President Obama’s budget for 2014, released today, includes a proposal to exclude radiation therapy services from the in-office ancillary services exception of the self-referral law. The budget estimates that excluding radiation therapy, as well as advanced imaging and physical therapy services, from the exception will save Medicare more than $6 billion over 10 years. Closing this loophole has been our top legislative priority for many years. ASTRO sent numerous letters encouraging the President to take this position, and our staff recently met with senior White House officials to urge them to close the loophole for radiation therapy services. The budget states:

Exclude Certain Services from the In-Office Ancillary Services Exception: The in-office ancillary services exception was intended to allow physicians to self refer quick turnaround services. While there are many appropriate uses for this exception, certain services, such as advanced imaging and outpatient therapy, are rarely performed on the same day as the related physician office visit. Additionally, evidence suggests that this exception may have resulted in overutilization and rapid growth of certain services. Effective calendar year 2015, this proposal would seek to encourage more appropriate use of select services by excluding radiation therapy, therapy services and advanced imaging from the in-office ancillary services exception to the prohibition against physician self-referrals (Stark law), except in cases where a practice meets certain accountability standards, as defined by the Secretary. [$6.1 billion in savings over 10 years]

While the budget is a proposal and will not likely be enacted into law given the partisan differences on key budget issues, inclusion in the President’s proposal is a huge boost to our advocacy efforts. It will serve as the starting point for budget negotiations and potentially Medicare reform. ASTRO will continue working with Congress to achieve our ultimate goal of permanently closing the self-referral loophole. We will provide more analysis as further details emerge.  Click