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Physician Self-Referrals for Imaging Cost Medicare $109M in 2010

John Commins, for HealthLeaders Media, November 7, 2012

"It's costing taxpayers millions of dollars, increasing costs on beneficiaries, and exposing patients to radiation that has real health consequences.  Once again, we're seeing how money drives behavior," Stark said.

Amy Nordeng, senior counsel in government affairs for the Medical Group Management Association, told HealthLeaders Media there is nothing in the GAO report that would indicate that the increased advanced imaging is inappropriate.

"It might very well be the case that the people who recognize the benefits of advanced imaging decided it just makes more sense to coordinate the care of their patients by having that imaging equipment in their own office or within their group practice," Nordeng says.

"We believe medical group practices are an excellent way for doctors to work together to provide comprehensive coordinated care to their patients. When you have a situation where a primary care physician, a cardiologist and a radiologist form a group practice and have imaging equipment in their practice, it doesn't make sense to say ‘we don't want you to use that imaging' or ‘we are concerned about the use of that imaging.'"

Nordeng says she cannot dispute the methodology of the GAO study. However, she notes that it ends at 2010, when the Centers for Medicare and Medicaid Services began working with providers to recognize efficiencies with multiple procedure payment reductions. In addition, she says the Affordable Care Act has since "locked in place a 75% equipment utilization assumption so reimbursement for all of these services is going down."

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