Tuesday, August 19, 2008

Changin' Times

We haven't seen a total reversal of self-referral yet, but there have been some victories here and there. The Times, They Are a Changin'. Slowly but surely.

Remember the blatant self-referral clinics in St. Louis? There were four imaging centers that skirted the Stark Laws by not accepting federally-paid patients (Medicare, Medicaid, etc.) According to a follow-up article by Mary Jo Feldstein of the St. Louis Post-Dispatch, three of the four have closed down. No one knows why this happened at this point, but maybe patients got wise to what was happening to them, or just maybe someone developed a conscience. More likely, they were about to get into trouble over insurance money:
Insurers are looking into whether the clinics violated a policy that requires physicians and facilities that care for some of their members to care for all of their members.
To care for "all of their members", the self-referrers would have had to take Medicare patients, too, which would disrupt their little operation. No doubt clinic #4, Cedar Plaza Imaging in south St. Louis County, is not long for this world, either.

CMS may have given us another early Christmas present. According to Diagnostic Imaging,

Following its charge to reduce costly imaging overutilization, the Centers for Medicare and Medicaid Services has announced more stringent prohibitions against self-referral practices. Final Stark rules for the Hospital Inpatient Prospective Payment System for 2009 could force providers to restructure numerous space and equipment arrangements. . .

The new provisions broaden the definition of Designated Health Services (DHS) "entities" and prohibit under-arrangements and "per-click" arrangements for space and equipment leases. . .

The final IPPS rules will become effective Oct. 1, 2009. They will be published in the Aug. 19 issue of the Federal Register.
The implications for radiologists are positive. The new rules will take further incentive away from self-referral and will make lease arrangements with imaging centers less attractive, said attorney Thomas W. Greeson, a partner in the law firm of Reed Smith LLP in Falls Church, VA,

"It will also mean that many of the arrangements where hospitals have been able to establish relationships with referring physicians based on ownership or leasing of services on a per-click basis will be less attractive and give radiologists the opportunity to be part of the technical component services that otherwise were provided under these various arrangements," Greeson told Diagnostic Imaging.

This is a pretty big step. It doesn't cure the problem, but it's a start. Sadly, the self-referrers will no doubt find ways around any new rules and regulations that CMS can deliver, but at least it's getting harder and harder to do so.

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