This article says it all. Yes, the harshest critic is Jean Mitchell who has shown the same thing in physical therapy as MedPAC has appropriately informed Congress. Unfortunately, the physical therapy data is a little old. High time an update is funded.
The most striking data is this:
Medicare spending on imaging services paid to doctors rose sharply in the past 10 years — to $13.7 billion in 2006 from $6.6 billion in 2000, according to the Centers for Medicare and Medicaid Services. Spending declined to $12.1 billion in 2009, after Congress cut reimbursement rates. But the number of advanced imaging tests has continued to increase, albeit at a slower rate, according to agency data. The agency does not break out data for imaging services provided under the in-office exemption.
Physical therapists in independent practice data likewise cannot be “broken out” for the purposes of analysis between physician self-referral and private practice. However, even at the $12.1 billiion in 2009, medicare pays 3x as much in MRI’s as it does the entire outpatient physical therapy industry in medicare! The irony is the consistency in CMS strategy. MRI is a commodity so let’s slow the growth by decreasing reimbursement rather than the root of the problem (self-referral). Likewise, let’s cut physical therapy in medicare by also reducing the reimbursement rate through some type of cochamamie multiple procedure reduction. CMS can save BILLIONS simply by removing the in office exemption for physical therapy or at least extending the disclosure requirement to physical therapy as this new requirement goes into place for MRI’s next year. I still believe a social media strategy built around MD Amnesty Day to drive the awareness of physician self-referral coupled with heavy lobbying to CMS would ultimately assist. It certainly can’t hurt.