Hopes dim for House anti-self-referral amendment

Jul 23, 2009

It's looking increasingly unlikely that the U.S. House of Representatives will add an amendment banning self-referral of imaging services performed in physician offices to healthcare reform legislation under consideration in Congress.

A House committee considering the healthcare reform package was unable to add the amendment to the legislation this week. Capitol Hill watchers say the lack of action may have doomed -- or at least delayed -- the amendment as Congress becomes embroiled in the larger issue of healthcare reform.

Current federal law, known as the Stark law after its author, Rep. Pete Stark (D-CA), prohibits physicians from referring patients to entities in which they have a financial interest. But the law includes a loophole for services performed in physician offices, including medical imaging. Radiology advocates believe the loophole has led to nonradiologist physicians installing imaging equipment in their own offices, contributing to increased -- and inappropriate -- imaging utilization.

That loophole would have been closed by anti-self-referral legislation originally introduced as a standalone bill on June 19 by Rep. Jackie Speier (D-CA) as HR 2962, or the Integrity in Medicare Advanced Diagnostic Imaging Act of 2009. Earlier this week, Rep. Anthony Weiner (D-NY) and Rep. Bruce Braley (D-IA), members of the House Energy and Commerce Committee, said that they would offer Speier's bill as an amendment to the healthcare reform package being debated in their committee.

But that committee's efforts to craft a healthcare reform bill have bogged down, leaving the fate of the anti-self-referral legislation in doubt. And if the Energy and Commerce Committee remains stymied, the amendment's chances of getting enacted are remote, because the House would then consider versions of the reform legislation passed by other committees -- and those versions don't include the anti-self-referral provisions, according to Josh Cooper, senior director of government relations for the American College of Radiology (ACR) in Reston, VA.

"There have obviously been some problems within the House's Energy and Commerce Committee that have cast doubt as to whether the bill as a whole could get out of that committee," Cooper said. "Committee members are still working to resolve those issues. But if they can't resolve them before the [August] recess, it's possible the House may take whatever versions of the bill [the] Ways and Means and Education and Labor [committees] have produced to the floor for a vote next week."

Both President Barack Obama and House Speaker Nancy Pelosi (D-CA) would like one of the congressional bodies to get something done before the impending August recess, Cooper said. Senate leaders said this week that they would not be able to pass their version of the measure before then.

Another possibility is that the House would drum up a representative willing to offer the anti-self-referral amendment on the floor if the legislation does go to a vote before Congress adjourns, Cooper said. But again, this is unlikely.

"If there are even any amendments allowed, they will be limited, so the anti-self-referral legislation is not guaranteed to be on the list," he said.

If the anti-self-referral legislation dies on the proverbial vine this go-round, Speier will turn to gathering co-sponsors for her bill and hope that it can pass next year, Cooper said.

"It would be rare for another Medicare bill to pass the year following a big package like [the healthcare reform bill]," he said. "But the bill is so big that there may be other opportunities next year to offer amendments and corrections."

By Kate Madden Yee
AuntMinnie.com staff writer
July 24, 2009

House bill would close Stark in-office loophole, July 2, 2009

MedPAC: Self-referring docs use more imaging, June 23, 2009

Senate report offers details on accreditation, Stark disclosure, May 6, 2009

The Profit Center: Part 2 -- Steering clear of Stark and false-claims violations, March 31, 2009