The introduction of the Medicare Imaging Disclosure Sunshine Act of 2008 (S 3343) is a response to a recent GAO report that, from 2000 through 2006, Medicare spending for imaging services more than doubled, increasing to $14.11 billion. The GAO’s analysis largely blames the growth in provision of imaging services in physician offices as the major driver of the spending increases.
The Stark law prohibits physicians from referring Medicare patients for certain services to providers with which the physician has a financial relationship and prohibits those entities from submitting claims for services provided to patients referred by physicians with a financial relationship. The law applies to a set of “designated health services,” including imaging services such as MRI and CT scans. Certain services provided in the physician office are exempted from the statute through the “in-office ancillary services” exception, which lets physicians provide radiology services in their offices or facilities and bill Medicare if conditions determined by the Secretary of Health and Human Services are met.
The bill would make the following self-referral proposals law effective Jan. 10, 2010:
- The in-office ancillary services exception to the physician self-referral prohibitions under Stark would be amended to require that physicians disclose their financial interest in certain imaging services provided through the in-office ancillary services exception, including MRI, CT, PET and other radiology designated health services.
- The referring physician would be required to inform the patient in writing at the time of referral that he could obtain services from another person.
- The referring physician would be required to provide the patient with a list of suppliers in the area in which he resides.
“We must do more to help control the potential for overutilization of imaging services [and] beneficiaries need more transparency and disclosure of potential conflicts of interest when physicians write referrals for imaging services,” says Sen. Grassley in his floor statement introducing the bill. Calling the provisions neither “onerous” nor “overly proscriptive,” he continues: “[The bill] merely require[s] referring physicians to disclose any conflict of interest related to their ownership of advanced imaging facilities or equipment. Patients still would be free to choose their physicians’ imaging facility or equipment or to go elsewhere.”
Sen. Grassley also included an imaging disclosure provision in the Medicare bill he introduced in June and in an agreement that he and Sen. Max Baucus (D-Mont.), Chairman of the Committee on Finance, had reached on Medicare legislation this summer, but the provision was dropped from Medicare bill that became law in July.
