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

John Commins, for HealthLeaders Media, November 7, 2012

"Growth in these services is below the overall Medicare growth. So, while that time period may have reflected certain volume of imaging I don't think that volume will be consistent going forward," she says.

In addition, Nordeng predicts that many of the utilization issues cited in the GAO study will likely disappear as new payment and coordinated care models are rolled out.

"When folks have looked at this issue, they have noted that healthcare is transforming. As we move toward more accountable care-type organizations there will be incentives built into those arrangements to be efficient in the use of imaging," Nordeng says. "So in that sense as the market transforms and the policies transform this will be a non-issue."

"Everyone is interested in coordinated care to the benefit of the patient. To the extent that the payment moves away from fee-for-service, this will not be as big of an issue going forward. If you were to even take that same analysis that GAO did and look at 2011 and 2012 the numbers would be different."

In the meantime, Nordeng says MGMA will continue to advocate for the in-office ancillary services exemption, which provides accountability and review structures that exempt physicians from Stark Law rules against self-referrals. "We believe it provides huge benefits to patients and providers," she says.


John Commins is a senior editor with HealthLeaders Media.

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