ASTRO getting rid of self-referral

[Gfunk6]

It is certainly not new or a surprise that ASTRO has been lobbying Congress to get rid of the self-referral loophole. Specifically, the want to get rid of the "in-office exception" for radiotherapy, diagnostic imaging, anatomic pathology, and physical therapy. They have teamed up with other large groups to form the Alliance for Integrity in Medicare (AIM).

For the longest time, I thought that this was an unwise political maneuver on the part of ASTRO. Sure we all don't like Urorads but the reality is that there area lot of groups where Rad Oncs are co-owners and equal partners with other specialists. Also, it is part of ASTRO's global strategy to push all Rad Oncs to employment models and, ultimately, academic satellites.

However, in their latest news blast, I saw the following interesting tidbit:

Rep. Speier’s PIMA legislation would expedite delivery and payment system reform in a manner consistent with the Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act (MACRA) passed in 2015. While MACRA and other policy changes will increase the numbers of physicians participating in alternative payment models, many may still participate in a traditional fee-for-service model that incentivizes over-utilization of health care services through self-referral. PIMA would ensure that only physicians participating in approved alternative payment models and other truly integrated medical groups focusing on quality could self-refer under the IOAS exception, thereby rooting out abuse in the traditional fee-for-service system while accelerating participation in alternative payment models.

With this exception, my group and others would be exempted because we are large, multi-specialty and participate in the bleeding edge of payment reform (Oncology Care Model). Interested to hear what others think.

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[napoleondynamite]

Very interesting Gfunk. Can you post the link to where you found this?

 

[medgator]

So basically if you go MIPS (Modified Fee-For-Service), no dice, you have to go down the APM path with Medicare starting in 2019?

It sounds like this is proposed legislation from a senator though, not law yet, correct?

 

[Gfunk6]

Correct, this is proposed legislation.

ASTRO link here: https://www.astro.org/News-and-Publ...o-propel-payment-reform-and-protect-patients/

 

[RadOncDoc21]

Please pardon my simplistic mind. What does all this mean? I've seen multiple types of setups (med onc-rad onc, urologist-rad onc, etc) in the same group or corporation, does this effect them?

How is this different from one doc in the hospital referring to another doc in the same hospital? Isn't there still an icentive to keep everything in house?

Please forgive my ignorance on this topic.

 

[mpdoc2]

Please pardon my simplistic mind. What does all this mean? I've seen multiple types of setups (med onc-rad onc, urologist-rad onc, etc) in the same group or corporation, does this effect them?

How is this different from one doc in the hospital referring to another doc in the same hospital? Isn't there still an icentive to keep everything in house?

Please forgive my ignorance on this topic.

Especially when the incentive is the threat of getting fired.

 

[Chartreuse Wombat]

I wouldn't hold your breath that this bill passes. In 2013 advocates against the bill sent a letter to congress and there were some very big (read well funded) organizations including AMA, ACS, AAOS. The $$$ available for lobbying from these groups trumps (sorry) the pennies available from AIM.

 

[medgator]

I wouldn't hold your breath that this bill passes. In 2013 advocates against the bill sent a letter to congress and there were some very big (read well funded) organizations including AMA, ACS, AAOS. The $$$ available for lobbying from these groups trumps (sorry) the pennies available from AIM.

Those points are completely valid. Hospital based imaging and radiation therapy costs more than those services delivered in freestanding centers, like in many other areas of medicine.

When hospitals buy up practices, they reduce competition in an area and drive up prices and Medicare spending as a result.

http://www.wsj.com/articles/SB10000872396390443713704577601113671007448

 

[Reaganite]

Please pardon my simplistic mind. What does all this mean? I've seen multiple types of setups (med onc-rad onc, urologist-rad onc, etc) in the same group or corporation, does this effect them?

How is this different from one doc in the hospital referring to another doc in the same hospital? Isn't there still an icentive to keep everything in house?

Please forgive my ignorance on this topic.

There is no difference. The whole point is to allow hospitals to gain complete control of us. Sorry, you cant throw your referring doc a bone but we can buy out the local med onc practice for millions of dollars and divert their xrt business to the foundation employed rad onc. F astro. Ioase allows shrewd pp guys to compete against the hospital machine.

 

[medgator]

There is no difference. The whole point is to allow hospitals to gain complete control of us. Sorry, you cant throw your referring doc a bone but we can buy out the local med onc practice for millions of dollars and divert their xrt business to the foundation employed rad onc. F astro. Ioase allows shrewd pp guys to compete against the hospital machine.

And gives payors a choice when it comes to contracting. A lot of insurers prefer to keep the freestanding center in-network rather than a hospital-based facility for the reasons I posted above.