GAO takes aim at urologist self-referral-again

Provision of intensity-modulated radiation therapy services performed by self-referring groups “increased rapidly” between 2006 and 2010 while the rate declined for non-self-referring groups, according to a report from the Government Accountability Office.

The July 19 report is the second in a month to take aim at self-referral practices, with urologists targeted in both. A June GAO report drew a similar conclusion about self-referred anatomic pathology services. Both reports have drawn strongly worded responses from organized urology.

In the latest report, the GAO said the number of prostate cancer-related IMRT procedures rose from approximately 80,000 to 366,000 over the 4-year period. The findings suggest that financial incentives for self-referring providers “were likely a major factor driving the increase in the percentage of prostate cancer patients referred for IMRT,” the GAO said.

The report concluded by recommending that “Congress should consider directing the Secretary of Health and Human Services… to require providers to disclose their financial interests in IMRT to their patients.” It also recommended that the Centers for Medicare & Medicaid Services identify and monitor self-referral of IMRT services.

In a statement, the American Society of Radiation Oncology called the report “striking” and said it “details clear mistreatment of patients who trusted their physicians to care for their prostate cancer,” although the group felt its recommendations did not go far enough.

“ASTRO believes that the GAO’s recommendations of increased tracking and transparency are well-intentioned but insufficient to stop the costly, hazardous abuse of the [in-office ancillary services] exception,” ASTRO said in a statement.

Meanwhile, the AUA, American Association of Clinical Urologists, and Large Urology Group Practice Association, in a joint statement, labeled the GAO report as “flawed” and “misleading.”

“Critically, the GAO failed to properly account for the fact that the increase in the overall number of IMRT treatments performed by urology groups is directly related to the number of urologists in group practices that now incorporate radiation therapy as part of their comprehensive, integrated strategy to treat prostate cancer,” the statement said. “Furthermore, the GAO completely disregarded peer reviewed literature that demonstrates that IMRT has become the clinical standard of care for prostate cancer patients and that patient understanding of their treatment options is substantially enhanced when there is shared decision making in a comprehensive, integrated cancer care setting-which results in patients choosing equally effective, less-invasive forms of cancer therapy.”

The urology groups also pointed out that the GAO did not recommend closing the in-office ancillary services exception, although this is the subject of a recently introduced piece of legislation, the “Promoting Integrity in Medicare Act of 2013.” That bill would prohibit self-referral for advanced imaging, anatomic pathology, radiation therapy, and physical therapy.

Look for additional coverage of the self-referral controversy in the September issue of Urology Times.

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