A bill introduced to Congress on April 9 aims to close a Medicare “loophole” by preventing physician self-referrals for advanced imaging, radiation therapy, anatomic pathology and physical therapy.
The Promoting Integrity in Medicare Act (PIMA)—HR 2143—was introduced by Reps. Jackie Speier (D-California) and Dina Titus (D-Nevada). Such legislation, according to the congresswomen, would close the “in-office ancillary services exception” in the Stark Law physicians have exploited in an effort to increase their Medicare reimbursements.
Closing the loophole would save an estimated $3.3 billion in overused and unnecessary medical utilization, according to a 2017 estimate from the Congressional Budget Office (CBO).
“Now is the time to improve the quality and cost-effectiveness of Medicare,” Speier said in a prepared statement. “This bill will help get that job done by saving tax dollars and helping vulnerable seniors who depend on Medicare for their quality of life.”
However, as reported by Radiology Business, the legislation is drawing both praise and criticism from medical societies.
The American Society of Radiology Oncology (ASTRO) applauded the introduction of PIMA, noting it would “accelerate health care payment reform, reduce Medicare costs and better protect patients by closing an expensive loophole in the physician self-referral law.”
“Inappropriate self-referral undermines ASTRO-supported efforts to move Medicare toward quality- and value-based reimbursement. Alternative payment models (APMs), for example, will not be successful if incentives remain for overutilization of medical services,” said ASTRO Chair Paul Harari, MD, in a prepared statement. “We applaud Rep. Speier and Rep. Titus for their leadership in introducing legislation that closes the self-referral loophole, drives needed payment reforms and reduces waste – all while protecting patients.”
The Alliance for Integrity in Medicare (AIM) has also demonstrated support for the bill, according to Reps. Jackie Speier and Dina Titus.
Most recently, AMGA, a trade association focused on improving healthcare, expressed “strong opposition” to PIMA, arguing the bill would restrict physicians in multispecialty groups from referring patients for advanced imaging within their groups. This move, the association argued, could actually inflate the cost of providing care.
“Restricting multispecialty medical groups and integrated delivery systems from providing advanced imaging services is contrary to AMGA members’ mission of providing value-based care,” said AMGA President and CEO Jerry Penso, MD, MBA, in a news release. “This legislation not only will impact the timeliness of diagnosing our patients. It also will negatively affect population health efforts and create more access burdens for patients seeking efficient, cost-effective treatment.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.