A report released today by Senate Finance Committee Chairman Max Baucus (D-Mont), Senate Judiciary Committee Ranking Member Chuck Grassley (R-Iowa), House Ways and Means Committee Ranking Member Sander Levin (D-Mich.) and House Energy and Commerce Ranking Member Henry A. Waxman (D-Calif.) revealed a dramatic increase in the rates of doctors ordering anatomic pathology tests and procedures when they stand to make financial gains. The Government Accountability Office (GAO) report estimated that in 2010 alone, the increase resulted in $69 million charged to Medicare and 918,000 treatments that would not have occurred had these physicians been referring patients at the same rates as physicians who do not stand to benefit financially from the referral.
“A doctor’s first concern should be their patients’ health – not their own personal wealth,” Senator Baucus said. “This is yet another example of why we need to move toward a health care system that pays for care based on value, not volume. And this isn’t just about waste in health care, it’s also about patients – many of whom are elderly Medicare beneficiaries – being subjected to unnecessary tests and procedures. We need to find ways to clamp down on these doctors and make sure patients are getting the tests that are necessary and right for them.”
“This report shows a relationship between the use of services and providers’ financial interests,” Senator Grassley said. “Federal policy should drive doctors to make decisions based on quality of care, not financial relationships. The taxpayers shouldn’t have to pay for services that aren’t medically necessary.”
“This is the second GAO analysis in less than a year highlighting concerns with self-referral practices. Abuse of these arrangements could impose unnecessary costs on taxpayers and beneficiaries, while exposing patients to potential complications from unnecessary procedures. Preserving the integrity of the program requires Medicare’s resources to be used wisely, with an accurate payment system based on patient needs and not provider profits,” Rep. Levin said.
“Today’s GAO report sheds new light on the behavior of physicians reaping personal gain by referring patients to services at locations where they have an ownership interest. The analysis suggests that financial incentives for self-referring providers is likely a major factor driving the increase in referrals for these services. As Congress looks to reign in unnecessary spending, my colleagues and I should explore this area in greater depth,” Rep. Waxman said.