With the publication of an article in Health Affairs this month, concerned urologists now feel that they have some added proof with which to persuade Congress that the loophole needs to be closed.
The Health Affairs study focused on self-referral among urologists who conduct prostate biopsy evaluations in their own pathology labs. It found that urologists involved in self-referral arrangements bill Medicare 72% more for specimen evaluations for patients who have suspected prostate cancer than urologists who send specimens to independent providers of pathology services.
More Billing, Less Detection
Oddly enough, despite the increased billing, the study found that self-referring urologists usually detect cancer at a much lower rate—about 57%—than do non-self-referring urologists, according to the study's author, Jean Mitchell, PhD, an economist at Georgetown University in Washington D.C.
The study findings show that "lower cancer detection rates linked to self-referring urologists suggest that financial incentives prompt those urologists to perform prostate biopsies on marginal cases," Mitchell writes. "Thus, self-referral of prostate surgical pathology services leads to increased use and higher Medicare spending, but lower cancer detection rates."