Physicians in group practices who send patients to their own laboratory or imaging facilities order tests at two to five times the rate of physicians who refer patients outside their own practices, a new government study has found.
The conclusion was contained in a draft of a study by the General Accounting Office, Congress' investigative arm.
The draft report was released by Fortney "Pete" Stark (D-Calif.), chairman of the health subcommittee of the Ways and Means Committee health subcommittee. His subcommittee last month approved a healthcare reform plan that included strict self-referral provisions. Group practices have argued the provisions would make it virtually impossible to operate satellite locations (April 4, p. 50).
The Stark plan would extend the self-referral ban that now applies only to Medicare and Medicaid patients to all pa- tients, and it wouldn't let group practices refer from one location to another in the same metropolitan area.
"There have always been problems with self-referrals, but the magnitude of over-ordering of tests by doctors who own an interest in an X-ray or (magnetic resonance imaging) practice is staggering," Mr. Stark said. The result is "billions of dollars of waste and abuse."
The study was based on a computer analysis of 2.4 million patient records involving seven different types of tests.
Brent Miller, director of government relations for the American Group Practice Association, which represents nearly 300 large group practices, agreed that "economic incentives can steer activity, and that can be a problem. In some instances, a higher referral rate would be entirely appropriate and, in some cases, it would not. We're just as concerned as Mr. Stark is, and we need to find some way to deal with it."
