare (AIM), a coalition of medical specialty, laboratory, radiation oncology and medical imaging groups, which released a statement applauding the report.

Among the specialty societies in the AIM coalition are three partners of the Choosing Wisely® campaign – the American College of Radiology (ACR), the American Society for Radiation Oncology (ASTRO) and the American Society for Clinical Pathology (ASCP). Of the 30 specialty societies now participating in Choosing Wisely, ACR was in the first nine specialty societies that participated in the campaign announcement in April 2012.

Self-referrals are exempt from the Stark law for certain services that are intended to facilitate a quick turnaround of diagnosis or kick start a treatment plan. This exception was intended for patient convenience, allowing “one stop shopping.” The exemption has since been abused beyond its original intent and AIM supports the GAO’s call for an end to self-referrals.

The statement by AIM acknowledges that unnecessary utilization leads to not just increased spending, but also puts patients needlessly at risk. When patients undergo a medical test or procedure they don’t need, there are significant downstream health and financial impacts to be considered.

Medical Professionalism in the New Millennium: A Physician Charter calls on physicians to maintain the trust of their patients by managing conflicts of interest. If physicians put their financial well-being before that of their patients, this trust is eroded and it jeopardizes their ability to deliver the best possible patient-centered care.

Providing physician leadership by developing a platform for more appropriate use of services and reimbursement of services is also an act of medical professionalism. Whether this can be all a zero sum game and the savings generated by eliminating self-referrals can be used to offset the scheduled Medicare cuts remains to be seen. But, with better access to health care for millions of Americans through the Health Insurance Exchanges scheduled to be implemented in 2014, I’d like to think it may be possible. We need to reduce unnecessary medical tests, procedures and services to ensure our health care system is prepared to meet the needs of 30 million Americans expected to gain better access to improving care.

Thank you to AIM, the specialty societies and the other members of the coalition for this act of professionalism. Doing the right thing for the public is what medical professionalism is all about.

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