JOINT STATEMENT FROM THE ALLIANCE FOR INTEGRITY IN MEDICARE APPLAUDING SELF-REFERRAL REFORM PROPOSAL IN THE PRESIDENT’S FY 2016 BUDGET

THE ALLIANCE FOR INTEGRITY IN MEDICARE (AIM), a broad coalition of medical specialty, laboratory, radiation oncology, and medical imaging groups committed to ending the practice of inappropriate physician self-referral, is extremely pleased that President Obama’s FY 2016 Budget http://ift.tt/WL8nvo released today again recommends removing anatomic pathology, advanced diagnostic imaging, physical therapy, and radiation therapy from

the physician self-referral law’s in-office ancillary services (IOAS) exception. AIM has long supported additional limitations on physician self-referral, and we applaud the Administration for supporting Medicare beneficiaries by proposing to close the self-referral loophole for the third consecutive year.

The organizations comprising the AIM coalition continue to be concerned about the ongoing misapplication of the IOAS exception to the physician self-referral law. Independent evidence, including from the Government Accountability Officei, Health Affairsii, and The New England Journal of Medicineiii, and, most recently, The Journal of the American Medical Associationiv, consistently shows that the physician self-referral loophole results in increased spending, unnecessary utilization of medical services and potentially compromised patient choice and care, thereby eroding the integrity of the Medicare program.

AIM also commends AARP, which represents 38 million members, for recently recognizing the need to defend Medicare patients at risk of receiving unnecessary care caused by abusive, profit-motivated practices exploiting the IOAS exception. In a December 2014 letter to

Rep. Jackie Speier(D-Calif.) on her legislation to restrict self-referral abuse, AARP wrote:

“Closing the in-office ancillary services exception for certain services will save taxpayers and Medicare beneficiaries money and reduce unnecessary care.”

In addition, bipartisan policy experts, including The Moment of Truth Project and the Bipartisan Policy Center, have recommended narrowing the IOAS exception to eliminate abuse caused by this loophole.

AIM commends the Administration’s FY 2016 Budget for recommending the exclusion of anatomic pathology, advanced diagnostic imaging, radiation therapy and physical therapy services from the IOAS exception. The Office of Management and the Budget estimates that closing the loophole for these services would provide a savings of $6.02 billion dollars during the standard ten-year budget window.

The AIM coalition remains dedicated to improving patient care and preserving valuable Medicare resources, therefore we believe the IOAS reform proposal in the President’s FY 2016 Budget is a praiseworthy step towards those ends. Furthermore, AIM strongly urges the 114th Congress to build upon the recommendations of the Administration and others and pass legislation that removes advanced diagnostic imaging, anatomic pathology, radiation therapy, and physical therapy from the IOAS exception. Reforming this policy will ensure that Medicare patients receive the highest qual-ity and safest health care most appropriate to their needs, in addition to properly aligning Medicare policy incentives — a positive for beneficiaries, providers and all Americans.

The Alliance for Integrity in Medicare

American Clinical Laboratory Association American College of Radiology

American Physical Therapy Association American Society for Clinical Pathology American Society for Radiation Oncology Association for Quality Imaging

College of American Pathologists

Radiology Business Management Association

i. A series of 2013 GAO reports requested by bipartisan leaders in Congress examining the rise of self-referrals found increases in self-referrals for magnetic resonance imaging (MRI), computed tomography (CT) services, and anatomic pathology ser-vices ordered by physicians who self-refer, when compared to those physicians who do not.

ii. Mitchell, J.M. (2012). “Urologists’ Self-Referral For Pathology Of Biopsy Specimens Linked To Increased Use And Lower Prostate Cancer Detection.” Health Affairs, 31:4741-749.

iii. Mitchell,J.M.(2013).“Urologists’UseofIntensity-ModulatedRadiationTherapyforProstateCancer.”TheNewEngland Journal of Medicine, 369, 1629-1637.

iv. AdashiEY,KocherRP.“PhysicianSelf-referral:RegulationbyExceptions.”JAMA.PublishedonlineJanuary12,2015. doi:10.1001/jama.2014.16600.

The Alliance for Integrity in Medicare (AIM) is a broad coalition of medical societies committed to ending the practice of inappropriate physician self‐referral and focused on improving patient care and preserving valuable Medicare resources. AIM partners include the American Clinical Laboratory Association (ACLA), the American College of Radiology (ACR), the American Physical Therapy Association (APTA), the American Society for Clinical Pathology (ASCP), the American Society for Radiation Oncology (ASTRO), the Association for Quality Imaging (AQI), the College of American Pathologists (CAP) and the Radiology Business Management Association (RBMA). More information is available at www.aimcoalition.com.

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