Promoting Integrity in Medicare Act: The Biggest Challenge to Physician Provide Ancillary Services
By: Albert R. Meyer, JD, MHA
On August 1, 2013, Representatives Jackie Speier (D-CA), Ways and Means Health Subcommittee Ranking Member Jim McDermott (D-WA) and Dina Titus (D-NV), introduced HB 2914 known as the Promoting Integrity in Medicare Act of 2013 (“PIMA”). This bill represents the biggest challenge to laws and regulations allowing physicians to provide certain ancillary services such as physical therapy, diagnostic imaging and clinical laboratory services.
The Stark law as it has become to be known is a set of laws and regulations first established in 1992 as a means of prohibiting certain physician self-referrals. Over the next two decades the regulations expanded to include numerous exceptions to allow self-referrals in certain arrangements. The major exception relied upon by physicians is the In Office Ancillary Services Exception (IOAS). This exception to the Stark Law, which applies to medical doctors as well as chiropractors, was created to allow physicians to provide certain designated health care services within the confines of their office and not be in violation of the prohibition on self-referrals provided certain conditions are met. The proposed bill would eliminate diagnostic MRI, CT, PET, and other advanced diagnostic imaging services, anatomic pathology, radiation oncology, and physical therapy from the in-office exception because they are services that are rarely provided on the same day as the initial office visit.
Proponents of the measure claim that eliminating these services from the exception will save Medicare more than $6 billion over the next 10 years and will foster efficiency and increased quality of care. Upon the bill’s introduction Congresswoman Speier issued a press release stating “the goal of PIMA is to cut spending in Medicare by hundreds of millions of dollars annually without reducing the essential care that seniors rely on.” The proposed bill would eliminate diagnostic MRI, CT, PET, and other advanced diagnostic imaging services, anatomic pathology, radiation oncology, and physical therapy from the IOAS exception because they are services that are rarely provided on the same day as the initial office visit.
Opponents of the bill give it little chance of becoming law. However, PIMA has support among a varied group professional associations, government offices and patient advocacy groups and continues to marshal support.
Not surprisingly, the sponsors and supporters of this bill are very short sighted. This is not a cost saving measure, but rather a cost shifting measure. If the measure is passed, these ancillary services will be provided by hospitals and other large corporate entities. When was the last time someone knew of hospital being an efficient provider of services! Additionally, the American Society of Orthopedic Surgeons (ASOS) warn that “Eliminating the IOAS exception would be detrimental to orthopedic patients because they would no longer be able to receive the continuum of care necessary to recover from musculoskeletal conditions,” argued Dr. John R. Tongue, President of the ASOS. “Fragmentation of care means lower quality and higher costs.”
This bill is a BIG deal and should not be lightly. The passage of PIMA will fundamentally change the way health care is delivered to most citizens. It’s time for physician groups to put aside petty divisiveness and come together to allow the continuation of ancillary services in a cost effective manner.
Physicians considering adding these services to their practices should be close attention to the progress of this bill.
Mr. Meyer is an attorney with over 20 years’ experience in health care law focusing on regulatory and transactional matters. His clients include physicians, medical equipment companies, surgery centers and diagnostic centers. He can be reached at 866-585-5444 or firstname.lastname@example.org.