"These analyses suggest that financial incentives for self-referring providers were likely a major factor driving the increase in referrals," according to the report.
Deepak Kapoor, MD, president of the Large Urology Group Practice Association, which represents more than has 2,000 urologists nationwide, takes exception to the findings. "I disagree profoundly with both the methodology and the report conclusions," he said in a telephone interview.
Among Dr. Kapoor's concerns is the number of physicians performing self referrals. Kapoor says the GAO reports on utilization and expenditures without taking into account the number of physicians performing the self-referral services, which he contends contributes to the increased number of services performed.
He also says the LUPGA met with the GAO and provided peer review literature that showed that during the study period the clinical standards for performing prostate biopsies increased the suggested samples from six to 12. The report notes that self-referring urology providers referred 47% more anatomic pathology services per biopsy procedure than non-self-referring urology providers (12.5 vs. 8.5).
"You can't aggregate behavior during a change in clinical standards," states Kapoor. He adds that other studies have found that physicians with their own pathology labs adopted the new clinical standard faster than others, which he says accounts for the differential between self-referring and non-self-referring providers.