Prospects brighten for federal ban against in-office imaging self-referral

July 22, 2009

Legislation that would eliminate the regulatory exemption that allows physicians to self-refer patients to office-based imaging equipment has gained backers on the House Energy and Commerce Committee, one of three committees debating the House of Representatives’ version of comprehensive healthcare reform.

Legislation that would eliminate the regulatory exemption that allows physicians to self-refer patients to office-based imaging equipment has gained backers on the House Energy and Commerce Committee, one of three committees debating the House of Representatives' version of comprehensive healthcare reform.

Even if it falls short of enactment, the proposal aimed at closing exceptions to in-office self-referral prohibitions would send policymakers a strong message that some provisions in the Stark Laws might need revision.

"We have to look at this as a very positive step in the right direction," said Cynthia R. Moran, assistant executive director for government relations and economic policy for the American College of Radiology.

Introduced July 2 as HR 2962 by Rep. Jackie Speier (D-CA), the Integrity in Medicare Advanced Diagnostic Imaging Act of 2009 would eliminate the in-office ancillary exemption to the federal Stark Law prohibition against imaging self-referral. Reps. Anthony D. Weiner (D-NY) and Bruce L. Braley (D-IA), both members of the House Energy and Commerce Committee, announced they would throw their support behind the bill as an amendment to their committee's version of healthcare reform legislation.

The bill and amendments would apply to in-office applications of MRI, CT, and PET. If enacted, the law would include a five-year grace period to allow nonradiologists who own imaging equipment to sell their interest.

The proposals would be generally good for radiologists, who are facing reimbursement reductions that are being discussed both by Congress and the Obama administration, Moran said. Impending payment cuts could be partially offset if fewer nonradiologists were allowed to perform advanced imaging, she said.

In a written statement to the ACR membership, Dr. James Thrall, chair of the ACR board of chancellors, said he considers the amendment to be "of supreme importance to diagnostic radiology."

The ACR action alert, transmitted July 21, urged the college's 7000 members who are constituents of House Energy and Commerce Committee members to phone their congresspersons to support the Weiner-Braley self-referral amendment.

"Our allies throughout the imaging world have also received this alert, and business managers and imaging centers throughout the country have been mobilized to support this amendment," Thrall wrote.

In addition to self-referral reform, numerous federal proposals would cut reimbursement for the technical component of diagnostic imaging studies, according to Thrall.

"These payment reductions, depending on how deep they go, could have a very negative impact on the delivery of advanced imaging in imaging centers and office settings, rural and urban," he wrote.

The ACR plans to issue recommendations next Monday, July 27, to all ACR members about how to communicate with their elected representatives about these issues.

The in-office self-referral bill faces imposing obstacles before making it to the House floor as part of the House's final bill for healthcare reform. Even if it survives in the Energy and Commerce Committee, it could be thwarted by other committees that oversee healthcare policy. Rep. Pete Stark (D-CA), chair of the Ways and Means subcommittee on health, has been reluctant to allow adjustments to the self-referral law, his signature legislation, because that may allow more sweeping changes if the policy is adopted, Moran said.

"He says (the law) has just become the ‘Full Employment Act' for a group of lawyers to find exceptions and to work around the existing laws," Moran told Diagnostic Imaging. "He may not be happy if this amendment gets included in the energy and commerce bill."

And even if it gets through the House, the amendment may not make it to the final version of the reconciled House-Senate bill. But it will still raise the profile of the self-referral issue, Moran said. On the one hand, it makes policymakers aware of concerns already raised by the Centers for Medicare and Medicaid Services about in-office imaging utilization; on the other, it builds a record.

"At some point down the road this issue may be addressed either by Congress or by CMS in a more definitive way than it has been up to this point," she said.