Federal law generally prohibits physicians from referring their own patients to a diagnostic facility in which they have an ownership issue — a practice called “self-referral” — unless the facility is located in their own practice. This exemption exists to allow patients with access to a laboratory test, X-ray, or other imaging test at the same time and place as when patients are seeing their physician for an office visit. Less inconvenience and speeder diagnosis and treatment — what could be wrong with that?
Much, say the critics, if it leads to overutilization and higher costs and doesn’t really represent a convenience to patients. This is the gist of two studies by staff employed by the American College of Radiology, published in the December issue of Health Affairs.
One study analyzes Medicare claims data and concludes that patients aren’t really getting “one-stop-shopping” convenience when their physician refers them to an imaging facility that qualifies for the “in-office” exemption.
“Specifically, same-day imaging was the exception, other than for the most straightforward types of X-rays. Overall, less than one-fourth of imaging other than these types of X-rays was accompanied by a same-day office visit. The fraction for high-tech imaging was even lower — approximately 15 percent.” Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
As a specialist, one of the saddest truisms about practicing medicine in the private world has always been how little one’s clinical skills determines referrals. Unfortunately, as our present healthcare climate pushes “providers” to consolidate along the lines of major hospital networks this injustice will only worsen.
A decade or so ago when I started private practice it was obvious that referrals came to me because of my association with an established group. This association was essential, as one could have been the next Michael Jordan of electrophysiology, but referrals would still have gone along historic lines, to the favored group. It would have taken a Herculean effort, over years, to encroach upon such long-established referral patterns, etched over the bonds of rituals like Wednesday afternoon golf matches and dinner clubs.
Thus, few specialists start independently. You join an established group, do good work, form relationships and eventually, your quality becomes known. As it should be: Do good work and doctors will trust you with their patients. But yet, even the highest caliber specialists may fall prey to the easily accessible, affable (but unknown and untested) “new guy.” For enhancing referrals, availability and affability trump [actual] skills at least 90 percent of the time. Read more »
*This blog post was originally published at Dr John M*
I’m always fascinated by the complaints that the emergency department is so overused and expensive. I admit that it is used a lot, and that care can seem expensive. But I want to make it clear that the reasons are myriad.
Whenever we in the specialty say that we feel that patients abuse our services, someone in academia reminds us that only a small number of those patients do not actually have serious illnesses. Whether or not that’s true, one of the reasons we are overused is due to none other than other physicians.
I’ve been paying attention lately to the way physician referral patterns happen. I suspect it’s the same in other facilities. Read more »
*This blog post was originally published at edwinleap.com*