SYS-CON MEDIA Authors: Liz McMillan, Carmen Gonzalez, Zakia Bouachraoui, Roger Strukhoff, David Linthicum

News Feed Item

GAO Reports Physicians Who Self-Refer Anatomic Pathology Cost Medicare Millions

CAP Calls on Congress to Act Immediately

NORTHFIELD, Ill., July 15, 2013 /PRNewswire-USNewswire/ -- The College of American Pathologists today called attention to a new report from the Government Accountability Office (GAO) documenting millions of dollars in wasteful health care spending by physicians who self-refer anatomic pathology services, and called on Congress to take immediate action outlawing this business practice.

(Logo: http://photos.prnewswire.com/prnh/20120314/DC69899LOGO-a)

"GAO issued a report today with irrefutable evidence that physician self-referral is a national problem," said CAP President-Elect Gene Herbek, MD, FCAP. "It contributes to widespread abuses, increased medical costs and over utilization, and it allows physicians to exploit a loophole that permits them to bill Medicare for certain additional services they provide to patients at the time of the office visit."

"However, this provision was never intended to protect self-referral of anatomic pathology services because unlike clinical laboratory services they can almost never be performed at the time of an office visit," Herbek said.

The GAO study found that financial incentives for self-referring providers were likely "a major factor driving the increase in anatomic pathology referrals", and in 2010, providers who self-referred made an estimated 918,000 more referrals for anatomic pathology services than they likely would have if they were not self referring. CMS estimated these additional referrals cost Medicare about $69 million in 2010.

While CAP applauded the GAO's findings and call for action, CAP said it disagreed with some of the GAO's recommendations for correcting the problem.

"The only correct course of action now is to remove anatomic pathology from the In-Office Ancillary Services (IOAS) exception as quickly as possible," said CAP's Gene Herbek.  "There is no better way to protect patients and eliminate a wasteful loophole that lets physician entrepreneurs line their pockets without any added benefit or convenience for patients."

In fact, CAP believes the reverse is true. Self-referral of anatomic pathology leads to added inconvenience, increased testing procedures, and increased costs for patients, which is completely counter to the intent of the law. "We call on Congress to act on behalf of patients and their constituents and pass legislation to close this loophole," Herbek said.

There is a mountain of research documenting wasteful Medicare spending by self-referring physicians. So much that the overwhelming evidence compelled a diverse group of leading patient and health policy groups such as the Simpson-Bowles Commission, AARP, the  New England Journal of Medicine, and the Bi-Partisan Policy Group to call for tighter restrictions and closing the loophole.

CAP was instrumental in drawing attention to the problem in anatomic pathology by co-sponsoring the first independent research published last year on the impact of self-referral of anatomic pathology (AP) services on utilization, patient care, and health care costs.

The research was conducted by well known health care economist, Jean Mitchell, Ph.D., and published in the leading peer-reviewed health policy journal, Health Affairs. It compared Medicare billing practices for anatomic pathology services related to prostate biopsies by self-referring and non self-referring urologists, and using Medicare's own data showed that self-referring urologists billed Medicare for 72% more prostate biopsy specimens compared to non self-referring physicians, with no increase in cancer detection.  In fact, self-referring urologists had a 40% lower cancer detection rate than those who did not self refer despite billing for nearly twice as many specimens. 

The Loophole

The CAP is the leading critic of a loophole that exists in the IOAS exception in the physician self-referral law, aka the Stark Law. The IOAS exception allows physicians to bill for certain medical services where an ownership interest exists.  It was intended to apply to services provided at the time of an office visit as a convenience to patients.  It also specifies clinical laboratory services rather than anatomic pathology.

Clinical pathology tests such as blood tests and urinalyses that do inform diagnosis and treatment at the time of the patient visit are rightly included in the exception. However, anatomic pathology services, which require extracting and analyzing human tissue or specimen during a biopsy or other surgical procedure and a complex multi-step process that cannot be performed at the time of an office visit were never intended to be included in the IOAS exception.

Over utilization by self-referring practices is costing Medicare billions, well over six billion dollars according to the President's 2014 budget proposal.

For more information on CAP's position on physician self-referral of anatomic pathology services, visit our Self-Referral Resource Center at www.cap.org/advocacy.

About the College of American Pathologists

As the leading organization for board-certified pathologists, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. With more than 18,000 physician members, the CAP has led as the gold standard in laboratory accreditation for 50 years with nearly 7,500 CAP-accredited laboratories in 50 countries. Find more information about the CAP at cap.org.

SOURCE College of American Pathologists

More Stories By PR Newswire

Copyright © 2007 PR Newswire. All rights reserved. Republication or redistribution of PRNewswire content is expressly prohibited without the prior written consent of PRNewswire. PRNewswire shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.

