Bill would end self-referral exceptions for imaging services

Physicians no longer would be able to furnish certain advanced diagnostic imaging services in their offices under a new House bill.

The legislation, introduced June 19 by Rep. Jackie Speier (D, Calif.), would exclude such services as MRI, CT and PET scans from the in-office ancillary services exception to the federal self-referral prohibitions, known as Stark laws.

Some physician organizations, including the American Medical Association, have said imaging arrangements can improve patients' access to diagnostic testing. But state and federal officials, along with the Medicare Payment Advisory Commission, have expressed concern that the deals may encourage unnecessary testing and inappropriate referrals.

Federal safe harbors currently permit physicians, under limited circumstances, to rent space and equipment for ancillary services. But the new bill would eliminate a perceived loophole in the law, said Joshua Cooper, senior director of government relations for the American College of Radiology. His organization supports the measure.

"When the law was written, ancillary services were meant to be low-cost services, like x-ray and ob ultrasounds, not these advanced modalities," Cooper said. "Ample evidence has shown that those who own these machines utilize them more than those who refer. Not only is that a potential burden on the patient, but it also puts a strain on the ever-diminishing resources of the Medicare system."

AMA policy and ethical guidelines support physician disclosure of any financial relationships when referring patients, and they prohibit doctors' involvement in leasing arrangements that are contingent upon referral activities. But the Association says physician practices must not be restricted unnecessarily. The AMA is opposed to legislative and regulatory efforts to repeal the in-office ancillary services exception to physician self-referral laws, including as they apply to imaging services.