Urologists laud senators’ support of self-referral

The AUA recently joined with the American Association of Clinical Urologists and the Large Urology Group Practice Association in applauding the Physician’s Caucus of the United States Senate for their “commitment to preserving patient access to independent, integrated medical services.”

In a letter to Senate Majority Leader Harry Reid and Senate Minority Leader Mitch McConnell, Sens. Tom Coburn, MD (R-OK), John Barrasso, MD (R-WY), Rand Paul, MD (R-KY), and John Boozman, OD (R-AR), expressed their support for the in-office ancillary services exception (IOASE) to federal self-referral regulations.

“Providing comprehensive services to patients through the integration of ancillary services at the point of service improves communications between physicians of different specialties, facilitates the development of coordinated clinical pathways, and enhances the development of disease-specific clinical expertise, all of which lead to improved quality at reduced cost,” said LUGPA President Juan A. Reyna, MD.

The letter affirmed that the utilization of certain ancillary services has actually decreased in recent years.

“It’s important to note that the letter stated that the volume of advanced imaging services has slowed significantly, from 13.4% growth in 2006 to 5.4% in 2007,” said AUA Health Policy Chair David F. Penson, MD, MPH. “Research shows that the utilization of intensity-modulated radiation therapy, or IMRT, to treat prostate cancer from 2007 to 2011 increased by only 2.2%, notwithstanding the approximately 160% increase in the number of urologists in practices with ownership of IMRT.”

The findings are in sharp contrast to the recent report from Jean Mitchell, PhD, of Georgetown University, Washington, which stated that IMRT utilization among self-referring groups increased from 13.1% to 32.3% once they became self-referrers (N Engl J Med 2013; 369:1629-37).

The leadership of physician members of Congress on this issue is particularly timely as both parties work toward modification of the sustainable growth rate formula, the three urology groups said in a joint statement. Repeal of the IOASE provision for radiation, advanced imaging, and physical therapy would make it illegal for physician practices to integrate these ancillary services into their practices and ultimately force more patients to receive these services in a hospital setting, thereby reducing access and increasing costs.

In their letter, the senators point out that hospitals typically mandate that employed physicians use the more expensive hospital services-a trend that is increasing as more physicians are becoming hospital employees. The senators also note that those advocating for repeal of the IOASE stand to gain financially from such a change.

“Shifting patients to less convenient, more expensive sites of service is not a solution,” said AACU President Richard Pelman, MD. “We need to focus on delivering high-quality, cost-effective care-not on where that care is delivered.”

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