Docs fight for Stark exceptions, despite apparent conflicts of interest

Urologists refer a substantially higher percentage of their prostate cancer patients to radiation therapy when the doctors owned linear accelerator or had financial ties to those who provided the treatment, according to a new Government Accountability Office report.

The report notes that providers who began to self-refer in 2008 or 2009 referred 54 percent of their patients who were diagnosed with prostate cancer in 2009 for prostate cancer-related intensity-modulated radiation therapy (IMRT), compared to 37 percent of their patients diagnosed in 2007.

This pattern is especially noteworthy considering the evidence suggesting that alternative treatments may be equally effective and less expensive for Medicare and beneficiaries, the New York Times reported, adding that Medicare patients rarely knew about their doctors' ability to profit from recommending radiation.

Furthermore, this tendency is not isolated to prostate-cancer treatment, investigators noted, as previous research has indicated doctors order more CT scans and magnetic resonance imaging when they own laboratories and imaging centers.

Nonetheless, national medical groups are fighting for the in-office ancillary exception to the Stark law that makes such potential bias possible. As Medpage Today reported, more than 30 national medical groups--including the American Medical Association, the American College of Surgeons, and the American Urological Association--wrote a letter to all members of Congress last week opposing the Promoting Integrity in Medicare Act (H.R. 2914), which would remove the exemptions.

Opponents of the newly introduced legislation have stated that ending exceptions would create barriers to integrated care and unfairly penalize independent physicians. "I can't provide in my practice global healthcare if I can't include ancillary," Deepak Kapoor, M.D., president of the Large Urology Group Practice Association in Schaumburg, Ill., told Medpage. "Every hospital is allowed to do that, and they are far more expensive sites of service than we are."

To learn more:
- read the article from the New York Times
- see the report from the GAO
- check out the story from MedPage Today
- here's the bill