Rep. Fortney "Pete" Stark (D-CA) will launch a frontal assault early this summer on referring physicians who have financial stakes in freestanding imaging clinics. Medicare payments for magnetic resonance imaging and computed tomography will also be targeted.
An aversion in the executive branch to budget cuts as well as prevailing economic rules on Capitol Hill may help Stark win additional support for his health-care initiatives.
"If Congress makes any improvements in Medicare (which require additional funding), we either have to cut some other part of Medicare or raise taxes, and I don't see us raising taxes soon," said William K. Vaughan, administrative assistant to the congressman.
Stark's office has asked the General Accounting Office to analyze data on high-tech imaging and self-referrals to make a case that money can be freed up for other Medicare programs. Much of this information has been gathered by other agencies or associations, providing Stark with the opportunity to estimate savings before the reports from the GAO are in.
Up to $300 million might be saved annually by prohibiting physicians throughout the U.S. from ordering tests at outpatient facilities in which they have financial investments, Vaughan said.
These estimates are based on a Florida study that indicated more than one-third of referring physicians in the state were ordering tests at facilities in which they had at least partial ownership.
More data regarding physician ownership of outpatient facilities in that state and a GAO report on the methodology of the research are expected in late spring or summer.
A GAO report on charges for CT and MRI and the savings that might accrue from price reductions in those modalities is also due in spring.
"We're paying too much. The reimbursement rate is too high," Vaughan said.
These claims are based on advertisements sent to potential investors in freestanding clinics and medical facilities that might be interested in leasing imaging equipment--advertisements that show excessive profit margins, according to Vaughan.
An American College of Radiology report lent support to the case that MR and CT Medicare reimbursements are too high. The report showed that costs are less than half the current rate of charges.
The GAO's role is to validate predictions of the amounts that might be saved by eliminating "abusive" self-referrals and cutting MR and CT costs. Stark will then ask the Congressional budget office to credit the expected savings to pay for amendments to improve Medicare coverage.
Stark should find ample support for his actions.
"We can turn to our members and say, `We have things senior citizens want: programs for nursing homes and home health care. And we have fraud, waste and abuse. We can package them,'" Vaughan said. "We can exert pressure to pass Medicare improvements by offering pay taken from the area wearing a black hat."
