Four Republican U.S. senators, who are also doctors, have sent a letter urging Senate leadership to strengthen Medicare reform and the physician payment system by preserving the in-office ancillary services exception (IOASE) to the Stark law.
Sens. Tom Coburn (R-OK), John Barrasso (R-WY), Rand Paul (R-KY), and John Boozman (R-AR) expressed concern that the president's proposal to repeal the IOASE would effectively force patients to receive radiation and advanced imaging services in the more expensive hospital setting.
Because of the disparity in reimbursement rates between hospital and physicians' offices is increasing, a repeal of the exception amounts to an attempt by Congress to pick winners and losers in the healthcare marketplace, which will ultimately increase costs and threaten patient access to quality, coordinated care, they wrote.
The senators applauded the development, adoption, and use of physician-developed, peer-reviewed appropriate use criteria. If the criteria are adopted, the questions related to financial incentives or the need for third-party authorization are laid aside, they stated
"Another serious concern we have with changes to the IOASE [is] that reducing the use of these services in the outpatient setting could not only drive the services to a higher cost inpatient setting, but could accelerate current trends in provider consolidation and further increase system costs over the long term," they wrote.
Reducing the full spectrum of care being delivered in an independent, outpatient setting will most likely centralize the delivery of healthcare around a few dominant health hospital systems, which in turn will reduce consumer choice and ultimately drive up cost, they added.
"We applaud bipartisan efforts to strengthen Medicare and reform physician payments," the senators wrote. "However, we hope you will agree to reject the unwise policy of closing the IOASE, since that approach would increase costs to consumers and taxpayers, reduce competition, increase inefficiency, and potentially further erode the quality of care that we believe is essential to America's patients and taxpayers alike."
