ARLINGTON, Va., April 7, 2017 -- The American Society for Radiation Oncology (ASTRO) and radiation oncologists nationwide hailed today’s introduction on Capitol Hill of federal legislation that would drive alternative payment models (APMs), protect patients and reduce Medicare costs by closing a costly loophole in the physician self-referral law. ASTRO Chair David C. Beyer, MD, FASTRO, called on Congress to support health care delivery and payment reform by passing the Promoting Integrity in Medicare Act of 2017 (PIMA), introduced today by Rep. Jackie Speier (D-Calif.).

The federal Ethics in Patient Referrals Act, also known as the physician self-referral 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.

If passed, PIMA would restore the original intent of the Ethics in Patient Referrals Act, limiting the in-office ancillary services (IOAS) exception by prohibiting physician self-referral for four complex services—advanced imaging, anatomic pathology, radiation therapy and physical therapy. The bill also would increase penalties for improper referrals, create new compliance review procedures involving Medicare and the U.S. Department of Health and Human Services’ Office of the Inspector General and strengthen provisions in the self-referral law that maintain access to care for rural beneficiaries.
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 AARP, the Center for American Progress and the Bipartisan Policy Center have recommended closing the self-referral loophole. The Congressional Budget Office estimated this change would lead to Medicare program savings of $3.3 million over 10 years.

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