What’s Behind the Threat to IOAS

Although the Stark self-referral laws extended restrictions on physicians’ self-referral of radiology services to entities in which they have an ownership interest, the IOAS exception allows physicians to refer patients for ancillary services in their own practices, including physical therapy, laboratory services, orthotics and prosthetics, among others.

As the use of imaging services has increased, physicians who provide imaging services outside of an imaging facility or hospital have come under attack. A recent Government Accountability Office (GAO) report argued that higher use of advanced imaging by providers who self-refer cost Medicare $109 million per year and $1.1 billion over 10 years. In addition, the issue of closing the IOAS exception to the Stark Law has been sent to the Congressional Budget Office (CBO) to determine if it would result in budgetary savings. In the current fiscal environment, if the CBO were to score this provision with a significant amount of savings, it could be introduced legislatively and used as a financial offset for other legislation.

AAOS actions
The American Association of Orthopaedic Surgeons (AAOS) has several concerns with the methodology and conclusions of the GAO report, which were articulated by John R. Tongue, MD, in a meeting with GAO Director of Healthcare James Cosgrove, PhD, and Rep. Tom Price, MD, on Feb. 28.

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