Urologists Follow the Money

Mitchell wrote, "Although self-referral for advanced imaging is widespread, the consequences of self-referral on the use of other ancillary services, such as surgical pathology services, has received little attention." She says there is "anecdotal evidence that self-referrals have become increasingly prevalent in recent years."

Mitchell's report adds academic weight to growing concerns about self-referrals. In December 2010, The Wall Street Journalwrote that "groups of urologists across the country have teamed up with radiation oncologists to capture the lucrative reimbursements" of intensity-modulated radiation therapy (IMRT). 

The Journal reported that critics of the procedures, including "independent radiation oncologists who are losing business, say the urology groups steer many patients toward IMRT for financial gain," which could include Medicare payments of $40,000 per patient.

Physician groups are reacting to the Mitchell report. The Alliance for Integrity in Medicare, a coalition of medical specialty, laboratory, radiation oncology and medical imaging groups, said it welcomed the study because it provides independent, peer-reviewed evidence that the self-referral practice, in which urologists use their own pathology labs to test prostate biopsies for cancer  provides no benefits to patients, and is only serving to drive up Medicare costs.

"There is increasing evidence of self-referral leading to similar inappropriate, unnecessary overutilization of radiation therapy services for prostate cancer patients," said Laura I. Thevenot, of the American Society for Radiation Oncology, one of the sponsors of the study, in a statement.

In the wake of the Mitchell study, it's time that Congress follows the money and closes the self-referral loophole for good.