Web Exclusive: ASTRO supports GAO study of self-referral in radiation oncology

The American Society for Radiation Oncology (ASTRO) applauds the leadership of Representatives Pete Stark (D-Calif.), Sander Levin (D-Mich.) and Henry Waxman (D-Calif.) for requesting that the Government Accountability Office (GAO) study the impact on patient care and Medicare spending on radiation oncology services provided in physician self-referral arrangements.

ASTRO’s highest priority is excellence in cancer patient care. 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. We are increasingly seeing 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 as radiation seed implants or even “watchful waiting,” have declined or disappeared. 

In a letter sent April 16 to the Acting Comptroller General of the United States, 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, 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 believes 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. We look 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.

“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,” said Tim R. Williams, M.D., ASTRO Chairman. “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.”

Ending abuses of the physician self-referral law for radiation therapy is ASTRO’s top legislative priority. ASTRO is committed to working with state and federal lawmakers, as well as the Obama Administration, to protect cancer patient choice and preserve the integrity of the Medicare program.