RSNA: Deficit Reduction Act did little to slow self-referrals

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CHICAGO—Although one of the goals of the Deficit Reduction Act (DRA) was to discourage self-referrals of advanced imaging, self-referral volumes continued to increase while payments to radiologists declined, according to a presentation at the annual meeting of the Radiological Society of North America (RSNA).

Vijay Rao, MD, of Thomas Jefferson University in Philadelphia presented the findings from work she and colleagues conducted that looked at MRI volumes before and after the implementation of the DRA in 2007. The law had aimed to reduce self-referral by making cuts to the technical component of reimbursements.

What they found, however, was that the law did more to cut payments to radiologists than it did to deter self-referrals. For radiologists, there was a growth in MRI volumes from 2000 to 2006. Then, following implementation of the DRA, there was a 10 percent drop in volume to 2010, accompanied by a 37 percent drop in payments.

When looking at the referral patterns orthopedic surgeons who self-referred, from 2006 to 2010, there was a 21 percent increase in volume, and only an 8 percent drop in payments. “In other words, orthopedic surgeons were able to mitigate the drop in payments by increasing the volume,” said Rao. She said it wasn’t clear from the study whether the volume increase was driven more by individual orthopedic surgeons ordering more studies, or by an increase in the number of orthopedic surgeons acquiring equipment.

“Surely enough, one can say the DRA was not a deterrent for orthopedic surgeons for purchasing or leasing their equipment,” said Rao.