The ACP Advocate Blog
by Bob Doherty
Thursday, August 20, 2009
Should doctors be allowed to own the tests they order?
A front page article in the July 31 Washington Post investigated the practice of physicians having an ownership interest in diagnostic and ancillary procedures they order for their own patients.
Reporter Shankar Vendantum reports on a urology practice that had a whopping 700 percent increase in CT scans after it bought its own machine:
"In August 2005, doctors at Urological Associates, a medical practice on the Iowa-Illinois border, ordered nine CT scans for patients covered by Wellmark Blue Cross and Blue Shield insurance. In September that year, they ordered eight. But then the numbers rose steeply. The urologists ordered 35 scans in October, 41 in November and 55 in December. Within seven months, they were ordering scans at a rate that had climbed more than 700 percent.
The increase came in the months after the urologists bought their own CT scanner, according to documents obtained by The Washington Post. Instead of referring patients to radiologists, the doctors started conducting their own imaging -- and drawing insurance reimbursements for each of those patients."
A lawyer representing the practice responded that the increase was unrelated to buying a scanner and that all tests ordered were within the "standard of care."
This is not a new issue. As far back as 1993, the GAO found that physicians in Florida who owned diagnostic imaging facilities had higher referral rates for all types of imaging services than non-owners.
The reason the issue is now getting a fresh look is that physician ownership of diagnostic testing facilities has steadily increased, and related or not, so has utilization of high cost imaging procedures. As Congress looks for ways to trim costs, self-referral will be under scrutiny.
ACP policy "opposes any financial arrangement that links income generation explicitly or implicitly to the volume or revenues generated by the investor-physicians; referrals if there is no valid medical need for the referral; any arrangement that involves an explicit or implicit inducement or encouragement of physicians by the management of the entity to increase the volume of referrals to the facility; and referrals to any entity (except those specifically exempted by law) unless disclosure has been made to patients of the physician's financial interest in the facility and, to the extent practicable, a list of alternative facilities from which the goods or services can be obtained." At the same time, ACP supports the current "in office" ancillary services exemption, which allows physicians to refer patients for testing done in their own offices. This policy was originally written in 1998 but reaffirmed in 2004 by the Board of Regents. The intent when the policy was written was to allow physicians to keep X-ray machines and minor diagnostic procedures in their offices. Technological innovation, though, has since led to much more advanced diagnostic procedures falling under the exemption.
Today's question: Do you think that physician ownership of the diagnostic tests they own benefits or hurts patient care? Why or why not?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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