GAO Report Looks at Self-Referral for CT, MR Imaging Services

The Government Accountability Office (GAO) on Oct. 31 released a congressionally mandated report examining the prevalence of self-referral for CT and MR and Medicare spending for these services.

The report examines:

  • The trends in the number of and expenditures for self-referred and non-self-referred CT and MR imaging services from 2004 through 2010.
  • The extent to which the provision of CT and MR imaging services differs for providers who self-refer when compared with other providers. 
  • The implications of self-referral for Medicare spending on CT and MR imaging services.

It also makes several recommendations for the Centers for Medicare and Medicaid Services (CMS) based on the findings including:

  • Insertion of a self-referral flag on the CMS Medicare Part B claims form that allows providers to indicate whether the advanced imaging services for which a provider bills Medicare are self-referred or not.
  • Development and implementation of a payment reduction for self-referred advanced imaging services to recognize efficiencies when the same provider refers and performs a service.
  • Development of an  approach to ensure the appropriateness of advanced imaging services referred by self-referring providers.

Meanwhile, data continue to show a decline in medical imaging growth since 2006. A recent report by the Medical Imaging and Technology Alliance for MedPAC found that spending on imaging services per Medicare beneficiary has declined by 16.7  percent since 2006, while spending on non-imaging services has increased by 21.3  percent over the same period. In addition, per-beneficiary use of imaging services has declined by 5.1  percent since 2009, while use of advanced imaging services has decreased 6.6 percent. Total spending on imaging services represents a smaller share of overall Medicare spending (9.3  percent) than at any point in the past decade and has shrunk by 28.4 percent since 2006.

Cardiovascular imaging has seen similar trends to overall medical imaging, with slowing of imaging utilization even prior to 2005. Factors contributing to the continued decline in growth include the Deficit Reduction of Act of 2005, increased awareness of cost and utilization, and the development of appropriate use criteria (AUC) by the ACC and the American College of Radiology. A recent study of 472 patients with suspected coronary artery disease found that the use of a real-time, multimodality decision-support tool, like the one used in ACC’s Imaging in FOCUS initiative, led to a reduction in inappropriate testing from 22 percent in the first two-month period to 6 percent in the last two months. Similarly, a significant impact of a continuous quality improvement initiative was seen on the use of coronary CT angiography in a recent study published in the Journal of the American College of Cardiology.

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