News item: At the urging of the ACR, Representatives Henry Waxman (D-CA);  Sandy Levin (D-MI); and Pete Stark (D-CA) recently called on the General Accountability Office (GAO) to study the effects of medical imaging self-referral and radiation therapy treatments on Medicare spending.

In what I can only see as ironic—oh, and it’s about time, too—Stark is finally looking into cleaning up a mess of which he is one of the chief architects. The so-called in-office exemption to federal self-referral and anti-kickback laws in Medicare were born from what ware once commonly called the Stark I and Stark II laws in 1992 and 1994. The in-office exemption was one of the widely discussed safe harbors for physicians in the federal antikickback law. Part of its purpose was to serve as a cookie for procedure-based physicians who were seeing their procedural reimbursement cut under the RVU-based Medicare Fee Schedule that was supposed to provide a boost primary care physicians and evaluation and management services.

Sixteen years later, the gap between primary care and specialist income is no better and self-referral is one major driver of upward spiraling healthcare costs. Holy unintended consequences, Batman!