The chair of the American Society for Radiation Oncology (ASTRO), Bruce D. Minsky, MD, FASTRO, (left) issued the following statement supporting witness testimony from the July 12 Senate Finance Committee hearing, “Examining the Stark Law: Current Issues and Opportunities,” during which all three witnesses testified in agreement that changes are needed to the law’s in-office ancillary services (IOAS) exception. ASTRO supports narrowing the IOAS exception to limit inappropriate physician self-referral for radiation therapy services.
“ASTRO applauds the Senate Finance Committee for its thoughtful, bipartisan examination of much-needed reforms to the physician self-referral law. All three expert witnesses at today’s hearing recommended changes to the law’s in office ancillary services exception (IOAS) to address concerns about overutilization stemming from physician ownership arrangements in radiation therapy and other services. ASTRO agrees that the time has come for Congress to close this loophole to help drive payment and delivery system reforms. We look forward to working with the committee to convert the bipartisan inquiry into bipartisan action to modernize the law in a manner that balances essential patient protections while accelerating important health reforms,” said Dr. Minsky.
The federal Ethics in Patient Referrals Act, also known as the physician self-referral law or the Stark law, prohibits physicians from referring a patient to a medical facility in which the physician has a financial interest. The law, which has been in effect since 1989, was designed to ensure that medical decisions are made in the best interest of patients without consideration of any financial gain that could be realized by the treating physician. Over the years, however, abuse of an exception to the law that allows physicians to self-refer for so-called “ancillary services,” including radiation therapy, has diluted the self-referral law and created a pathway for physicians to avoid its prohibitions and intent.
ASTRO urges restoring the original intent of the law and limiting the IOAS exception by prohibiting physician self-referral for four complex services—advanced imaging, anatomic pathology, radiation therapy and physical therapy. Multiple studies, including reports published by the Government Accountability Office (GAO) and in the New England Journal of Medicine, have shown that physician self-referral leads to increased utilization of services that may not be medically necessary, poses a potential risk of harm to patients and costs the health care system millions of dollars each year. Moreover, bipartisan groups including the Center for American Progress, the Bipartisan Policy Center and the AARP, have recommended closing the self-referral loophole. President Obama recommended closing the loophole in four consecutive budget proposals (FY 2013 -- FY 2017), and the Office of Management and Budget estimated this change would lead to Medicare program savings of $3.3 billion over 10 years.
Legislative changes to the IOAS exception would expedite delivery and payment system reform in a manner consistent with the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act (MACRA) passed in 2015. While MACRA and other policy changes will increase the numbers of physicians participating in alternative payment models, many may still participate in a traditional fee-for-service model that incentivizes over-utilization of health care services through self-referral. ASTRO believes that ensuring that only physicians participating in approved alternative payment models and other truly integrated medical groups focusing on quality could self-refer under the IOAS exception, thereby rooting out abuse in the traditional fee-for-service system while accelerating participation in alternative payment models.
ASTRO is a partner in the Alliance for Integrity in Medicare (AIM), a coalition of medical societies committed to ending the practice of inappropriate physician self-referral and improving patient care by preserving valuable Medicare resources. In addition to ASTRO, AIM partners include the American Clinical Laboratory Association, the American Physical Therapy Association, the American Society for Clinical Pathology, the Association for Quality Imaging, the College of American Pathologists and the Radiology Business Management Association.