Latest Stories
The platform combines the strengths of Singtel's extensive, intelligent network capabilities with Microsoft's cloud expertise to create a unique solution that sets new standards for IoT applications," said Mr Diomedes Kastanis, Head of IoT at Singtel. "Our solution provides speed, transparency and flexibility, paving the way for a more pervasive use of IoT to accelerate enterprises' digitalisation efforts. AI-powered intelligent connectivity over Microsoft Azure will be the fastest connected pat...
There are many examples of disruption in consumer space – Uber disrupting the cab industry, Airbnb disrupting the hospitality industry and so on; but have you wondered who is disrupting support and operations? AISERA helps make businesses and customers successful by offering consumer-like user experience for support and operations. We have built the world’s first AI-driven IT / HR / Cloud / Customer Support and Operations solution.
ScaleMP is presenting at CloudEXPO 2019, held June 24-26 in Santa Clara, and we’d love to see you there. At the conference, we’ll demonstrate how ScaleMP is solving one of the most vexing challenges for cloud — memory cost and limit of scale — and how our innovative vSMP MemoryONE solution provides affordable larger server memory for the private and public cloud. Please visit us at Booth No. 519 to connect with our experts and learn more about vSMP MemoryONE and how it is already serving some of...
Darktrace is the world's leading AI company for cyber security. Created by mathematicians from the University of Cambridge, Darktrace's Enterprise Immune System is the first non-consumer application of machine learning to work at scale, across all network types, from physical, virtualized, and cloud, through to IoT and industrial control systems. Installed as a self-configuring cyber defense platform, Darktrace continuously learns what is ‘normal' for all devices and users, updating its understa...
Codete accelerates their clients growth through technological expertise and experience. Codite team works with organizations to meet the challenges that digitalization presents. Their clients include digital start-ups as well as established enterprises in the IT industry. To stay competitive in a highly innovative IT industry, strong R&D departments and bold spin-off initiatives is a must. Codete Data Science and Software Architects teams help corporate clients to stay up to date with the mod...
As you know, enterprise IT conversation over the past year have often centered upon the open-source Kubernetes container orchestration system. In fact, Kubernetes has emerged as the key technology -- and even primary platform -- of cloud migrations for a wide variety of organizations. Kubernetes is critical to forward-looking enterprises that continue to push their IT infrastructures toward maximum functionality, scalability, and flexibility. As they do so, IT professionals are also embr...
Platform9, the leader in SaaS-managed hybrid cloud, has announced it will present five sessions at four upcoming industry conferences in June: BCS in London, DevOpsCon in Berlin, HPE Discover and Cloud Computing Expo 2019.
At CloudEXPO Silicon Valley, June 24-26, 2019, Digital Transformation (DX) is a major focus with expanded DevOpsSUMMIT and FinTechEXPO programs within the DXWorldEXPO agenda. Successful transformation requires a laser focus on being data-driven and on using all the tools available that enable transformation if they plan to survive over the long term. A total of 88% of Fortune 500 companies from a generation ago are now out of business. Only 12% still survive. Similar percentages are found throug...
When you're operating multiple services in production, building out forensics tools such as monitoring and observability becomes essential. Unfortunately, it is a real challenge balancing priorities between building new features and tools to help pinpoint root causes. Linkerd provides many of the tools you need to tame the chaos of operating microservices in a cloud native world. Because Linkerd is a transparent proxy that runs alongside your application, there are no code changes required. I...
In his general session at 21st Cloud Expo, Greg Dumas, Calligo’s Vice President and G.M. of US operations, discussed the new Global Data Protection Regulation and how Calligo can help business stay compliant in digitally globalized world. Greg Dumas is Calligo's Vice President and G.M. of US operations. Calligo is an established service provider that provides an innovative platform for trusted cloud solutions. Calligo’s customers are typically most concerned about GDPR compliance, application p...
Modern software design has fundamentally changed how we manage applications, causing many to turn to containers as the new virtual machine for resource management. As container adoption grows beyond stateless applications to stateful workloads, the need for persistent storage is foundational - something customers routinely cite as a top pain point. In his session at @DevOpsSummit at 21st Cloud Expo, Bill Borsari, Head of Systems Engineering at Datera, explored how organizations can reap the bene...
"NetApp's vision is how we help organizations manage data - delivering the right data in the right place, in the right time, to the people who need it, and doing it agnostic to what the platform is," explained Josh Atwell, Developer Advocate for NetApp, in this SYS-CON.tv interview at 20th Cloud Expo, held June 6-8, 2017, at the Javits Center in New York City, NY.
Druva is the global leader in Cloud Data Protection and Management, delivering the industry's first data management-as-a-service solution that aggregates data from endpoints, servers and cloud applications and leverages the public cloud to offer a single pane of glass to enable data protection, governance and intelligence-dramatically increasing the availability and visibility of business critical information, while reducing the risk, cost and complexity of managing and protecting it. Druva's...
Kubernetes as a Container Platform is becoming a de facto for every enterprise. In my interactions with enterprises adopting container platform, I come across common questions: - How does application security work on this platform? What all do I need to secure? - How do I implement security in pipelines? - What about vulnerabilities discovered at a later point in time? - What are newer technologies like Istio Service Mesh bring to table?In this session, I will be addressing these commonly asked ...
BMC has unmatched experience in IT management, supporting 92 of the Forbes Global 100, and earning recognition as an ITSM Gartner Magic Quadrant Leader for five years running. Our solutions offer speed, agility, and efficiency to tackle business challenges in the areas of service management, automation, operations, and the mainframe.