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Friday, August 2, 2013

Are Self-Referring Providers Driving Up Medicare Costs?

by James Swann

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Self-referring providers have dramatically expanded their use of an expensive prostate cancer treatment over the last few years, and Medicare costs have been rising as a result, according to a recent GAO report. Intensity-modulated radiation therapy (IMRT) is the most expensive prostate cancer treatment, with the exception of proton therapy, and it's use by self-referring providers has grown from roughly 80,000 treatments in 2006 to 366,000 in 2010, an annual increase of 46 percent. Over the same period, non-self-referring provider use of IMRT actually declined, moving from 490,000 to 466,000, an annual decrease of 1 percent.  

As IMRT use has expanded among self-referring providers, so have Medicare payments, which increased from $52 million in 2006 to $190 million in 2010, an average annual increase of 38 percent.  For non-self-referring providers, Medicare payments for IMRT decreased from $330 million to $239 million, an average annual decrease of 8 percent. 

Sen. Max Baucus (D-Mont.) said Congress needs to close the exception in the Stark law that allows for the self-referral of certain services, including IMRT treatment. He said the GAO report is  "more evidence that our health care system needs to reward the value of care, rather than the volume of treatments and procedures."   

 
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