OPPOSE H.R. 2914


The “Promoting Integrity in Medicare Act of 2013” (PIMA)

CUA POSITION: OPPOSE H.R. 2914, the “Promoting Integrity in Medicare Act of 2013” (PIMA)

Dear CUA Member, you may have already received the following action alert from the AUA but because the lead author, Jackie Speier, is a California legislator, this is an especially important issue to California urologists and requires a strong response. Please take a few minutes to send the letter to OPPOSE H.R. 2914. Thank you!

The following is forwarded from the AUA

Recently, Reps. Jackie Speier (D-CA), Jim McDermott (D-WA) and Dina Titus (D-NV) introduced H.R. 2914, the “Promoting Integrity in Medicare Act of 2013” (PIMA), which would eliminate the IOASE to the Stark Law for advanced imaging, anatomic pathology, radiation therapy, and physical therapy. The bill sponsors argue that the original intent for the IOAS exception was to permit physicians to provide ancillary services in their offices to better inform diagnosis and treatment decisions at the time of the patient’s initial office visit. Therefore, they seek to distinguish between routine clinical laboratory services or simple x-rays that are provided during the patient’s initial office visit, and other health care services (such as advanced imaging, anatomic pathology, etc.) that cannot be performed during the patient’s initial office visit. The AUA is asking members to contact lawmakers to oppose this legislation.

The bill language cites a 2012 Health Affairs study, stating that “urologists’ self-referrals for anatomic pathology services of biopsy specimens is linked to increased use and volume billed along with a lower detection of prostate cancer.” The bill also cites several major newspapers, including a November 2012, Bloomberg News report stating that “California prostate cancer patients treated by a urology clinic that owns radiation therapy equipment… resulted in a detrimental impact on patient care and drove up health care costs in the Medicare program.”
Recent reports from the Government Accountability Office target the IOASE. The AUA is responding to these reports, but it is important to note that the reports do not recommend eliminating or even narrowing the in-office ancillary services exception to the Federal self-referral statute.

The AUA has prepared a sample letter for you to use in crafting a strong letter to your representative asking him or her to oppose H.R. 2914. Members of Congress will not have the opportunity to sign on to legislation before they return on September 9. Therefore, it will be helpful for your Members of Congress to hear from you before Congress reconvenes. At this time, no companion bill has been introduced in the U.S. Senate.
Please consider including the following information to personalize your letter:
·         Any examples of the impact on patients of eliminating the in-office ancillary services exception, e.g., impact on compliance, successful diagnosis, etc.
·         If you’re part of a multi-specialty practice, please include any examples to demonstrate how changing the IOASE could fragment patient care?
Thank you for lending your voice to this issue.

About the Stark legislation
A number of years ago legislation was introduced by Rep. Pete Stark (D-Ca) that prohibited so-called physician self-referral. When this legislation passed, physicians were prohibited from referring their patients to any other facility in which the physician or a family member had a financial interest. Congress and Rep. Stark realized, however, that certain services performed by physicians in their offices or associated facilities were important to quality and efficient patient care and should be specifically exempted from these rules. The AUA has strongly supported the current in-office ancillary services exception (IOASE) within the Stark physician self-referral law. This exception is threatened by some who claim the exception results in overuse and increases Medicare spending and has expanded beyond its intended scope of tests.

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