In June 2013, the U.S. Government Accountability Office (GAO) published a report, “Medicare Action Needed to Address Higher Use of Anatomic Pathology Services by Providers Who Self-Refer” (GAO Report), which discussed the utilization of anatomic pathology (AP) services in the fee-for-service (FFS) Medicare program. The GAO Report focused on the growth of AP services between calendar years 2004 through 2010 as well as on the increase in the number of physicians who self-refer AP services. The GAO Report highlighted utilization of AP services, including self-referral of those services, within three primary specialties: dermatology, gastroenterology, and urology.
The Digestive Health Physicians Association (DHPA) has an interest in further understanding the information presented in the GAO Report as it relates to Medicare-covered services performed or referred by gastroenterology specialists. This white paper presents an analysis of a subset of Medicare Part B services in the professional and outpatient hospital settings extracted from the calendar year 2009 through 2013 Medicare 5% sample data files, made available by the Centers for Medicare and Medicaid Services (CMS).