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Mitchell Report: Urologist Self-Referral of Pathology Services Inflates Utilization, Decreases Likelihood of Detecting Cancer

Wednesday, April 11, 2012

ePolicy News Special Edition

On April 10, the influential health policy journal Health Affairs published a study by noted Georgetown University health economist Jean Mitchell, PhD, providing clear evidence that urologists who profit on their referrals for anatomic pathology services overutilize these services. In addition, Dr. Mitchell found that self-referring urologists were less likely to diagnose cancer possibly because “financial incentives prompt self-referring urologists to perform prostate biopsies on men who are unlikely to have prostate cancer.”

Dr. Mitchell’s research found that, on average, urologists who profit on their pathology orders bill for 72 percent more pathology services (10.3 specimens vs. six specimens) than their non-self-referring colleagues. The Mitchell study confirms what many pathologists and laboratory practitioners have suspected for years. Professor Mitchell documented that “non-self-referring urologists were twelve percentage points more likely to diagnose cancer than self-referring urologists.”

The Alliance for Integrity in Medicine (AIM)—a broad coalition of medical specialty, laboratory, radiation oncology, and medical imaging groups, which includes ASCP—applauded publication of the new study that focuses on the practice of self-referral among urologists who conduct prostate biopsy evaluations in their own pathology labs.

AIM said the study was particularly welcome because it provides independent, peer-reviewed evidence that this self-referral practice—in which urologists use their own pathology labs to test prostate biopsies for cancer—provides no benefits to patients and is only serving to drive up Medicare costs.

“ASCP commends Dr. Mitchell on the publication of her seminal research exposing the seriously troubling business of physician self-referral of anatomic pathology services,” said ASCP President C. Bruce Alexander, MD, FASCP. “Her study adds to a wealth of evidence illustrating that self-referral may result in overutilization of costly medical services.”

The American Clinical Laboratory Association and the College of American Pathologists co-funded the study. The funding for the study had no bearing on the content of the research, which was independent.