ASTROnews: Congressional heavyweights demand investigation of radiation oncology self-referral

On April 16, Reps. Pete Stark (D-Calif.), Sander Levin (D-Mich.) and Henry Waxman (D-Calif.) sent a letter requesting that the Government Accountability Office (GAO), the investigative arm of Congress, study the impact on patient care and Medicare spending on radiation oncology services provided in physician self-referral arrangements.

Ending abuses of the physician self-referral law for radiation therapy is ASTRO’s top legislative priority. The letter represents more than a year’s worth of intense advocacy by ASTRO volunteers, leaders and staff to call attention to the serious problems for patients and Medicare posed by self-referral in radiation oncology. Staff and volunteers have had numerous meetings and communications with influential leaders on Capitol Hill and their staff, which led to an agreement to carefully study the impact of self-referral in radiation oncology before determining whether taking action is appropriate. 

The GAO self-referral study was initially proposed in health reform legislation passed by the House in November 2009. However, Congress ultimately passed and the president signed into law the Senate-passed health reform bill and a reconciliation bill. Nonetheless, Reps. Stark, Levin and Waxman were committed to moving the study forward.

The April 16 letter said there are “concerns that the potential financial incentives associated with self-referral could lead to the overprovision” of radiation oncology services. The letter also said, “Studies have suggested that physicians tend to be responsive to these financial incentives and that self-referral may be a contributing factor in the rapid increase of the use of these services.” Because of these concerns, the letter asks GAO to evaluate the extent of physician self-referral arrangements on the use of radiation oncology services provided to Medicare beneficiaries and the effects of such arrangements on Medicare spending.

ASTRO will now begin working with the GAO to ensure they have all the necessary information to produce their report. In particular, ASTRO will express its concerns about business ventures across the country designed to generate additional revenues within a group practice by incorporating radiation therapy. ASTRO believes these arrangements erode patient choice and can result in dramatic increases in one form of radiation therapy for prostate cancer, while the use of other clinically appropriate, sometimes significantly less expensive treatments, such brachytherapy or even “watchful waiting,” have declined or disappeared. At press time, it was unclear when that report will be completed.
 
In response to the letter to GAO, ASTRO issued a press release praising the leadership of Reps. Levin and Waxman, the respective chairs of the House Ways and Means Committee and Energy and Commerce Committee, as well as Rep. Stark, the chair of Ways and Means Health Subcommittee and original author of the physician self-referral law that bears his name. Reps. Levin, Waxman and Stark are among the most influential members of Congress on healthcare policy and primary authors of the new health reform law.

When a patient’s medical condition requires a referral for specialized care, the treatment decision must be based on quality care and informed patient choice, not financial incentives. ASTRO believes it is wrong to create business enterprises centered on rewarding physicians for making referrals.

ASTRO has been telling Capitol Hill and the Obama administration that the inclusion of radiation therapy services in the “in-office ancillary services exception” to the physician self-referral law is leading some physicians to create business arrangements that compromise the quality of care, limit treatment options for patients and result in unnecessary Medicare spending. ASTRO’s position is that radiation therapy should be removed from the law’s exception.

“High-quality, effective patient care and informed patient choice supersedes financial benefit. We are committed to preserving Medicare patients’ independent choices in making important treatment decisions,” Tim R. Williams, M.D., ASTRO chairman, said in the release. “We are grateful to Chairmen Stark, Levin and Waxman for studying this important issue and their willingness to consider a sound policy solution that protects patient choice and access to high-quality services.”

The release also noted that ASTRO looks forward to GAO’s analysis and recommendations, as well as forthcoming recommendations from the Medicare Payment Advisory Commission, to help inform congressional consideration on closing the physician self-referral law’s loophole for radiation oncology services.

Government Accountability Office (GAO)
GAO’s mission is to investigate how the federal government spends taxpayer dollars. GAO supports Congress in meeting its constitutional responsibilities and helps improve the performance and ensure the accountability of the federal government. GAO says it provides Congress with timely information that is objective, fact-based, nonpartisan, nonideological, fair and balanced.

GAO reports, such as this self-referral study, come at the request of congressional committees or subcommittees or are mandated by public laws or committee reports.
The agency supports congressional oversight by:

• Auditing agency operations to determine whether federal funds are being spent efficiently and effectively.
• Investigating allegations of illegal and improper activities.
• Reporting on how well government programs and policies are meeting theirobjectives.
• Performing policy analyses and outlining options for congressional consideration.

GAO also advises Congress and the heads of executive agencies about ways to make government more efficient, effective, ethical, equitable and responsive. Its work leads to laws and acts that improve government operations, saving the government and taxpayers billions of dollars.