Dr. Walsh joins ASTRO in denouncing self-referral

In its push to close the loophole on physician self-referral for prostate cancer treatment, the American Society for Radiation Oncology now has what some may call an unlikely ally.

Urologist Patrick C. Walsh, MD, has joined radiation oncologist Theodore L. DeWeese, MD, both of Johns Hopkins University in Baltimore, in denouncing the practice of physician self-referral “and to clarify that the debate is not a turf war,” ASTRO said in a statement.

“As a urologist and a radiation oncologist, we collaborate every day to provide high quality prostate cancer care to our patients. Today, we are proud to continue our work together on behalf of patients by pressing for an end to the wasteful overtreatment of prostate cancer resulting from the physician self-referral law’s loophole for radiation therapy services,” Drs. Walsh and DeWeese said in a written statement.

“Urology-ownership of radiation therapy presents a clear conflict of interest, often with a for-profit motive, that risks overuse of intensity modulated radiation therapy (IMRT),” they added. “This activity is an affront to the vast majority of urologists and radiation oncologists who partner every day to provide well-coordinated care in community practices and hospitals without self-referral’s additional financial incentives.

“For our patients and our own ethics, we disavow self-referral abuse, and we ask our urology and radiation oncology colleagues to join us to end it.”

As it has done previously, ASTRO called attention to a July 19 report from the Government Accountability Office, which said the number of intensity-modulated radiation therapy procedures for prostate cancer rose from approximately 80,000 to 366,000 from 2006 to 2010, and that financial incentives for self-referring providers “were likely a major factor driving the increase.” In a joint statement, the AUA, American Association of Clinical Urologists, and Large Urology Group Practice Association called the GAO report “flawed” and “misleading.”

“We agree with Senator Max Baucus and the recent GAO report that now is the time for Congress to take action to protect patients by closing the self-referral loophole and we strongly support passage of the Promoting Integrity in Medicare Act immediately,” Drs. Walsh and DeWeese wrote.

The Promoting Integrity in Medicare Act, H.R. 2914, would prohibit self-referral for four complex services: advanced imaging, anatomic pathology, radiation therapy, and physical therapy. The bill also enhances enforcement of the self-referral law by increasing penalties for improper referrals and creating new compliance review procedures involving Medicare and the Office of Inspector General. Finally, according to ASTRO, the bill clarifies that physician groups participating in accountable care organizations in the Medicare Shared Savings Program can continue to provide integrated services and maintains access to care for rural beneficiaries.

Dr. Walsh is professor of urology and the former director of The James Buchanan Brady Urological Institute at John Hopkins Medical Institutions. Dr. DeWeese is professor and chairman of Johns Hopkins’ department of radiation oncology and molecular radiation science.

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