A bill to permanently replace the sustainable growth rate (SGR) formula for Medicare physician payment continues to circulate through the House Energy and Commerce Committee. With one missing ingredient: No one so far has breathed a word about how Congress will pay for the change.
Physician societies, however, are taking no chances. In particular, there’s one offset they don’t want to see – repeal of the in-office ancillary services exception (IOASE). The exception allows physician practices to continue to provide and bill for services such as imaging, clinical lab tests and physical therapy in their offices under the Stark self-referral law.
President Obama’s 2014 budget
proposes to repeal the IOASE for radiation, advanced imaging and physical therapy as a way to offset a permanent SGR fix.
In response, 20 physician-friendly members of Congress signed a June 28, 2013 letter defending the IOASE. Limiting the IOASE “would present significant barriers to appropriate screenings and treatments, increase inefficiencies and make care less accessible,” the letter states. It cites the June 2011 Medicare Payment Advisory Commission report to Congress that warns of “unintended consequences” of repealing the IOASE such as inhibiting the development of “organizations that integrate and coordinate care within a physician practice.”
Critics of the IOASE have long maintained that it contributes to physician overbilling for ancillary tests and other services they provide themselves. But the June 28 letter lists numerous cases of utilization actually decreasing. For example, “the volume of advanced imaging services has slowed significantly, from 13.4% growth in 2006 to 5.4% in 2007, with an estimated growth of only 2% in 2011,” the letter states.
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