Self-referral

The physician self-referral or "Stark" law was enacted to prohibit physicians from referring Medicare patients for healthcare services when the physician has a financial interest with the service provider. The intent was to assure that clinical decisions related to patient treatment were made without financial considerations, assuring patient access to high quality services and discouraging overutilization. Unfortunately, a loophole was left in the law. The "in-office ancillary services exception" (IOAE) was intended to apply to services such as x-rays ans lab tests that required a quick turnaround to facilitate medical care. Radiation Oncology was inadvertantly added to that list. Our service is ancillary to no other. As a result, arrangements have been made, whereby urologists have formed groups that invest in linear accelerators and are now able to diagnose and treat prostate cancer patients, while capturing all the technical charges associated with this type of treatment. These business arrangements have the financial incentive to "cherry-pick" cancer patients for the most profitable treatment, thus giving them an unfair competitive advantage over radiation oncology centers that offer a full range of treatment for all cancers. Patients are unaware of the financial incentives and the impact it has on thier care. The American Society for Therapuetic Radiation Oncology (ASTRO) has called upon Congress to strentghten the "Stark" law by removing radiation oncology from the "in-office ancillary exception" list. This bill is currently being reviewed by President Obama as part of the Health Care Reform package.